WHAT’S WRONG WITH BEING OVERWEIGHT?

So why are we so concerned about weight gain, apart from the aesthetic value? What are the potential health problems associated with weight gain? An estimated 300,000 adults in the United States die annually of obesity-related diseases. It has been well documented that being overweight with a BMI greater than 25 kg/m2 is associated with early death. With each incremental increase in BMI over 25 kg/m2, there is a commensurate increase in the risk for early death. The risk becomes particularly high when BMI exceeds 30 kg/m2. It has also been estimated that obese male patients have a life expectancy 3 to 7 years less than their non-obese counterparts. Obese women have a life expectancy 3.3 years less than their non-obese counterparts. Even a moderate increase in weight of approximately 20 pounds over the ideal body weight increases the risk of death, particularly for adults between the age of 30 and 64. A complete list of complications associated with obesity is shown below.
Cardiovascular
High Blood Pressure
Congestive Heart Failure
Right Heart Failure
Varicose Veins
Pulmonary Embolism
Coronary Artery Disease
Endocrine
Metabolic Syndrome
Type 2 Diabetes
Elevated Cholesterol and Triglycerides
Polycystic Ovarian Syndrome
Menstrual Cycle Disorders (female)
Gastointestinal
Gastroesophageal reflux disease (GERD)
Non-alcoholic fatty liver disease (NAFLD)
Cholelithiasis
Hernias
Colon cancer
Genitourinary
Urinary Stress incontinence
Obesity-related glomerulopathy
Hypogonadism (male)
Breast and uterine cancer (female)
Pregnancy complications
Integument
Striae distensae (stretch marks)
Status pigmentation of legs
Lymphedema
Cellulitis
Intertrigo, carbuncles
Acanthosis nigricans/skin tags
Musculoskeletal
Hyperuricemia and gout
Immobility Osteoarthritis (knees, hips)
Low back pain
Psychological
Depression/low self esteem
Body image disturbance
Social stigmatization
Neurologic
Stroke
Idiopathic intracranial hypertension
Meralgia paresthetica
Respiratory
Dyspnia
Obstructive sleep apnea
Hypoventilation syndrome
Pickwickian syndrome
Asthma

Let’s consider some of the co-morbidities associated with obesity and being overweight individually, since they are particularly important for cardiovascular disease and other frequent illnesses. Please excuse the density of the information, because there is lots of data and talk of risk factors. I want to impress on you the importance of taking control of your situation, because it is easier to prevent problems rather than treating them after they occur.
1. Hypertension: The recommended target blood pressure is less than 140 mmHg systolic (top number) and less than 90 mmHg diastolic (bottom number). A BMI greater than 30 kg/m2 is associated with a higher risk for hypertension. For example, approximately 30% of men and 32% of women with a BMI greater than 30 kg/m2 are hypertensive, as compared to 18% of men and 16% of women with a BMI less than 25 kg/m2. Why is this factor an important issue? Chronically elevated blood pressure, especially if poorly controlled, increases one’s risk for heart artery blockages and heart attacks, neck artery blockages and strokes, leg artery blockages and difficulty walking as well as possible loss of limb, kidney failure, congestive heart failure, and many other problems. Unfortunately, we have done a poor job in controlling hypertension, even in the general population. It has been documented that 32% of Americans with hypertension don’t even know they have high blood pressure. Another 15% of Americans with hypertension know they have high blood pressure, but are not being treated. Of the 53% of patients with hypertension who are being treated, only one half of them have adequate control of their blood pressure. Summarizing these statistics we find that only 27% of Americans with hypertension have adequate control of their blood pressure.
2. High cholesterol: A BMI level greater than 25 kg/m2 increases ones risk for high cholesterol levels. The ideal cholesterol level is less than 200 mg/dL. Cholesterol level is subcategorized into HDL (good cholesterol), and LDL (bad cholesterol). HDL levels in men greater than 40 mg/dL and in women greater than 50 mg/dL are protective against heart disease. HDL levels are elevated through regular physical activity such as walking 4-5 times a week for 30 minutes a day at a moderate pace. LDL cholesterol levels should ideally be less than 100 mg/dL. LDL cholesterol levels can be decreased by adopting a low cholesterol diet and taking medication. A cholesterol level greater than 240 mg/dL increases the risk for heart disease by 200%. Normal serum triglycerides should be less than 150 mg/dL. A high serum triglyceride level increases the risk for heart attacks, strokes, and other circulation problems. Triglycerides can be controlled through diet, exercise, and medication. The recommended lipid levels are summarized in the table below.
