Alarming Health Implications of Obesity
Alarming Health Implications of Obesity
Joy Stepinski, MSN, RN-BC
December 2, 2024
Obesity has been an increasing health concern in recent years. One study states that “excess weight has become the leading risk factor for disease burden in high-income countries” [1]. Described as excess body fat, obesity has risen substantially over recent decades, having an enormous impact on population and individual health. The Commonwealth Fund, a private organization that supports independent research on healthcare issues, published that the United States has an obesity rate twice the average among the 28 high-income countries researched [2]. Carrying around extra weight can have enormous negative health implications.
According to data collected by the National Health and Nutrition Examination Survey (NHANES), the prevalence of obesity among adults between August 2021 and August 2023 was 40.3% in the United States [3]. These rates steadily increased since 1960, reaching the highest documented in recorded history [4]. In 1960 - 1962, obesity prevalence was 13.4%, which grew to 23.2% in 1988 - 1994, and 36.1% by 2009 – 2010. Obesity is defined by the Centers for Disease Control and Prevention as a body mass index (BMI) greater than or equal to 30 kg/m2. Severe obesity is characterized by a BMI greater than or equal to 40 kg/m2 [3].
Obesity is related to many chronic diseases, including cancer. In the Women’s Health Initiative, 73,913 postmenopausal women participated in an observational research study [5]. The women were initially free from cancer. Within the 12.6-year duration, 6,301 obesity-related cancers occurred. The researchers concluded that “a dose-dependent relationship with increasing overweight duration was found for almost all cancers” (p. 7), including breast, colon, rectum, gallbladder, liver, endometrium, ovary, pancreas, kidney, and thyroid. The cancers were termed obesity-related due to their link with excess BMI.
Approximately 20% of malignancies are caused by extra weight [6]. One of the mechanisms is due to insulin resistance. Insulin is an important hormone that regulates the amount of blood sugar in the body. When cells do not respond effectively to insulin, the pancreas tries to secrete more. Some cancers are more aggressive when the body has higher insulin, such as colorectal, liver, pancreatic, endometrial, and premenopausal breast cancers.
Metabolic syndrome represents a cluster of metabolic problems well-correlated with excess weight, contributing to a high risk of cardiovascular disease and type 2 diabetes. Traits include dyslipidemia, high blood pressure, and high fasting blood glucose. Inflammatory markers may or may not be present [7]. Weight is carried notably in the abdomen. Two-thirds of people with metabolic syndrome are also insulin-resistant.
Adipose tissue is not just a means for storing fat. This active endocrine organ produces hormones and is the only organ with unlimited growth potential [8]. In the 1980s, researchers discovered that adipose tissue secreted adipsin protein, which increases insulin secretion when glucose is present. Other molecules have been discovered since, including other proteins (i.e., adiponectin), enzymes (i.e., lipoprotein lipase), proinflammatory cytokines (i.e., serum amyloid A, pentraxin-3), and hormones. The hormone leptin regulates food intake and energy expenditure for adipose tissue.
Produced in proportion to the size of fat stores within the body, leptin is related to nutritional status and appetite control [9]. High leptin levels are associated with obesity [10]. Increased levels play a role in inflammatory conditions. For example, high leptin levels were found in obese people with osteoarthritis in their joints. Excess hormone contributes to inflammation, which further damages joints.
Chronic pain is discussed in the health literature as often co-existing with obesity. One systematic study [11] showed that excess weight is frequently connected with pain. Associated ailments include low-back pain of higher intensity, osteoarthritis, fibromyalgia, headache, and neuropathy. The authors relate that “available evidence indicates that obesity, pain, and inflammation are linked” (p. 100). Several mechanisms are proposed. C-reactive protein (CRP) is an inflammatory marker regulated by adipose tissue. A study on low back pain found high CRP levels in study participants with pain. Another study on pelvic pain in endometriosis suggested that leptin is involved with inflammatory processes. When fatty food is consumed, adipose tissue grows. This leads to insulin resistance, high leptin levels, and low-grade inflammation. Ultimately degenerative disease and pain can occur, such as osteoarthritis due to the breakdown of cartilage.
Extra weight can have a direct effect on breathing [12]. Obstructive sleep apnea (OSA) occurs when the airway is compromised during sleep. Perhaps a lesser-known condition is obesity-hypoventilation syndrome (OHS), in which high blood carbon dioxide levels persist during the day causing excessive daytime sleepiness. OHS is present in 10 – 20% of obese patients with OSA. “OHS is associated with higher morbidity and mortality than either OSA or simple obesity” (p. 3). Asthma can also be a result of increased BMI. The chest wall contains higher adipose tissue, leading to a restrictive lung disease in which total lung capacity is impaired.
Furthermore, scientists have proposed that there is a significant link between obesity and the SARS-CoV-2 infection. In a postmortem study [13], investigators found that SARS-CoV-2 RNA was detected in 23 of 47 thoracic adipose tissue samples, aligning with other studies. The SARS-CoV-2 spike protein was detected in adipose tissue of the samples where the viral RNA was found. The study states, “These results do not exclude the possibility that increased fat mass serves as a potentially more extensive reservoir for SARS-CoV-2” (p. 2). The cells within visceral fat, which surrounds organs, are prone to infection and are likely a factor in inflammation.
Obesity has a profound effect on human health. Above all, excess weight is a contributing factor in many chronic illnesses that affect quality of life and overall survival. The Commonwealth Fund published that the U.S. has the highest rate of people with more than one chronic condition [2]. Moreover, the country has the highest death rates for avoidable or treatable conditions. Obesity cannot be overlooked. The effects of obesity seem grim. Yet, there are effective methods of losing weight that do not involve crash dieting, starvation, pharmacological drugs, or surgery. Losing weight can help preserve health.
References
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The Commonwealth Fund. (2024). U.S. Health Care from a Global Perspective, 2022: Accelerating spending, worsening outcomes. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022
Emmerich, S., D., Fryar, C. D., & Ogden, C. L. (2024, September). Obesity and severe obesity prevalence in adults: United States, August 2021 – August 2023. (NCHS Data Brief, No. 508). Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db508.htm
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