INTRODUCTION–
Now a days obesity is not only an individual or a social issue alone along with cosmetic nuisance but it also plays a major role in various health issues and early death due to different systemic problems. Overall, it possesses as metabolic disorder which threatens one’s life in multiple ways as once a person become obese it becomes very difficult to bring back the non-obese state even after diet or exercises, so it is very important to check it before it creates major health issues for an individual.
MEDICAL DEFINITION-
In medical terminology it is defined as body weight over height. For an individual waist-to-hip ratio should not exceed 0.8.
BMI (Body mass index) for calculation is as follows-
Normal BMI (fit)- Between 18.5 and 24.9
Underweight BMI- > Below 18.5
Overweight BMI- Between 25-29.9.
Obese BMI- Between 30-35.
Morbidly obese BMI – Over 35.
AETIOLOGY AND RISK FACTORS-
Pregnant lady environment contributes towards obesity in foetus as it is considered a metabolic disorder in particular.
Condition named ‘foetal macrosomia’ is observed in pregnancy in women having conditions like-
1)Over- nutrition (intake of higher calories than needed and lack of adequate activity which leads to over-
2)Glucose intolerance.
3)Diabetes, etc.
This condition and its metabolic changes during pregnancy persists throughout the baby life till adulthood which results into obese individual and issues of overweight in general.
OTHER FACTORS ARE AS FOLLOWS-
1)LIFESTYLE – In today’s scenario where we live in a technology driven world where physical needs for so many activities are now dependent on various gadgets in sort luxurious life style where physical activity is least required as compared to previous generations.
Today’s lifestyle is less demanding on physical plain which means the calorie consumption must be regulated otherwise it can lead to obesity in long run.
2) GENETIC INDISPOSITION- In some cases where there is history of obesity runs in family then individual tends to grow fat which is not easy to be managed since childhood and adolescence which shows the genetic indisposition.
3)PRE-PREGNANCY WEIGHT- When a women is already Overweight mothers gain more
weight than normal women during pregnancy. They
also retain increased weight gain postpartum, and put
on some extra pounds or so following each delivery;
multiparae therefore tend to be overweight compared to
primis and those with lesser pregnancies.
4)AT MENOPAUSE- Hormonal changes and low metabolic rate acts as factor to gain weight after menopause in women.
5)DIETRY HABITS- Fast food, oily and high fat diet as well as irregular diet pattern, overeating is one of the contributing factor of obesity in all.
6) DISEASES-Many systemic diseases leads to obesity in many cases such as hypothyroidism, etc.
7)MEDICATIONS USAGE-Side effects of many drugs also leads to obesity in women especially in cases of regular hormonal contraceptives, etc
8)OTHERS- Modern lifestyle which is sedentary and lacks active physical activities, improper diet pattern, lack of sleep or irregular circadian rhythm , etc.
PATHOPHYSIOLOGY–
In human body bones make up around 12 %, muscles 35%, fats 27% and rest composed of organs, blood and body fluids.
In females as compared to males there is indisposition to accumulate abdominal fat more than hips area. These abdominal and visceral fat are linked to many diseases in adulthood.
Role of hormone ‘’leptin’’ (167 amino acid protein released from adipocytes in the fat) is established in cases of obesity as this influences the hypothalamus regarding appetite. It is directly proportional to fat accumulation which means high leptin level leads to high fat accumulation.
Other factors which regulate its secretion is regulated by insulin which stimulates its production in body. During pregnancy in some women develop insulin resistance and hyperinsulinemia which triggers the release of leptin in large amount which in turns leads to excessive weight gain during pregnancy and retention during postpartum.
CLINICAL FEATURES-
1)Age- In females two phases of life – pregnancy and menopause are linked to obesity.
2)Parity- In comparison to primiparous it is more common in multiparous women.
3) Family history- In this genetic disposition also plays an important role in obesity, it means it is more likely to affect those who have family history in compared to others.
4)Innate- some women are overweight since birth not acquired later in lifetime.
COMPLICATIONS AND SEQUELAE-
1)Cases of precocious puberty (reduction in overall height) is common in those who suffers from obesity in their adolescence.
2) Disorders of menstruation are more common due to various hormonal and metabolic dysfunction.
3)PCOS (Polycystic ovarian syndrome) which leads to anovulatory infertility.
5) Low rate of IVF success in obese women.
6) Gynaecological cancers namely of Breast, uterus, cervix, etc. affects more to obese women than in lean women.
