Can You Overcome Obesity?


What is Obesity? 
Obesity is a preventable, multifactorial, and complex disease that impacts over a 3rd of the global population (Hruby & Hu, 2015). The body weight elevation in comparison to height affirms the establishment of obesity. Obese people carry excessive body fat or adiposity that potentially increases their risk of metabolic complications. Obesity, if sustained for a longer duration, increases the risk of cancers, cardiovascular disease, type-2 diabetes, depression, disability, and mortality. The premature onset of childhood obesity adversely impacts the health and wellness of individuals during their adulthood. The psychosocial and economic adversities related to obesity appear insurmountable in a variety of scenarios. The excessive weight gain among obese people occurs due to a marked disruption in their energy expenditure versus energy intake. The societal, cultural, and genetic factors predominantly influence the development of obesity and its deleterious complications. The preliminary factors that increase the risk of obesity include energy metabolism disruption, food advertisements, medications, endocrine disorders, food habits, insomnia, and decreased physical activity. Some of the commonly reported syndromes with obesity include Alstrom syndrome, Wilson Turner congenital leptin deficiency, Bardet-Beidl syndrome, Fragile X, MC4R syndromes, and Prader Willi syndrome (Panuganti & Kshirsagar, 2020).   
How Can You Identify Obesity?
Obesity and overweight are classified by waist circumference and BMI (body mass index). You must check your BMI based on the following parameters to understand your risk of obesity and/or overweight (Feingold, Anawalt, & Boyce, 2000). 
1.     Underweight (BMI less than 18.5)
2.     Normal weight (BMI ranging from 18.5 to 24.9)
3.     Overweight (BMI ranging from 25 to 29.9)
4.     Obesity class I (BMI between 30 to 34.9)
5.     Obesity class II (BMI between 35 to 39.9)
6.     Extreme obesity/Obesity class III (BMI equal to or above 40)
How Does Obesity Impact Your Life?
The physical impact of obesity appears disastrous in human populations. Obesity disrupts the overall wellness and health-related quality of life of individuals. Obesity potentially increases the risk of the following conditions/comorbidities (Djalalinia, Qorbani, Peykari, & Kelishadi, 2015). 
1.     Premature death
2.     Disability 
3.     Pulmonary embolism 
4.     Musculoskeletal problems 
5.     Asthma 
6.     Cerebrovascular disease 
7.     Stroke 
8.     Hypertension 
9.     Type-II diabetes 
10.  Cancers 
Obesity extends deleterious effects on the mental health outcomes of populations while increasing their risk of the following complications. 
1.     Sexual health deterioration 
2.     Reduction in interpersonal communication 
3.     Reduction in coping skills 
4.     Impairment of body image 
5.     Eating difficulty 
6.     Motivational disorders 
7.     Mood disorder 
8.     Reduced self-esteem 
Obesity deteriorates the emotional, spiritual, and social well-being of people while concomitantly disrupting their eating habits. Obesity also increases the risk of the following social issues. 
1.     Humiliation 
2.     Rejection 
3.     Social bias 
4.     Ridicule 
5.     Discrimination 
6.     Stigma  
What are the Causes of Obesity?
Obesity develops in individuals due to a range of biological, psychosocial, behavioral, and environmental factors. Some of them are mentioned below (Mitchell, Catenacci, Wyatt, & Hill, 2011) (Medicine Net, 2019). 
1.     Elevated consumption of food items rich in energy density/carbohydrates and sugar content 
2.     Overeating and/or increased eating frequency 
3.     Lack of/reduced physical activity 
4.     Medications including antihistamines, oral contraceptives, antidiabetics, and antidepressants elevate the risk of obesity 
5.     Psychological disturbances (including anger, stress, sadness, and boredom) and related food addiction/binge eating patterns 
6.     Leptin deficiency and genetic predisposition  
7.     Diseases including Prader-Willi syndrome, Cushing’s syndrome, and polycystic ovary syndrome 
8.     Socioeconomic factors including poverty, stigmatization, limited walking places, and unavailability of a healthy diet
9.     Ethnicity (i.e. Hispanic and African-American people experience a greater risk of obesity based on their environmental and geographical factors) 
10.  Teenage overweight or obesity potentially contributes to the development of obesity in adulthood
11.  Menopause and pregnancy are the physiological episodes that change the production of hormones in women while increasing their risk of obesity  
12.  High cholesterol levels 
13.  Elevated insulin resistance 
14.  Sleep problems 
15.  Pre-existing chronic disease conditions including congestive heart failure and arthritis also increase the risk of obesity and related complications 
What is the Pathophysiology of Obesity?
The following mechanisms potentially aggravate the onset and prevalence of obesity and related health burden (Zhang et al., 2014). 