Lipid Type Recommended Level
Total Cholesterol <200 mg/dL
LDL Cholesterol (bad cholesterol) <100 mg/dL
HDL Cholesterol (good cholesterol) >40 mg/dL in men
>50 mg/dL in women
Serum Triglycerides <150 mg/dL
3. Diabetes: Type 2 diabetes is a condition in which the body either does not react normally to insulin that is produced in response to elevated blood sugar levels, or insulin is not produced in adequate amounts. Diabetes increases the risk of heart disease as well as blockages of other blood vessels in the body. The detrimental effects of poor diabetes control are so profound that it would take another book to just discuss that topic. If you are diabetic, good control of your blood sugar is so important to prevent problems years down the line such as hardening of the arteries, kidney failure, infections, and loss of limbs due to poor circulation. It has been estimated that the relative risk of diabetes increases by approximately 25% for each additional unit of BMI over 22 kg/m2.
4. Coronary artery disease: The risk for both fatal and non-fatal heart attacks increases in men and women with increasing BMI. Below a BMI of 22 kg/m2, the risk of heart problems at an early age is low. As compared to people with a BMI of less than 22 kg/m2, those with a BMI between 25 to 28.9 kg/m2 have twice the risk of coronary heart disease, while those with a BMI greater than 29 kg/m2 have three times the risk of coronary artery disease. It has also been estimated that a 5 to 8 kg gain in body weight increases ones risk for heart disease related death by 25%. If the weight gain is over 20 kg, then the increased risk for heart attacks and heart disease is 250%. A British study has demonstrated that with each 1 kg/m2 increase in BMI over 22 kg/m2, the risk of coronary artery disease increases by 10%. Clearly, the link between elevated BMI and coronary artery disease and coronary artery related deaths is very strong.
5. Congestive heart failure: Congestive heart failure is a frequent cause of death in overweight patients. Obesity results in excessive strain on cardiac function, leading to thickening of the heart muscle. Chronic strain and thickening of the heart muscle lead to subsequent heart chamber failure. Duration of obesity in years is a strong predictor of developing congestive heart failure.
6. Stroke: There is an approximately 75% increased risk of stroke in women with a BMI greater than 27 kg/m2 and a 135% increased risk of stroke in women with a BMI greater than 32 kg/m2 as compared to women with a BMI less than 21 kg/m2.
7. Gallstones: Women with a BMI greater than 40 kg/m2 have approximately a 20 out of 1000 chance of having gallstones or the need for gallbladder surgery, as compared to 3 out of 1000 women with a BMI less than 24 kg/m2.
8. Arthritis: Increased weight has been associated with increased risk for developing arthritis of the knee and possibly of the hip. Arthritis is known to be the number one cause for workplace disability. More than 70% of women and 30% of men with arthritis of the knee are overweight.
9. Sleep apnea: Sleep apnea is defined as a condition in which the individual does not breathe involuntarily for more than 10 seconds while sleeping. These episodes can occur many times throughout the sleep cycle, leading to poor sleep quality and fatigue the next day. Sometimes, the breathe is held so long that the body’s oxygen level gets very low, leading to heart irregularities. People with sleep apnea have a higher risk for strokes and heart attacks. Sleep apnea has been strongly associated with having a BMI level greater than 30 kg/m2. In addition, neck circumference seems to correlate with the risk of sleep apnea. Men with a neck circumference greater than 17 inches and women with a neck circumference greater than 16 inches are at a higher risk for sleep apnea.
10. Cancer: There is an increased risk for certain cancers associated with obesity. Initially, it was thought that being overweight was only linked to an increased risk of colon and breast cancers. However, obesity has recently been associated with an increased risk for colorectal cancer, postmenopausal breast cancer, endometrial cancer, pancreatic cancer, and esophageal cancer. The exact mechanism for this increased risk of cancer is not known. Recent reports from Sweden and the United States which have shown an improved survival at 10 years in patients who underwent weight loss surgery as compared to those who did not have weight loss surgery also showed some unexpected and exciting results. In the American arm of the study, it was found that the surgical group of patients had a 60% lesser chance of dying from cancer than the non-surgical group. In the Swedish arm of the trial, there appeared to be a decreased risk of developing certain cancers such as non-Hodgkin’s lymphoma, cervical, ovarian, and prostate cancers. However, further studies are needed to definitely prove that weight loss leads to a decreased risk of cancer and cancer deaths.