Understanding Obesity: Causes, Risks, and Treatment Options

Written By Adama Diarra, DO, FACP

What is Obesity?

Obesity is a complex medical condition where excess body fat negatively impacts a person's health. It’s not just about weight or appearance; obesity significantly increases the risk of developing a range of serious health conditions.

To understand obesity, we often use Body Mass Index (BMI) as a key measure. BMI is a simple calculation using a person’s height and weight. Here’s how it’s categorized:

  • Normal weight: BMI of 18.5 to 24.9

  • Overweight: BMI of 25 to 29.9

  • Obesity: BMI of 30 or higher

While BMI is a common tool, it doesn’t tell the whole story. Waist circumference and body fat percentage are also important in assessing obesity. For example, carrying excess fat around your abdomen can be particularly harmful, even if your BMI isn’t extremely high. Waist circumference greater than 40 inches for men and 35 inches for women indicates a higher risk of health complications associated with obesity.

What Causes Obesity?

While it may seem like an oversimplification of a complex socioeconomic and cultural issue, obesity occurs when the body consistently takes in more calories than it burns, leading to the accumulation of excess fat. Over millions of years of evolution, hormones (proteins secreted by glands into the bloodstream) and neurotransmitters (proteins released in the brain between nerve cells) have created biological pressures that make it easier to gain weight during times of excess and much harder to lose it and keep it off. In other words, it’s not just about overeating—several factors contribute to obesity:

1. Poor Diet

A diet high in processed foods, sugary drinks, and unhealthy fats can cause weight gain. These foods are often calorie-dense but lack essential nutrients.

2. Lack of Physical Activity

A sedentary lifestyle is a significant contributor to obesity. With modern conveniences and desk jobs, many people aren’t moving enough throughout the day, which leads to fewer calories being burned.

3. Genetics

Genetics play a role in obesity by influencing how your body stores fat and how efficiently it uses energy. While you can’t change your genes (yet), understanding this link can help guide your approach to managing weight.

4. Environmental Factors

Your surroundings can influence your eating habits and activity levels. For example, living in areas where healthy food options are limited, or where it’s difficult to exercise, can increase the risk of obesity.

5. Hormonal Imbalances

Hormones like leptin and insulin play a role in hunger, fat storage, and energy use. Conditions like hypothyroidism or polycystic ovary syndrome (PCOS) can make weight management more challenging. Next, Cortisol (a stress hormone) can also be a major factor leading to obesity. Another hormone that plays a major role in not only gaining weight but also regaining weight is Leptin. Leptin is a hormone produced by fat cells that helps regulate appetite and energy balance by signaling the brain when the body has enough stored fat. When you lose weight, leptin levels drop, leading to increased hunger and a slower metabolism, which makes it harder to maintain weight loss. This drop in leptin is one of the reasons why people often regain weight after dieting.

6. Emotional and Psychological Factors

For some, emotional stress, anxiety, or depression can lead to overeating or unhealthy food choices. Additionally, some individuals may use food as a way to cope with negative emotions, leading to weight gain.

Health Complications of Untreated Obesity

Obesity has far-reaching effects on almost every system in the body. Left untreated, it can lead to serious, life-threatening conditions. Here are a few key complications:

1. Heart Disease and Stroke

Obesity is a major risk factor for heart disease and stroke. The extra fat in your body raises cholesterol and blood pressure levels, which can lead to clogged arteries and poor heart function.

2. Type 2 Diabetes

Obesity is strongly linked to insulin resistance, which can eventually lead to type 2 diabetes. Excess fat, particularly around the abdomen, makes it harder for your body to use insulin effectively.

3. Joint Problems

Carrying extra weight puts a strain on your joints, particularly in the knees and hips. This can lead to osteoarthritis, which causes pain and limits mobility.

4. Sleep Apnea

People with obesity are at higher risk of developing sleep apnea, a condition where breathing repeatedly stops and starts during sleep. This can result in poor sleep quality, fatigue, and other health issues including dementia.

5. Liver Disease

Obesity can lead to non-alcoholic fatty liver disease (NAFLD), where excess fat builds up in the liver. Over time, this can lead to liver damage or scarring.