1.     The disordered eating patterns and conditions like bulimia nervosa and anorexia nervosa not only elevate the social problems of people but also deteriorate their health-related quality of life. They eventually encounter one or more of the conditions including obstructive sleep apnea, hypercholesterolemia, gastrointestinal complications, and blood pressure elevation that potentially elevate their risk of obesity. 
2.     Food addiction is based on the abnormal activation of the food-related motivational centers of the human brain, including the orbitofrontal cortex, anterior cingulate cortex, and amygdala. 
3.     The genetic imprinting disorder like Prader-Willi Syndrome leads to hyperphagia that increases the obesity predisposition of the affected patients to many folds. 
4.     The abnormal eating behavior develops due to the abnormal food-related brain signaling or hyperactivity of the brain regions including the medial prefrontal cortex, paralimbic regions, nucleus accumbens, ventromedial prefrontal cortex, insula, and hypothalamus. 
5.     The elevated production of leptin due to genetic factors increases the development of leptin resistance that potentially upregulates appetite-stimulating neuropeptides. The affected people experience greater eating temptations that eventually elevate their obesity predisposition. 
6.     Insulin resistance modulates dopaminergic pathways related to abnormal eating habits. The affected people tend to consume palatable food items that increase their risk of obesity and metabolic complications. 
7.     The increased production of the orexigenic peptide ghrelin leads to metabolic complications while disrupting the function of hypothalamic neurons. Ghrelin activates the brain locations that extend incentive and hedonic responses to diet-related cues. Ghrelin also increases the reward processing mechanisms associated with the elevated functioning of the mesolimbic dopaminergic pathway that eventually elevates the daily food consumption. 
8.     The reduced production of peptide YY in obese people increases the frequency of their gastric emptying and intestinal motility. This increases their food consumption desire as compared to healthy individuals. 
9.     The decreased production of glucagon-like peptide 1 from the gut’s distal intestinal L-cells of the obese people impacts their glucagon release, beta-cell growth, and glucose-dependent insulin secretion that eventually increases their dietary intake frequency. 
10.  The reduced production of endogenous peptide hormone ‘cholecystokinin’ elevates the frequency of gastric emptying, digestive behavior, and appetite in overweight people. They resultantly gain more weight that increases their risk of obesity. 
Is it Possible to Treat Obesity?
You can rely on one or more of the following conservative obesity management procedures to get rid of your extra fat (Ruban, Stoenchev, Ashrafian, & Teare, 2019). 
1.     Serotonin administration for appetite management 
2.     The coadministration of topiramate with phentermine helps to reduce the energy consumption 
3.     The endoscopically-guided placement of intragastric saline-filled silicone balloon inside the stomach for a tenure of 24 weeks facilitates weight loss in obese people. 
4.     Bariatric surgery followed by plasma nutrient regulation and management of nutrient absorption/gut motility/appetite helps to reduce obesity to many folds. 
5.     Laparoscopic adjustable gastric banding is based on the placement of inflatable silicone band across the stomach’s upper portion to reduce the length of its lumen. This lumen narrowing proceeds through the configuration of a proximal stomach pouch that restricts the passage of food. However, this technique is associated with complications including gastric erosion, band slippage, gastrointestinal reflux, and esophageal pouch dilatation. 
6.     The Roux-en-Y gastric bypass is a procedure that facilitates the segregation and reconnection of the small intestine (distal part) with proximal stomach pouch. This modifies the food passage and facilitates its transfer from the small pouch to the distal small intestine. This also limits the food absorption in the proximal intestine and distal stomach following their reconnection with the small intestine. The entire procedure enhances the admixing of food items with the digestive enzymes. 
7.     Sleeve gastrectomy is a procedure that requires excision of the stomach for minimizing the passage of the ingested food volume. 
8.     BPD-DS (biliopancreatic diversion with a duodenal switch) is a 2-staged procedure that proceeds laparoscopically for the configuration of a tubular pouch (similar to sleeve gastrectomy). Secondly, the bifurcation of the small intestine occurs across the ileocecal valve and pylorus. The next step proceeds with the anastomosis between the duodenum and distal small intestine followed by the integration of small intestine (near ileocecal valve) and middle fragment’s distal end. 
What Natural Ways You May Adopt to Overcome Obesity?
You must customize your obesity prevention or treatment interventions after consulting your physician, dietician, and physical therapist. However, some of the standard measures are documented below (IOM, 2004) (Harvard School of Public Health, 2020). 
1.     The consumption of anti-obesity herbs helps to reduce weight to some extent (Liu, Sun, Yao, Liu, & Gao, 2017). These herbs include Rhizoma coptidis, Panax ginseng, Radix Lithospermi, Ephedra sinica, Rheum palmatum, green tea, Astragalus membranaceus, Carthamus tinctorius, Ganoderma lucidum, Tripterygium wilfordii. However, dietary management is highly needed for expanding the health advantages of these herbs in obese people. 