7) Urinary complaints in form of stress incontinence of urine is more common to overweight women, as well as UTI (bacterial as well as fungal ) affects more to them than lean women.
8) Obesity always comes with the basket of disease and obese women tends to suffer in their lifetime, some common health issues which every obese woman suffers are as follows-
a) Stone complaints – Most commonly ‘Cholelithiasis’
b) Hyperlipidaemia (abnormal high level of any or all lipids or lipoprotein in blood of an individual which also act as precursor of cardiovascular disease in many obese cases leading to stroke, MI, etc.
c)Respiratory system is affected, suffers from difficulty in breathing, pulmonary embolism, asthma, etc.
d) Irregularities in sleep pattern, insomnia, etc.
e) Diabetes type 2
10) In a obese patient during surgery it is very difficult to procure a vein for various IV procedure needed during and post op procedure.
11)Many surgeries like laparoscopic is very difficult in obese patients , also postoperative complications (ex- scar, hernia, infection, poor wound healing, etc.) are more common to obese than in a normal weight patients.
13)During Pregnancy-
a) PIH (Pregnancy induced hypertension), gestational diabetes, insulin resistance is more reported in obese women.
b) Incidence of macrosomic babies which leads to foetal distress, cephalopelvic disproportion as well as higher chances of caesarean section is present due to such complications.
14)After Pregnancy (Post partum) –
a)Weight gain during pregnancy is hard to shed after baby is born
b)Post partum depression is seen .
c)Lactation issues – Lack of milk production in obese women which leads to poor lactation and baby is feed through bottle which increases chances of obesity in new born.
15) Family planning – Hormonal contraceptive pills are contraindicated in already obese women.
16)Others- Many functional limitations, day to day life struggle due to obesity is seen in women.
MANAGEMENT–
It includes both-
1)Diet
2)Prophylaxis/Prevention.
3)Treatment.
1)Diet-
Proper balanced diet is very important to maintain the normal weight and to avoid unnecessary weight gain. Daily intake of calorie of an average adult is 1800-2000 is optimum but it also depends on gender, height, age , etc, which should be maintained and should be consumed if taken extra in any case to avoid extra gain of weight. High fibre diet is highly recommended as it delays absorption and lowers glucose levels in body. Carbs with low glycaemic index and proteins with amino acids are to be included in diet.
2)Prevention-
It is very important to prevent obesity as reduction is very difficult in many cases in comparison to prevention, it involves-
1)Exercise and different life style changes-
As per expert advices different yoga techniques, meditation and exercises are prescribed but it is never recommended to reduce weight hastily (weight loss 1 pound means around 450gms per week is safe).Healthy life style adaptation by incorporating yoga, pranayama, other regular exercises in daily routine yield better results and helps individual to remain under normal body weight and avoid obesity and its complications in long run.
2)Preparation of pregnancy-
During Antenatal care and also those women who are planning to have a baby are monitored-
a)Already obese women is asked to maintain their weight under the range of normal height – weight chart and then plan a baby , so as to avoid unwanted complications during and after pregnancy.
b)During antenatal care weight gain is monitored and it should be under limits of a healthy pregnancy.
c) Post partum weight loss is also checked and as most of the women return to their pre-pregnancy weight at the end of 3 months after delivery. If it is not observe then with the help of counsellor and healthcare professional diet and exercise should be started for healthy weight loss during lactation period.
d) Breast feeding is very important for mothers and baby both as it helps in preventing obesity in infants and thus prevents its complications in future life and at the same time it helps mother to maintain body weight in most natural and healthy way.
All these must be applied in practice and awareness among women so as to avoid unnecessary health complications and for life long health benefits.
3)Treatment-
It includes drug line as well as surgical treatment-
It includes lipase inhibitors group of drugs which prevents absorption of fat from intestinal tract. These drugs also induce several side effects too in the form of fatigue, depression some drugs also causes prevention of fat – soluble vitamins from diet,also loss of appetite in many cases.
When medicinal approach does not work, surgery is prescribed in severe cases which is fatal to health of the individual, it is classified as –
1)Bariatric lipectomy.
2) Laparoscopic adjustable gastric band surgery (Lap band).
3)Bypass surgery.
Along with drugs and surgery,in many cases Gene therapy is proved beneficial to prevent obesity .
It must be kept in mind obesity needs a holistic approach in its treatment as it is very important to treat as well as prevent it from recurrence too in almost all the cases.
Contributor- Dr. Apurva Varangi
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