The bad and ugly faces of obesity

Ogbera

WORLDWIDE, there has been an alarming rise in rates of obesity and overweight in both adults and children, with the number of overweight and obese people rising from 857 million in 1980 to 2.1 billion in 2013, according to a major new analysis. 

  In Africa, South Africa has the biggest population of overweight/obese people and Nigeria is not far behind South Africa. The health implications or burden of obesity if you will on the health and economy of a developing country like Nigeria will definitely be devastating.  

  The risk for many medical complications is increased with obesity. In the words of Hippocrates, the Father of Medicine “corpulence is not only a disease itself, but the harbinger of others”.

  What then is Obesity? Obesity  refers to excessive weight that may impair health. 

There is no such thing as an ‘ideal weight’, just as there are no perfect measures of overweight or obesity. However, there are a couple  of measures that are used to assess whether ones weight is in a healthy range. 

  One of such  measures  take into account ones height and weight  and this is referred to as Body mass index (BMI). The BMI    categorises adults into underweight, healthy weight, overweight or obese. It is calculated by dividing  weight in kilograms by  height in metres squared. The ideal healthy BMI is between 18.5 and 24.9. (The normal values for Africans are not known but despite this irrespective of race ethnic background or age, a BMI of 30 or over 30 is referred to as being in the obese range with  potentials for adverse health implications). 

What are the causes of Obesity?  

  Obesity is a complex condition with biological, genetic, behavioral, social, cultural, and environmental influences .  Obesity stems from consuming an excessive amount of calories, but not burning any of the excess off. Calories not used in the body or burnt off through the person’s metabolism gets converted to fat tissue and stored within the body. In developing countries, like Nigeria, obesity is primarily a result of individual behaviors and environmental factors that lead to excess caloric intake and inadequate amounts of physical activity. 

  What are the factors that contribute to excess calorie intake?

Increased consumption of soft drinks and so called “power drinks.

 Increased snacking 

Eating large portions of food especially late at night

Intake of high calorie dense foods such as meat pies, chicken pies and all forms of unhealthy pastries.

More meals consumed or purchased away from home at eateries

More exposure to advertising that encourages food consumption and promotes unhealthy foods 

What are the factors that contribute to inadequate amounts of physical activity?

Labor-saving technological advances (e.g., computers) 

Increased media use (e.g., television, video games). Our children play foot ball using their hands on computers rather than in the field

Limited access to safe, convenient recreation facilities or walking areas 

Limited opportunities for activity during the workday

Limited time for daily physical education and recess in schools 

What are the implications of obesity?

Obesity can lead to many other diseases and can limit the life of the person affected by this illness. It can shorten their life, increase risk factors for other diseases and generally affect the quality of the person afflicted with obesity.  

  With obesity comes a lack of health problems; shortness of breath, excess cholesterol in the bloodstream, increased blood pressure, etc. It can be a major cause for serious diseases and could spawn a chain reaction of more serious diseases with increased risk factors. The risk for many medical complications is increased with obesity. 

 Hypertension

With obesity, the chance of developing hypertension or high blood pressure is up to five times greater compared to someone with a normal weight. Hypertension is when a patient has inappropriately elevated blood pressure. It is a major risk factor and can go on to cause other diseases like atherosclerosis, stroke, diabetes, nephropathy and many more. Hypertension is the biggest risk factor for heart disease and Stroke and accounts for 10 in 100 deaths in the hospital setting in Nigeria. There is a vast amount of evidence available that suggests that obesity is the biggest cause of hypertension. 

Heart Disease

  With excessive eating and calorie consumption comes greater risk of  developing heart disease and associated acute coronary syndrome (ACS)  also referred to as “heart attack” or  ACS. Eating fatty foods can cause an excessive amount of cholesterol to build up within the blood. Low-density lipoproteins, or LDL’s, in excess is “bad cholesterol” and are the leading cause of  heart diseases. They can damage the lining of the artery leading to a narrowing of the blood vessels. This  narrowing or blockage causes a restricted blood flow thus increasing the risk of developing heart attack or Stroke.

Diabetes mellitus

  Diabetes mellitus is a defect in the body, where the blood glucose level is persistently higher than normal. Diabetes has two types viz type 1 whose onset is in childhood and type 2 which has an onset in adults. (Persons with type 1 DM lack insulin, a hormone that maintains blood glucose within normal limits and as such require insulin injections lifelong).

  Unlike people with type 1 diabetes, the bodies of people with type 2 diabetes make insulin. But either their pancreas does not make enough insulin or the body cannot use the insulin well enough. This is called insulin resistance. When there isn’t enough insulin or the insulin is not used as it should be, glucose (sugar) can’t get into the body’s cells. When glucose builds up in the blood instead of going into cells, the body’s cells are not able to function properly. Anyone can get type 2 diabetes. 

  There is a plethora of risk factors for developing type 2 DM and the key risk factor is obesity. Type 2 or adult onset  Diabetes and obesity usually go hand in hand, with approximately 60 per cent of all diabetes cases being linked to weight issues. Type 2 diabetes is found to be on the rise as with the rising amount of obesity cases. 

  Just a few years ago, it was rare to hear about a child with type 2 diabetes. It used to be thought that if diabetes occurred in childhood, it was type 1 but not anymore. Now, there are  Reports from Western  countries and developing countries like  Nigeria that indicate  that people younger than age 20 have diabetes sometimes develop the adult type of  DM. 

  The single greatest risk factor for type 2 diabetes in children is excess weight. Once a child is overweight, chances are more than doubled that the child will develop diabetes. Unhealthy eating patterns and lack of exercise contributes to obesity in children.

  The high blood sugar in DM leads to  complications, such as heart disease, blindness, and kidney failure.

  The respiratory system may be affected in obesity such that sleep apnea may occur. Sleep apnea refers to halted breathing during sleep and  is much more common in those who have obesity. Also, Asthma is more common as BMI goes up or as people become obese.

  The joints may be affected especially  joints that carry excessive weight, such as the hips and knees  resulting in  arthritis. There is also evidence that other joints, like the ones in the hands, might also be more involved. 

There are some forms of cancers that are common in patients with obesity and these include cancers of the breast, colon, uterus, kidney and esophagus. About 10 per cent of all cancer deaths that are not from smoking are related to obesity. In women who have obesity there are more thyroid cancers, blood cancers and cancers of the pancreas. In men who have obesity there are more thyroid cancers, skin cancers, blood cancers and gallbladder cancers.

•Dr. Anthonia Ogbera is an Associate Professor of Medicine and the current Head of the Department of Medicine, Lagos State University College of Medicine



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