What Is The Obesity? What Are The Symptoms and Treatments Of Obesity?

Obesity can be defined as the body mass index (BMI) of a person is over 85 percentile by bringing with it several risks. The men who have an average body weight has a 15-20% body fat rate, this is a 25-30% for women.

Since determining the body fat index is not easy, obesity is defined according to the overweight instead of over body fat. WHO identifies overweight and obesity based on the body mass index [BMI = Weight (kg) / Height (m2)].

Obesity which is growing like a snowball has a significant place in health charges together with the diseases it creates, today. In this respect, preventing obesity is much more important than treating it. Moreover, obesity is an important problem that concerns not only endocrinology and internal medicine specialists, but also cardiology, neurology, psychiatry, gastroenterology, eye diseases, physical therapy and rehabilitation, orthopaedics and many similar branches.

The main symptom of obesity is overweight. However, this disease does not show its effect as only the increase in body size of individuals. Obesity which affects the life quality negatively gives some symptoms such as,

• It restrict your breath.
• It makes you sweat more than normal.
• It causes to snore.
• You always feel tired.
• Your sleep cycle is disturbed.
• It causes anti-socialism, forgetting self-identity and depression.
• It makes deepen skin colour, also it can cause heat spots or fungus.
• You can’t make your physical activities and leave them with tiredness.
• The lipoidosis begins in the waist region.
• You begin to feel muscle and joint pain.
• Your appetite is always high and you always feel hungry.
•  It gives acid reflux, cramp and pressure feeling.
• It turns your hormonal balance upside down.

The reasons for obesity are the change in modern life dietary habits and decrease in physical movements because of the lifestyle that becomes easier in terms of transportation, production and agriculture together with the developed technology. Unhealthy fast foods and over greasy dietary habits which are rich in carbohydrate and refined sugar but poor from vegetable fibre, are important factors that cause obesity. Besides, the spread of using the technological devices (mobile phone, television, computer, home theatre etc.) which fill our leisure times easily, contributes to increasing in obesity. The higher amount of obesity prevalence in women in Turkey rather than the world average is not surprising. Current studies about this issue indicate that physical activity lowness of Turkish women, a high birthrate, long lactation period, accompanied diabetes and hypertension, low income and low education levels affect obesity significantly.

10% decreasing of body weight during the obesity treatment quite benefits to prevent the health problems that obesity causes. Complete recovery is rare after obesity occurs, and quickly gaining weight that lost during the treatment is frequent. Only 5% of people that lost weight, can keep their weight stable, however, most of them gain weight again. Dietary has a very essential role in providing a positive energy balance. Obesity is an expected situation when the total energy intake is more than the consumed energy for a long time. Also, the ratio of essential nutrients is important. There is a positive correlation between the consumption of high-fat foods and obesity. Knowing the foods that can be eaten instead of each other provides great convenience while arranging the nutrition program. The foods in different groups with similar protein, carbohydrate, fat and energy values can be gathered together, and exchange lists can be prepared. The foods of each group can be eaten instead of each other since all foods provide the almost same amount of energy, protein, carbohydrate or fat. If we list the treatment methods,

• Medical nutrition therapy
• Treatment exercises
• Social psychological support treatment
• Pharmacological therapy of obesity
• Surgical therapy
• Dietary suggestion intended for obese persons

• For obese patients, a systemic physical examination should be done and a detailed medical history that focused on obesity should be taken to exclude the secondary reasons for obesity, and obesity-related diseases and comorbid situations.
• Family doctors, practitioners, and experts ( Internal Diseases and Endocrinology and Metabolic Diseases) should use BMI (body mass index) to assess obesity. While following the weight loss and the effectiveness of the treatment, only body weight (kg) can be used.
• To classify obesity and determine the disease risk, BMI should be used.
• To assess abdominal obesity, a measure of waist circumference should be used.
• In addition to BMI, measurement of WC (waist circumference) should be used to assess the disease risk for adult patients.
• For whole obesity patients, fasting blood glucose, fasting serum lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, the ratio of total cholesterol/HDL-cholesterol and triglycerides) should be measured and EKG should be taken.
• To scan and exclude the seconder obesity causes and obesity-related sickness and comorbid situations serum uric acid and liver enzymes (ALT, AST, GGT, ALP) should be measured. In addition, BUN and CREATININ levels should be measured for the elderly. If required, further laboratory workups should be done.
• Body composition analysis is not necessary for clinical applications since its validity is unclear.
• To diagnosis and treatment for obesity-related diseases, consultation should be requested from relevant sciences in necessary cases.
• The aim of lifestyle change treatment is at least 5% weight loss of basal weight in 6 mounts.

