Obesity and Weight Problems
Obesity and weight problems are among the most significant health challenges of modern life. They don’t just affect our appearance; they severely impact our quality of life and pave the way for many serious illnesses. Obesity is a chronic disease characterized by excessive fat accumulation in the body. While individuals with a Body Mass Index (BMI) over 30 are considered obese, those with a BMI between 25 and 29.9 fall into the risk group for weight problems and the progression towards obesity. In other words, weight problems can be seen as a precursor to obesity.
What Are the Types of Obesity?
Obesity is a complex health issue marked by excessive fat accumulation in the body. However, obesity isn’t merely about being overweight. The distribution and amount of body fat are crucial for assessing individual health risks. For the right approach and expert advice, please consult our physician, Uzm. Dr. Burcu Meryem Atak Sançmış.
Here are useful tools and methods for diagnosing obesity:
Types of obesity, classified by fat distribution:
- Apple-shaped Obesity (Android Obesity):
- Fat accumulation in the waist, upper abdomen, and chest area.
- More common in men.
- Increased health risks such as heart disease, diabetes, and high blood pressure.
- Pear-shaped Obesity (Gynoid Obesity):
- Fat accumulation in the hips and legs.
- More common in women.
Carries fewer health risks compared to apple-shaped obesity, but should still be considered.
Which Tests/Anthropometric Methods Are Used in Clinical Obesity Diagnosis?
Body Mass Index (BMI): A Tool for Determining Obesity Stages
The most commonly used method for diagnosing obesity and weight problems and determining their stages is BMI calculation. BMI is determined by dividing a person’s body weight by the square of their height. It is classified as follows:
- BMI 25–29.9: Overweight
- BMI 30–34.9: Obesity Stage 1
- BMI 35–39.9: Obesity Stage 2
- BMI 40 and higher: Obesity Stage 3 (Morbid Obesity)
- BMI 50 and higher: Extreme Obesity
- BMI 60 and higher: Extreme Obesity
Waist Circumference Measurement:
- Waist circumference measurement is used to assess fat accumulation in the abdominal area.
- A waist circumference over 90 cm in women and 100 cm in men increases the health-related risk of obesity.
Other Methods: Other anthropometric values such as the waist-to-hip ratio and waist-to-height ratio can also be used. Studies also show that neck circumference, skinfold thickness, and especially wrist circumference are related to the degree of obesity. However, observer differences can occur in all these measurements, making standardization difficult.
Detailed Assessment:
- For individuals diagnosed with obesity, a comprehensive examination by a physician is essential to identify underlying causes and assess potential complications.
This assessment may include medical history, physical examination, laboratory tests, and imaging procedures.
What Diseases Does Obesity Cause?
Abnormal fat accumulation in the body makes obesity a complex health problem. It is not just a disease in itself but also a trigger for many chronic diseases. The question “What diseases does obesity cause?” highlights that it indeed triggers many chronic conditions. The most important of these diseases caused by obesity and weight problems are:
Type 2 Diabetes and Prediabetes:
- Obesity disrupts blood sugar regulation due to increased insulin resistance and raises the risk of Type 2 Diabetes.
- Prediabetes refers to a pre-diabetic state and is common in overweight individuals.
Cardiovascular Diseases:
- Obesity increases the risk of cardiovascular diseases by causing high blood pressure, high cholesterol, and triglyceride levels.
- It can lead to serious problems like heart attack, stroke, and coronary artery disease.
Kidney Diseases:
- Obesity alone impairs the kidney’s glomerular filtration rate and can affect kidney function. It can also be the cause of diseases that cause protein excretion through the kidneys.
Hypertension (High Blood Pressure):
- Being overweight contributes to the development of hypertension by increasing blood pressure.
Hyperlipidemia (High Cholesterol):
- Obesity increases LDL levels and lowers HDL levels, negatively impacting vascular health.
Sleep Apnea:
- Being overweight increases the risk of sleep apnea, leading to pauses in breathing during sleep.
Fatty Liver Disease (NAFLD):
- Obesity leads to fat accumulation in the liver, affecting liver function.
Certain Cancers:
- Increases the risk for certain cancers such as esophageal cancer, liver cancer, kidney cancer, pancreatic cancer, gallbladder cancer, thyroid cancer, ovarian cancer, multiple myeloma, non-Hodgkin lymphoma, and malignant melanoma.