6. Cancer

Obesity increases the risk of several types of cancer, including breast, colon, and endometrial cancer. While the exact reasons are still being researched, inflammation caused by excess fat likely plays a role.

How to Manage and Treat Obesity

The good news is that obesity is treatable, and the earlier it’s addressed, the better the chances of avoiding complications. Each person’s treatment plan should be personalized, based on their unique circumstances, including genetics, lifestyle, and overall health.

1. Lifestyle-Based Management

Lifestyle changes are the first line of defense in managing obesity. These changes include:

Healthy Diet

Adopting a balanced, nutrient-rich diet is crucial. Focus on:

  • Whole foods: These include fruits, vegetables, lean proteins, whole grains, and healthy fats.

  • Portion control: Eating appropriate portions helps prevent overeating.

  • Limiting processed foods: Foods high in sugar and unhealthy fats should be avoided.

  • Mediterranean or plant-based diets: These diets have been shown to promote weight loss and reduce the risk of obesity-related complications (Salas-Salvadó et al., 2011).

Physical Activity

Regular exercise plays a crucial role in burning calories and improving overall health. Aim for at least 150 minutes of moderate physical activity per week, such as brisk walking, swimming, or cycling. Incorporating strength training can also help build muscle, which burns more calories even at rest.

Behavioral Therapy

Some patients benefit from behavioral therapy, which helps them identify emotional or environmental triggers for overeating. Working with a counselor or a weight management specialist can help develop healthier eating habits and coping strategies.

2. Medications for Obesity

For some individuals, lifestyle changes alone may not be enough to achieve significant weight loss. In these cases, medications can be prescribed to help with weight management. It’s important to understand that medications are typically used alongside lifestyle changes for the best results.

FDA-Approved Medications for Weight Loss

Several medications are currently approved in the U.S. to help manage obesity, including:

  • Orlistat (Alli, Xenical): This drug works by reducing the amount of fat your body absorbs from food. It’s typically recommended for patients who have trouble losing weight with diet and exercise alone.

  • Phentermine-Topiramate (Qsymia): This medication suppresses appetite and can help patients feel full on smaller amounts of food.

  • Liraglutide (Saxenda): Originally developed to treat type 2 diabetes, this medication helps regulate appetite and can lead to weight loss.

  • Semaglutide (Wegovy): Another GLP-1 receptor agonist, Semaglutide was recently approved for weight management and helps reduce appetite and food intake (Wilding et al., 2021).

  • Naltrexone-Bupropion (Contrave): This drug is a combination of two medications that work together to control appetite and reduce food cravings.

Medications are typically recommended for patients with a BMI over 30 or BMI over 27 with obesity-related conditions, such as diabetes or heart disease. It’s important to remember that not everyone is a candidate for weight loss medications, and the risks and benefits should be carefully considered with your healthcare provider.

Personalized Treatment Plans for Every Patient

It’s crucial to recognize that every patient is different. Some may achieve their goals through diet and exercise alone, while others may require additional support from medications or other interventions. Personalized care ensures that each treatment plan is tailored to fit the patient’s unique needs, health goals, and challenges.

Conclusion

Obesity is a serious but manageable condition. With early intervention, proper lifestyle changes, and medical treatments when necessary, patients can avoid the long-term complications of obesity. The key to success is personalized care—working with your healthcare provider to create a plan that’s right for you.

If you’re struggling with obesity, don’t wait for complications to arise. Talk to your healthcare provider today to discuss your treatment options and start taking control of your health.

References:

  • Salas-Salvadó, J., Bulló, M., Babio, N., Martínez-González, M. A., Ibarrola-Jurado, N., Basora, J., ... & Estruch, R. (2011). Reduction in the incidence of type 2 diabetes with the Mediterranean diet. Diabetes Care, 34(1), 14-19. https://doi.org/10.2337/dc10-1288

  • Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., ... & Semaglutide Treatment Effect in People with Obesity (STEP) Study Group. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989-1002. https://doi.org/10.1056/NEJMoa2032183