Obesity which begins with lipoidosis can bring really serious problems if it is not treated. Cirrhosis, liver failure, palpitation, arrhythmia are the most important problems. If we handle a few diseases in detail,

• The insulin resistance in obesity, dyslipidemia and increased inflammation causes the fatty liver disease to become more severe over time.
• The prevalence of reflux is quite high as 40-50% for obese patients.
• It can cause thickening, hairing, crevices, lymphedema, cellulite, hidradenitis and psora in the skin, more frequently.
• Oesophageal carcinoma, gastric cancer and colon cancer are increased depending on the increase of BMI. Also, it is stated that there is a serious relationship between obesity and endometrial cancer, gall bladder cancer and kidney cancer for women.

The epidemic health problems accompanied by obesity, threaten the obesity restricted health expenses, especially, it causes an increase in the incidence of type 2 diabetes, cardiovascular diseases, cancer and hypertension. The alterations of obesity can be separated into two groups simply. The increase in adipose tissue mass and the increase in the oscillation of pathogen products (adipokine) in raised adipose tissue.

Classifying the obesity pathogenesis by popularising as this provides classifying the obesity complications according to the reasons simply. Essentially, the problems depend on the increase in adipose tissue: The “social and psychological” problems caused by obesity in a person, obstructive sleep apnea syndrome which grows depending on increased paraferangeal fat storage, osteoarthritis which grows as a result of a joint tear due to increased adipose tissue. The problems that occur as a result of metabolic and emunctory function changes of fat cells: Products that released from enlarged fat cells and are effective fat from the adipose tissue (ADIKOPIN) lead up to these complications.

The general example of this situation is “insulin resistance”. Insulin resistance is related to the increased fat acid oscillation, and the storage of these fatty acids in the liver and striated muscle. When insulin resistance exceeds the functioning capacity of beta cells in the pancreas, “type 2 diabetes” occurs. The oscillation of increased cytokine from the adipose tissue especially can start the process of low degree inflammatory (interleukin 6 – IL-6).

Increased oscillation of prothrombin activator inhibitör-1 generates inclination to thrombosis and procoagulant situations. Accompanied by endothelium malfunction to this lead up to “cardiovascular disease” and “hypertension”. The oscillation of oestrogen from the enlarged stromal mass creates a risk for “breast cancer”. Increased cytokine oscillation may play a role in the development of other cancers.

When the pathogenic factors of increased adipose tissue are together, the expected lifetime is shortened. Type 2 diabetes Show parallelism with being overweight in both genders and all ethnic groups. Type 2 diabetes risk is strongly related to the degree and duration of being overweight.

According to the data accepted by the World Health Organization and the Ministry of Health, the body mass index is obtained by dividing the weight by the square of the height. The result gives the BMI (body mass index) of the individual. Formula: The Weight of the Individual / The Square of the Height of the Individual = BMI. Primarily, we square the height of an individual. Then, we divide the weight of an individual by the square of the height.

• Between 0-18,4 are accepted underweight.
• Between 18,5-24,9 evaluated normal in terms of weight.
• Between 25-29,9 accepted as overweight.
• People whose BMI exceeds 30 are accepted as fatter.
• Obese: BMI exceeds 30 (up to 40)
• Morbid Obese: BMI exceeds 40 (up to 50)
• Super Obese: BMI exceeds 50

When the duration of obesity increase, the risk of growing class 2 obesity raise. It is stated that the risk of developing class 2 obesity is two times higher in people whose BMI exceeds 30 kg/m2 during the 10 years in comparison with less than 5 years. In addition to the BMI, an increase in weight is a significant risk factor. In current studies, it is detected that men who gained more than 13,6 kg during the 5 years under 4,5 times risk in comparison with men who gained approximately 4,5 kg. The waist/hip ratio should not exceed 1,0 for men and 0,8 for women. The waist/hip ratio indicates the central type of obesity. It is known that central obesity is related to the development of class 2 obesity. The risk of developing class 2 diabetes is higher in individuals who have central obesity.

