Obesity is an excess accumulation of adipose tissues. Obesity is recognized and added as a non-communicable disease by WHO in 2015.
CAUSES
* Obesity can be either Endogenous, i.e, genetic or familial or hormonal or exogenous, i.e, due to lifestyle issues.
* Also people can either be insulin sensitive i.e. they have “good metabolism.” Most can usually get away with eating to their satisfaction without gaining weight or losing control over appetite.
Generally speaking, if you are physically and mentally healthy, you feel good, and your body weight is naturally normal and stable, you probably fall into this category.
If so, you can probably eat naturally-occurring carbohydrates such as fruits and starchy vegetables relatively safely, just like our healthy ancestors did, without worrying about how many carbohydrate grams you eat per day. However, you could still easily become insulin resistant if you eat refined carbohydrates, especially as you get older.
Carbohydrate metabolism tends to worsen with age. To protect yourself from insulin-resistant conditions down the road, stick to whole foods and hopefully you won’t lose your ability to process carbohydrates later on or
Insulin resistant
They are the unlucky ones. Most of them gain weight by simply thinking about a muffin. If you have insulin resistance, then your carbohydrate metabolism is badly damaged. For those of us who are insulin-resistant, the sad truth is that we need to limit ALL types of carbohydrate, including fruits, starchy vegetables, grains and beans, not just added sugar and refined carbohydrates. The happy truth is that since carbohydrates lie at the root of most of our problems, we have the power to change the course of our future simply by changing our diet!
Different classifications:
* Stage 0 overweight but have no complications, whereas
* Stage 1 overweight and have 1 mild-to-moderate complications.
* Stage 2 at least 1 severe complication.
* “ABCD,” which stands for “Adiposity-Based Chronic Disease”.
* “Edmonton Obesity Staging System,” individuals with obesity are classified into 5 graded categories, based on their morbidity and health-risk profile along 3 domains, including medical, functional, and behavioral. The staging system was shown to predict increased mortality in 2 large population cohorts.
Disbesity – Patho-Physiology
* The relationship between obesity and diabetes is of such interdependence that the term 'diabesity' has been coined.
* The passage from obesity to diabetes is made by a progressive defect in insulin secretion coupled with a progressive rise in insulin resistance.
* An increase in overall fatness, preferentially of visceral as well as ectopic fat depots, is specifically associated with insulin resistance.
* The accumulation of intramyocellular lipids may be due to reduced lipid oxidation capacity. The ability to lose weight is related to the capacity to oxidize fat. Thus, a relative defect in fat oxidation capacity is responsible for energy economy and hampered weight loss.
Increased fat mass compensates for insulin resistance
Inflammatory response
* Studies suggest that abdominal fat causes fat cells to release ‘pro-inflammatory’ chemicals, which can make the body less sensitive to the insulin it produces by disrupting the function of insulin responsive cells and their ability to respond to insulin.
* This is known as insulin resistance – the hallmark of type 2 diabetes.
* Having excess abdominal fat (i.e. a large waistline) is known as central or abdominal obesity, a particularly high-risk form of obesity.
DIisruption of fat metabolism
* Obesity is also thought to trigger changes to the body’s metabolism. These changes cause fat tissue (adipose tissue) to release fat molecules into the blood, which can affect insulin responsive cells and lead to reduced insulin sensitivity.
* Another theory put forward by scientists into how obesity could lead to type 2 diabetes is that obesity causes prediabetes, a metabolic condition that almost always develops into type 2 diabetes.
Cost of obesity
* Globally obesity and related conditions such as type 2 diabetes is putting a huge, unsustainable drain on National economy.
* Treating obesity, type 2 diabetes and diabetic complications such as nephropathy, heart disease and amputation is very expensive, and with new cases of obesity-related type 2 diabetes soaring each year, these costs are expected to keep rising.
* To tackle this problem, there is a need for widespread and far-reaching culturally appropriate educational literature that informs the population of the risk of eating badly and not taking exercise.
Treatment modalities
* Weight reduction can be achieved via different weight loss strategies, including lifestyle intervention (diet and exercise), pharmacotherapy, or bariatric surgery.
Bariatric surgical mechanism
* Randomized clinical trials show metabolic surgery, particularly gastric bypass, results in complete remission or improvement of diabetes within two years for more than 90% of patients, in some cases at the time of hospital discharge and even before significant weight loss occurs.
* Head-to-head studies show metabolic surgery is superior to nonsurgical treatment including drug therapy and intensive lifestyle intervention in producing long-term diabetes remission with 25-50% more surgery patients maintaining glycemic control without medication for up to five years.
* Global clinical guidelines endorsed by 45 medical professional societies include metabolic surgery as a treatment option for type 2 diabetes in patients with BMI of 30 or more.
* Weight loss, which improve first hepatic and later peripheral insulin sensitivity, in combination with increased postprandial insulin secretion by hormone glucagon-like peptide-1 responsesand peptide-YY.
* The increased secretion is due to an accelerated exposure to and absorption of nutrients in the small intestine.
* 2018: ” The statement is supported by the American Diabetes Association (ADA) and has been endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).
Metabolic surgery vs medical therapy
* Randomized clinical trials have demonstrated that metabolic surgery is more effective than medical and/or lifestyle interventions including pharmacological therapy in producing diabetes remission, glycemic control, and weight loss.
* Final five-year results of the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiency (STAMPEDE) Study show in patients with uncontrolled type 2 diabetes (mean BMI 37), metabolic surgery plus intensive medical therapy was more effective than intensive medical therapy alone for achieving and maintaining glycemic control, weight reduction, medication reduction, and improvements in lipid levels (NEJM, 2017).
(Dr Sanjay Borude is a Bariatric Surgeon)