2.     Mindful eating relies on limited consumption of food items 
3.     Physical activity not only helps to reduce weight but also preserves lean body mass
4.     Physical activity and/or exercise helps to enhance lipoprotein level, blood pressure, and glycemic control   
5.     Self-assessment of environmental and personal factors improves dietary habits and a healthy lifestyle 
6.     Positive reinforcement through an extended engagement in enjoyable activities enhances the overall health-related quality of life 
7.     Cognitive restructuring technique helps to overcome dysfunctional beliefs regarding diet and exercise
8.     Social support and nutrition education improve dietary habits and health-related behavior 
9.     Meal replacement programs also help in reducing the consumption of saturated fat 
10.  The regular consumption of low fat and high-fiber diet helps in shedding the extra pounds 
11.  The regular consumption of avocados, eggs, beans, yogurt, salmon, fruits, popcorn, almonds, whole grains, vegetables, whole fruits, poultry products, fish, beans, seeds, nuts, and olive oil facilitates the maintenance of a healthy weight. 
12.  The avoidance of sugar-sweetened beverages, fruit juices, refined grains, potatoes, red meat, and processed food is highly needed for obesity management 
13.  The consumption of small meals in short spurts reduces the accumulation of extra fat 
14.  Obese people must avoid consuming alcohol and smoking to reduce their risk of life-threatening and/or chronic disease conditions
15.  The obese people must avoid the frequent consumption of high-calorie food since that increases the risk of severe obesity and associated comorbidities 
16.  The restricted use of sugar-sweetened beverages is highly recommended to reduce the risk of obesity and its potential complications 
17.  You must consume a rich breakfast to avoid the overconsumption of mid-day meals 
18.  Slow eating helps to attain early satiety and reduce hunger 
19.  Eating must not be accompanied by distractions based on the use of the smartphone, computer, and television 
20.  The restricted consumption of takeaway food items, restaurant-based meals, and fast food limits the consumption of extra fat 
21.  The obese people should consider vigorous or moderate physical activity for a duration of one hour per day to cut off their extra pounds 
22.  Brisk walking and/or running are highly recommended for healthy people to reduce their risk of obesity 
23.  Muscle-strengthening activities not only enhance endurance but also help in controlling weight gain 
24.  Restriction in screen time for children is highly recommended to modify their sedentary lifestyle 
25.  7-8 hours of daily (night) sleep for adults, 8.5-9.25 hours of daily (night) sleep for adolescents, and 10-14 hours of daily (night) sleep for children is recommended to improve their weight maintenance paradigm 
26.  Stress management and relaxation activities also help to reduce the risk of weight gain in adults and middle-aged people         
 References

Djalalinia, S., Qorbani, M., Peykari, N., & Kelishadi , R. (2015). Health impacts of Obesity. Pakistan Journal of Medical Sciences, 31(1), 239-242. doi:10.12669/pjms.311.7033
Feingold, K. R., Anawalt , B., & Boyce, A. (2000). Definitions, Classification, and Epidemiology of Obesity. In Endotext. South Dartmouth (MA): MDText.com, Inc. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK279167/
Harvard School of Public Health. (2020). Obesity Prevention Source. Retrieved from Healthy Weight Checklist: https://www.hsph.harvard.edu/obesity-prevention-source/diet-lifestyle-to-prevent-obesity/
Hruby, A., & Hu, F. B. (2015). The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics, 33(7), 673-689. doi:10.1007/s40273-014-0243-x
IOM. (2004). Weight Management: State of the Science and Opportunities for Military Programs. In Weight-Loss and Maintenance Strategies. Washington (DC): National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221839/
Liu, Y., Sun, M., Yao , H., Liu, Y., & Gao, R. (2017). Herbal Medicine for the Treatment of Obesity: An Overview of Scientific Evidence from 2007 to 2017. Evidence-Based Complementary and Alternative Medicine. doi:10.1155/2017/8943059
Medicine Net. (2019, 02 12). Obesity . Retrieved from https://www.medicinenet.com/obesity_weight_loss/article.htm
Mitchell, N., Catenacci, V., Wyatt, H. R., & Hill, J. O. (2011). Obesity: Overview of an Epidemic. Psychiatric Clinics of North America, 34(4), 717-732. doi:10.1016/j.psc.2011.08.005
Panuganti, K. K., & Kshirsagar, R. K. (2020). Obesity. In StatPearls. Treasure Island (Florida): StatPearls Publishing;. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459357/
Ruban, A., Stoenchev, K., Ashrafian, H., & Teare, J. (2019). Current treatments for obesity. Clinical Medicine, 19(3), 205-212. doi:10.7861/clinmedicine.19-3-205
Zhang, Y., Liu, J., Yao , G., Ji, G., Qian, L., Wang, J., . . . Liu, Y. (2014). Obesity: Pathophysiology and Intervention. Nutrients, 6(11), 5153-5183. doi:10.3390/nu6115153

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