Obesity is a significant health problem in childhood period. The 1/3 of obesity of adult obese individuals has started in their childhood. Obesity can be seen depending on the hormonal disorder. In 2016 it is revealed that the number of obese or overweight individuals aged 18 and older is over 1,9 billion and 650 million of them are adult obese.

Also, it is found out in 2016 that the number of overweight children aged under 5 is 41 million. It is found that obesity is 9,9 %, for 10-18 aged children the obesity is 9% and overweight is 18,3%. It is detected that fatness is 10,5% overweight is 19,6% for secondary school children, and for high school, the period is the fatness is 5,6% and the overweight is 15%.

Also, has been reported that the bodyweight of men or women who have normal body weight or obesity shows increase until 65 age, and decrease at later ages. Obesity is defined as an unhealthy increase in body fat which increases the risk of prematüre mortality and diseases.

Since detecting body fat in the clinic is not very practical, the body mass index which depending on the relation between height and weight, and shows a correlation between body fat mass in young and middle-aged individuals, is used. Between 1976 and 1997, it increased from 4,9% to 8,5% in males and increased from 6,2% to 9,3% for females.

• Joint Diseases: Generally the frequency of osteoarthritis increased in the knees and ankles of obese individuals.
• Stroke: It is indicated that having a BMI ≥ of 27 kg/m2 and gaining weight after the age of 18 increased the risk of ischemic stroke.
• Coronary Heart Disease: Many observational studies showed that obesity causes an increase in cardiovascular mortality and coronary heart disease.
• Respiratory System: Many serious respiratory disorders such as hypoventilation and obstructive sleep apnea syndrome may be seen in obesity.
• Polycystic Ovary Syndrome: Related to visceral obesity the production of testosterone is increased in obese individuals.
• Cancer: The frequency of some cancer types increases with obesity.
• Kidney Disease: Obesity has been found as an independent risk factor for kidney diseases in important epidemiological studies.

Insulin resistance and central obesity in pathogenesis of the metabolic syndrome which is characterized by the coexistence of factors that causes risk for cardiovascular diseases has important effects. Obesity, especially visceral obesity is effective as a primer in the high amount of lipolytic activity and pathogenesis of the metabolic syndrome with its released cytokines.

Maternal obesity is increasingly common in the World and it is a well-known risk factor for serious OBSTETRIC Complications including hypertensive disorders, GDM, THROMBOFLEVIT, urinary tract infection, birth abnormalities, invasive delivery, surgical delivery, surgical and anaesthetic complications, preterm delivery, fetal macrosomia, shoulder dystocia, and fetal death.

Gastric Cancer: Stomach cancers or thy name is gastric cancers are among the significant cancer types. Altough it occurs in the fourth frequency, it increased the second rank in deaths depending on cancer since being asymptomatic or having no specific symptoms.

Prostate Cancer: When the relationship between obesity and prostate cancer examined, it is found quite complicated results in literatüre. Some authors mentioned that the increase of risk with obesity while others state that decrease of risk.

Breast Cancer: Many studies that examine the relationship between breast cancer and obesity has been done since the 1970s. These studies generally emphasized that obesity is related to breast cancer in the postmenopausal period.

Thyroid Cancer: In a current study, it is detected that the LEPTIN level of the individuals that have papillary thyroid cancer is increased.

Gall Bladder Cancer: Gall bladder cancer has a quite poor prognosis and it is seen 4 times more in females than males. Generally, there is a gall bladder stone problem in the stories of patients. In the conducted researches, it is seen that individuals with metabolic syndrome are at risk in terms of gall bladder stone and gall bladder cancer.

Liver cancer: Cirrhosis, chronic hepatitis b and c infections using chronic ethanol, non-alcoholic steatohepatitis (NASH), aflatoxins B1 or other mycotoxins cause risk factors for liver cancer.

Kidney Cancer: In obese or overweight patients, a 1,5-2 times increase in the risk of renal cell cancer is detected.

Oesophagus Cancer: The mechanism of obesity that causes cancer in the oesophagus is attributed to the fact that the reflux formed the barret epithelium in the distal oesophagus.

In the studies about the relationship between cancer and obesity, the reason why obesity increases the cancer risk in other organs, and if exist its carcinogenic effect is being tried to be proven. Within this scope, a wide range of subjects that includes various hormones, cytokines, substances involved in signal transmission and energy metabolism are discussed in the researches.