Gallbladder Diseases:
- Being overweight can trigger gallbladder diseases like gallstones and cholecystitis.
Gastroesophageal Reflux:
- A condition typically causing retrosternal burning, or the sensation of food moving up from the stomach. This is caused by stomach contents rising into the esophagus and occurs in 20% of the population.
Infertility:
- Hormonal imbalances can lead to infertility in both women and men.
Polycystic Ovary Syndrome (PCOS):
- Overweight women with PCOS have higher testosterone levels, lower sex hormone-binding globulin (SHBG) levels, higher glucose and insulin levels, dyslipidemia, and up to double the risk for Metabolic Syndrome.
Asthma/Reactive Airway Disease:
- Being overweight is associated with an increased incidence and severity of asthma, as well as poor response to treatment. Asthma is linked to mucus production, abnormal bronchoconstriction, and muscle reaction due to chronic inflammation.
Joint Problems (Osteoarthritis):
- Being overweight increases stress on joints, leading to arthritis and joint pain.
Mental Health Problems:
- Being overweight can cause mental health problems such as depression, anxiety, and low self-esteem.
Treatment Methods for Obesity and Weight Problems
Obesity can be treated in various ways, from lifestyle changes to surgical interventions. Surgical methods are not always the first choice; non-surgical treatment methods can also be very effective. However, if these methods are insufficient and treatment compliance is not maintained, surgical options come to the forefront. The most effective treatment methods for obesity and weight control are:
Non-surgical Treatment Options for Weight Loss and Obesity
Lifestyle Changes:
- Diet: A healthy and balanced diet is the cornerstone of obesity treatment. Individualized meal plans, portion control, and regular meal times are essential.
- Exercise: Regular physical activity supports weight loss by increasing calorie expenditure. Activities like walking, swimming, and cycling play an important role.
- Behavioral Changes: Understanding eating habits and triggers is crucial for obesity management. Professional support for stress management and dealing with emotional eating should be sought.
Medication Therapy: Some medications, taken under medical supervision, support weight loss by reducing appetite or preventing fat absorption. Current treatment methods for obesity and weight management are available after individual assessment.
- Medication therapy is recommended for patients who cannot achieve the desired weight loss despite lifestyle changes, have a BMI ≥ 30 kg/m² or ≥ 27 kg/m², and suffer from an obesity-related condition (e.g., Type 2 Diabetes, Hyperthyroidism, Dyslipidemia, sleep apnea, etc.).
- Although there is no definitive consensus, it is recommended to continue medication therapy for at least one year. The treatment duration can be extended for patients who benefit from it.
- Orlistat: It binds to enzymes (lipases) in the digestive system, preventing them from digesting fats consumed during meals. Maximum benefit occurs in combination with diet and exercise. Weight loss begins within two weeks of starting Orlistat. Statistically, Orlistat leads to significant weight loss when used for more than two months. The average weight loss after one year is approximately 2.9–3.4%.
- Liraglutide: This substance has a structure similar to GLP-1, a satiety hormone that increases insulin secretion in the pancreas and delays gastric emptying. Liraglutide supports weight loss by reducing appetite and increasing feelings of fullness. It is injected subcutaneously daily. Dosage and administration method may vary depending on the patient’s health status and needs. The recommended daily dose for obesity treatment is 3.0 mg. However, some people achieve good weight loss with lower doses.
- Semaglutide: It is approved for the treatment of obesity and Type 2 Diabetes mellitus. In Türkiye, it is approved in dosages of 0.25 mg, 0.5 mg, and 1 mg for the treatment of obesity and diabetes in Type 2 Diabetes. It is administered once a week. The recommended dose of Semaglutide for obesity treatment is 2.4 mg once weekly. This dosage form is not available in Türkiye.
- Tirzepatide: It has two different indications for the treatment of obesity and Type 2 Diabetes. The recommended initial dose of Tirzepatide for obesity treatment is 2.5 mg subcutaneously once weekly. After four weeks, the dose is increased to the approved obesity treatment dose of 5 mg/week. Treatment can be continued at this dose or increased by 2.5 mg every four weeks up to a maximum dose of 15 mg per week, if needed.
For the correct procedure, expert opinions, and detailed information, please contact our physician Uzm. Dr. Burcu Meryem Atak Sançmış.
