Obesity-associated morbidity

Obesity-associated morbidity
Gynecomastia as seen in an obese male.

Whether obesity should be considered a disease on its own, it is also an important risk factor for many chronic physical and mental illnesses.[1]

Contents

Cardiology

Ischemic heart disease

Obesity is associated with cardiovascular diseases including angina and myocardial infarction.[2][3] A 2002 report concluded that 21% of ischemic heart disease is due to obesity[1] while a 2008 European consensus puts the number at 35%.[4]

Congestive heart failure

Having a BMI of greater than 30 increases ones risk of heart failure by two.[5][6]

High blood pressure

More than 85% of hypertension occurs in people with a BMI of greater than 25.[6] The risk of hypertension is 5 times higher in the obese as compared to those of normal weight. A definitive link between obesity and hypertension has been found using animal and clinical studies, from these it has been realized that many mechanisms are potential causes of obesity induced hypertension. These mechanisms include the activation of the sympathetic nervous system as well as the activation of the renin–angiotensin-aldosterone system.[7]

Abnormal cholesterol levels

Obesity is associated with an increased LDL cholesterol and a lowered HDL cholesterol.[6][8]

Deep vein thrombosis and Pulmonary embolism

Obesity increases one's risk of venous thromboembolism by 2.3 fold.[9][10]

Dermatology

Stretch marks on the abdomen.

Endocrinology and reproductive medicine

Diabetes mellitus

One of the strongest links between obesity and disease is that with type 2 diabetes. These two conditions are so strongly linked that researches in the 1970s started calling it “diabesity”.[6] Excess weight is behind 64% of cases of diabetes in men and 77% of cases in women.[13]

Polycystic ovarian syndrome (PCOS)

Due to its association with insulin resistance, the risk of PCOS increases with adiposity. In the US approximately 60% of patients with PCOS have a BMI of greater than 30.[14]

Menstrual disorders

[6]

Infertility

Obesity leads to infertility in both men and women. This is primarily due to excess estrogen interfering with normal ovulation in women[6] and altering spermatogenesis in men.[15] It is believed to cause 6% of primary infertility.[6][16]

Complications of pregnancy

Obesity is related to many complications in preganacy including: haemorrhage, infection, increased hospital stays for the mother, and increased NICU requirements for the infant.[17] Obese women have more than twice the rate of C-sections compared to women of normal weight.[18] Obese women also have increased risk of preterm births and low birth weight infants.[19]

Birth defects

Those who are obese during pregnancy have a greater risk of have a child with a number of congenital malformations including: neural tube defects such as anencephaly and spina bifida, cardiovascular anomalies, including septal anomalies, cleft lip and palate, anorectal malformation, limb reduction anomalies, and hydrocephaly.[20]

Intrauterine fetal death

[16]

Gastrointestinal

Gastroesophageal reflux disease

Several studies have show that the frequency and severity of GERD symptoms are higher in those who are obese.[21][22]

Fatty liver disease

Non-alcoholic fatty liver disease

[6]

Cholelithiasis (gallstones)

[6]

Neurology

Stroke

Ischemic stroke in increased in both men and women who are obese.[6] For women with BMI of greater than 30 their risk of ischemic stroke was 1.7 times greater.[23] While men with a BMI of greater than 30 had a risk of stroke 2.0 times greater.[24]

Meralgia paresthetica

[25]

Migraines

[26]

Carpal tunnel syndrome

[27]

Dementia

Those who are obese have a rate of dementia 1.4 times greater than those of normal weight.[28]

Idiopathic intracranial hypertension

[29]

Multiple sclerosis

Women that are obese at age 18 have a greater than twofold increased risk of MS.[30]

Oncology

Many cancers occur at increased frequency in those who are overweight or obese. A study from the United Kingdom found that approximately 5% of cancer is due to excess weight.[31] These cancers include: [32]

Psychiatry

Depression

Risk of suicide decreases with increased body mass index in the United States.[33]

Obesity has been associated with depression.[6] The relationship is strongest in those who are more severely obese, those who are younger, and in women.[34] Suicide rate however decreases with increased BMI.[33]

Social stigmatization

In the United States young women who are overweight complete 0.3 year less school, are 20% less likely to get married, and make $6,710 less than their normal weight counterparts.[6][35]

Respirology

Obstructive sleep apnea

[6][36]

Obesity hypoventilation syndrome

CPAP machine commonly used in OHS

Obesity hypoventilation syndrome is defined as the combination of obesity, hypoxia during sleep, and hypercapnia during the day, resulting from hypoventilation.[37] Based on its definition it occurs only in the obese.

Chronic lung disease

Obesity is associated with a number of chronic lung diseases including: Asthma and COPD.[36] It is believed that a systemic pro-inflammatory state induced by some causes of obesity may be contributing to airway inflammation and thus leading to asthma.[38]

Complications during general anaesthesia

[6][39]

Rheumatology and Orthopedics

Gout

Compared to men with a BMI of 21 - 23, men with a BMI of 30 - 35 have 2.3 times more gout and men with a BMI of greater than 35 have 3.0 times more gout. Weight loss decreases these risks.[40]

Poor mobility

There is a strong association between obesity and musculoskeletal pain and disability[41]

Osteoarthritis

Increased rates of arthritis are seen in both weight bearing and non weight bearing joint.[6] Those with a BMI greater than 26.4 had rate of osteoarthritis of the knees 6 times greater than those with a BMI of less than 23.4, well rates of osteoarthritis in the hand was about 1.5 times greater.[42]

Low back pain

Obese individuals are twice to four times more likely to have lower back pain than their normal weight peers.[43]

Urology and Nephrology

Erectile dysfunction

One third of obese men with erectile dysfunction who lose weight have improvement in their sexual functioning.[44]

Urinary incontinence

Urge, stress, and mixed incontinence all occur at higher rates in the obese.[45] The rates are about double that found in the normal weight population.[46] Urinary incontinence improves with weight lose.[47]

Chronic renal failure

Obesity increases ones risk of renal failure by three to four times.[48]

Hypogonadism

[49]

References

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