Obesity

Obesity is a condition characterised by the excessive storage of body fat, which causes a significant increase in weight. Medical practice uses the body mass index (BMI) to measure it, an indicator calculated from weight and height: a BMI over 30 indicates obesity, and a BMI over 40 reveals morbid obesity.

Obesity has become a health problem affecting more and more developed and developing countries — a frequency that turns the disease into a real epidemic. Find out which weight category you are in with the body mass index calculator.

What are the causes of morbid obesity?

The aetiology of obesity includes the following predisposing factors:

• High calorie intake — food consumption is much higher than the body’s burn rate.
• Eating disorders — for example night eating syndrome (morning anorexia, evening hyperphagia and insomnia) and bulimia nervosa (recurrent episodes of excessive food intake followed by excessive compensatory behaviour, such as the use of diuretics and laxatives or inducing vomiting).
• Genetic factors — research has identified several genes involved in the appearance of obesity; hereditary factors significantly increase susceptibility to the disease.
• Environmental and behavioural factors — the modern, hectic lifestyle with unbalanced eating can trigger weight gain. Sedentariness favours obesity, low energy expenditure contributing to the onset or worsening of energy imbalances.
• Psychological factors — the risk of developing morbid obesity is higher in people experiencing anxiety, depression, stress or low self-esteem.
• Medical conditions — hormonal and thyroid diseases, hypothalamic conditions.
• Certain medications — oral contraceptives, phenothiazines, antidepressants, antiepileptics, steroids, antihypertensives; through their effect on appetite, these substances can favour excessive calorie intake.

What complications can morbid obesity have?

• Diabetes — people with morbid obesity develop resistance to the hormone that regulates blood sugar. Over time, blood sugar imbalances can lead to complications of high severity.
• Heart conditions — excess body fat can impair the heart’s ability to function correctly and can lower peripheral resistance. Patients may present hypertension, acute stroke, acute myocardial infarction, atrial fibrillation, venous insufficiency, venous thrombosis.
• Respiratory diseases — the excessive accumulation of fat in the head and neck region causes the intermittent obstruction of airflow; such problems usually appear at night, during sleep.
• Heartburn — because of abdominal fat, stomach acids reach the oesophagus, causing burning sensations.
• Depression — people with weight problems can be discriminated against at work, disapproved of by family or friends, or subjected to remarks that lower their self-esteem, all of which lead to anxiety and depression.
• Osteoarthritis — the cartilage protecting the joint surfaces is destroyed, direct bone-to-bone contact appears and, over time, the bones themselves are damaged. The pain is severe, especially in the knees, spine and hips.
• Infertility — obesity causes hormonal changes that can create fertility problems in both men and, especially, women.
• Urinary incontinence — the involuntary loss of urine is due to the size of the abdomen and the relaxation of the pelvic muscles.
• Sexual dysfunction — impotence or erectile dysfunction frequently appears as a consequence of obesity; in women, obesity causes gynaecological problems such as irregular periods and hormonal imbalances.
• Increased cancer incidence — among the types with increased risk are breast, endometrial, oesophageal, gastric and kidney cancer.
• Brain conditions — the metabolic changes associated with obesity (raised blood sugar and cholesterol) can affect brain function, increasing the risk of dementia.

How is obesity treated?

Treatment starts with diet, exercise, behavioural therapies, endocrine treatment and medication, alongside treating the associated conditions. When these methods have been exhausted without result, bariatric surgery — gastric sleeve, gastric plication, gastric bypass or gastric banding — offers the most significant and lasting weight loss, with improvement of the associated diseases.

Frequently asked questions

How do I calculate my body mass index?

BMI is calculated from weight and height. You can use the BMI calculator directly: a result over 30 indicates obesity, and over 40 morbid obesity.

Is obesity only a cosmetic problem?

No. Obesity is a disease with serious complications — diabetes, heart disease, sleep apnoea, osteoarthritis, infertility, increased cancer and dementia risk — which is why treating it is a health matter, not one of appearance.

When should I consider surgery?

When diets, exercise, medication and behavioural therapies have not delivered results, and the excess weight affects your health. The specialist evaluation establishes whether you are a candidate and which procedure suits you.