Overview
Obesity is the accumulation of body fat to a level that threatens health. About one third of adults are within the obesity range; this rate is above the world average.
Body Mass Index (BMI) is calculated as weight (kg) divided by height (m) squared:
- Underweight: below 18.5
- Normal: 18.5-24.9
- Overweight: 25-29.9
- Obesity (class I): 30-34.9
- Obesity (class II): 35-39.9
- Morbid obesity: 40 and above
Waist circumference is also important: a waist circumference greater than 102 cm in men and 88 cm in women indicates increased risk.
Complications
Obesity is a major risk factor for many diseases:
- Heart disease, stroke
- Type 2 diabetes
- High blood pressure
- High cholesterol
- Sleep apnea
- Fatty liver disease
- Certain cancers (breast, colon, uterus, kidney, prostate)
- Osteoarthritis
- Gallstones
- Polycystic ovary syndrome, infertility
- Depression
- Gastroesophageal reflux
- Asthma, breathing difficulties
Causes
Obesity occurs when energy intake exceeds energy expenditure. However, the process is multifactorial:
- Sedentary lifestyle: Desk jobs, screen time
- Unhealthy eating: High-calorie, processed, sugary foods
- Genetics: Family history
- Hormonal disorders: Hypothyroidism, Cushing's syndrome, polycystic ovary
- Medications: Antidepressants, corticosteroids, antipsychotics, some diabetes medications
- Psychological causes: Stress, emotional eating, depression
- Sleep deprivation
- Changes in gut microbiota
- Age: Metabolism slows with age
Risk Factors
- Family history
- Childhood obesity
- Sedentary lifestyle
- High-calorie diet
- Insufficient sleep
- Stress and emotional issues
- Some medications
- Hormonal diseases
- Pregnancy and menopause
- Socioeconomic level
When to See a Doctor
- If your BMI is 30 or higher
- If your BMI is 25-29.9 with related conditions (diabetes, hypertension)
- If you cannot lose weight with diet and exercise
- If you experience psychological distress due to weight
- If your child has a weight problem
Diagnosis and Treatment
Diagnosis:
- BMI, waist circumference
- Body fat measurement
- Blood tests (sugar, cholesterol, thyroid, liver)
- ECG; sleep apnea screening when needed
Treatment (stepwise approach):
1. Lifestyle changes:
- Dietary adjustment (reducing calories, balanced nutrition)
- Regular physical activity
- Behavioral therapy
- Stress management, sleep regulation
2. Medication (BMI ≥30 or BMI ≥27 + comorbidity):
- Liraglutide, semaglutide (GLP-1 analogs)
- Orlistat
- Naltrexone-bupropion
- Must be used under medical supervision
3. Bariatric surgery (BMI ≥40 or ≥35 + comorbidity):
- Sleeve gastrectomy
- Gastric bypass
- Gastric banding
Prevention
- Develop healthy eating habits in childhood
- Reduce plate size; practice portion control
- Avoid processed foods and sugary drinks
- Increase vegetable and fruit consumption
- Prefer whole grains
- Exercise at least 150 minutes per week at moderate intensity
- Get 7-9 hours of sleep per day
- Manage stress (emotional eating is an important trigger)
- Eat meals together with family members
- Monitor your weight regularly