- Endoscopic Methods:
- In gastric operations, gastric volume is reduced using volume-absorbing materials. This achieves an early feeling of fullness and leads to weight loss by reducing overall calorie intake. Gastric operations include intragastric balloon applications, transpyloric shuttle procedures, volume-absorbing treatments with superabsorbent hydrogel capsules, reshaping techniques, and aspiration treatments. For the correct procedure and expert opinions, please contact our physician Uzm. Dr. Burcu Meryem Atak Sançmış.
Surgical Treatment Methods for Obesity:
- These surgical procedures, which have proven effective in treating metabolic diseases such as diabetes and dyslipidemia in obese individuals, as well as for weight loss, are also referred to as “metabolic surgery.”
- Besides surgical techniques such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), which are widely used in bariatric surgery, many new surgical and endoscopic methods are being developed. This guide includes methods recognized as standard by international surgical societies. As long-term data for other methods are insufficient, it is recommended to perform them within the framework of research studies with the approval of the ethics committee and the patient. All applied surgical methods have their own advantages and disadvantages.
The selection of the appropriate surgical procedure should be multidisciplinary, considering the patient’s comorbidities, risk level, preferences, and the center’s experience. Nowadays, it is recommended to prefer laparoscopic techniques over open surgeries for this method, as they shorten the recovery period and are less invasive.
Frequently Asked Questions
What are the main factors that make weight loss difficult?
Hormonal imbalances, genetic predisposition, unbalanced and inadequate nutrition, lack of exercise, stress, sleep disturbances, and side effects of certain medications can make weight loss difficult. Uzm. Dr. Burcu Meryem Atak Sançmış evaluates these factors individually and offers a personalized treatment plan.
What is the importance of diet in obesity treatment?
Diet is one of the cornerstones of obesity treatment. A healthy and sustainable diet supports both weight loss and long-term weight management.
Is exercise effective in obesity treatment?
Regular exercise supports weight loss by increasing calorie expenditure, boosting metabolism, and improving cardiovascular health.
How can childhood obesity be prevented?
To prevent obesity in children, it is very important to develop healthy eating habits, promote an active lifestyle, and support the family. Early and correct counseling significantly reduces health risks later in life.
What is morbid obesity?
Morbid obesity is defined as a Body Mass Index (BMI) over 40 and can cause severe health problems. This can significantly impair the quality of life.
At what weight does obesity begin?
Obesity is diagnosed not based on weight, but on the Body Mass Index (BMI). A BMI of 30 and higher is considered obesity. However, for a BMI over 25, Uzm. Dr. Burcu Meryem Atak Sançmış performs an early individual assessment with BMI calculation and body analysis to allow for preventive measures.
Who is eligible for obesity surgery?
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- Bariatric surgery should be considered for obesity in Stage 3 (BMI ≥ 40 kg/m²), including cases in Edmonton Stage 0 and 1 (Evidence Level A).
- Bariatric surgery should be considered for obesity in Stage 2 (BMI 35–39.9 kg/m²) and from Edmonton Stage 2 onwards, in cases of coronary artery disease (BC) (Evidence Level: A).
- Bariatric surgery may be considered for patients with obesity in Stage 1 (BMI 30–34.9 kg/m²) and Type 2 Diabetes that cannot be controlled despite optimal medical treatment (Evidence Level: A).
- Bariatric surgery may also be considered for patients with obesity in Stage 1 and from Edmonton Stage 3 onwards (Evidence Level: C).
- When choosing the appropriate surgical method, comorbidities and the center’s experience should be taken into account (Evidence Level: D).
Are obese people considered disabled?
Obesity alone is not considered a disability. However, advanced health problems caused by obesity can lead to disability in some individuals. The assessment of this situation is carried out by health authorities.
Which doctor should people with weight problems consult?
Individuals with weight problems should consult competent medical professionals in their field, such as endocrinologists, dietitians, or bariatric surgery specialists. You can contact Uzm. Dr. Burcu Meryem Atak Sançmış for a comprehensive examination regarding obesity and weight management.
Will weight be regained if the recommended treatments of the weight loss program are stopped?
Obesity is recognized as a chronic disease by the World Health Organization. It may require long-term management. Regular and continuous adherence to medications is important for effective results. Therefore, individuals who cannot effectively integrate a healthy lifestyle into their daily lives may experience weight regain. In such cases, a doctor should be consulted immediately once the Body Mass Index… (the sentence seems to be cut off).
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