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Obesity: Causes and Consequences

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Kaustubh Bora
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1st Issue:16 Nov., 2016

Obesiity: Causees and Coonsequencces

Dr. Kaustubh Bo
ora
Dept. of Biocchemistry, NEIGRIHM
N g – 793018,, Meghalaya (India)
MS, Shillong

“I guess I don’t so much

m mind being
b old ass Cau
uses of obesityy:
I mind being fat and old” – Benjaminn
Obessity is a muulti-factorial disorder, annd the
Franklin (1706 – 17990)
roless of both genes and environmental factors fa
Thus saidd one of thee greatest vissionaries andd are recognised.
r A
Although obessity tends to run
r in
founding fathers of thee United Statees of Americaa famiilies, indicatinng a hereditaary componennt, the
in the 18thh century AD D. It is said thhat at the timee classsical Mendeelian patternn of inheriitance
of his deaath, Franklinn, aged 84 yeears, weighedd (typiical of monnogenic disorders) is eluusive.
around 300 pounds. The world has changedd Genoome wide asssociation studdies (GWAS)) have
much sincce the times ofo Franklin. ButB describingg identtified a numbber of suscepptibility loci in i the
a person as ‘fat’ stiill carries thhe same oldd humman genome which
w are suppposedly assocciated
connotatioons and morre. This is because beingg withh obesity. How wever, by annd large, genees are
‘fat’ (which is the everryday term ass the lay mann now thought to set s only the stage and prrovide
knows itt) or ‘obesee’ (which is i the moree the backdrop,
b agaainst which thhe decisive effects
e
scientific term) is not only a cosm metic concernn are eventually
e drriven by the environmenta
e al and
but it is also one of the risk facttors to majorr behaavioural facttors. At thhe heart off the
health prooblems like heeart disease, diabetes,
d highh envirronmental annd behaviouraal factors are those
blood pressure and stro oke. Obesity is i a conditionn that influence dieet and physicaal activity. Obbesity
of excesssive fat depo osition in thee body to ann occuurs when a peerson regularrly consumes more
extent thaat it adversely
y affects healtth. The worldd calorries than neeeded. The exxcess caloriees are
continues to grow ‘fat’, so much soo that obesityy storeed in the bodyy as fat and manifest
m as obbesity.
is now prrevalent in paandemic propoortions. Oncee In thhat sense, obbesity can bee thought of as an
considered a malady of o affluent nattions, obesityy imbaalance betweeen energy intake i and energy
e
is now a major publiic health conncern even inn expeenditure. Althhough rather simplistic,
s yett most
developinng and underd developed couuntries. of thhe cases of obesity in the present times
confform to this view.
v Unhealtthy diets (viz. junk
This writte-up is an attempt to sensitize thee foodds high in refined grains, red meat, sugary
reader aboout the rising
g incidence of obesity andd drinkks, and unheealthy fats, etc.)
e and phyysical
its causees, summarizze the assocciated healthh inacttivity (sedenttary jobs, tellevision watcching,
problems and discusss the uniquee features off lack of physicaal exercise due d to increeasing
obesity inn the Indian context.
c A brrief outline off autom mation in all spheres of life, etc.), whicch are
the diffeerent measurres of obessity and thee typiccal of ‘urbanization’ and a the ‘mmodern
author’s opinion abo out perspectiives for thee lifesttyle’, have contributed
c enormously too this
future is also
a provided.. skewwed balance between ennergy intakee and
expeenditure, thuus facilitatingg the spreaad of
obessity. This sorrry situation iss often capturred by
the maxim “ppassive oveerconsumptionn of

 
 

energy”. Thus, now-a-days it is not uncommon increased low density-lipoprotein cholesterol,

to come across a multitude of children, increased triglycerides, increased very low
indulging in junk foods, video games and long density-lipoprotein cholesterol, decreased high
hours of television watching who are obese from density-lipoprotein cholesterol) which favour
a very tender age (described in medical parlance atherosclerotic changes on the walls of blood
by the term ‘childhood obesity’). vessels. Atherosclerosis constitutes the basic
pathology of hypertension and coronary heart
Having said that, it deserves mentioning that disease, and also a sizeable proportion of
there are some conditions where a well cerebrovascular diseases. Obesity (particularly
characterized genetic defect is the cause of central obesity) also has strong links with
obesity. However, such instances are rare, and diabetes mellitus (DM). Increased intra-
they are usually a part of some specific abdominal fat impairs insulin action. It promotes
syndrome (e.g. Prader-Willi syndrome, insulin resistance and predisposes to type 2
Laurence-Moon-Biedl syndrome, Cushing’s diabetes. In fact, central obesity is a major
syndrome, Ahlstrom syndrome, etc.). component for defining metabolic syndrome – a
Measures of obesity: clinical entity, characterized by the presence of
interrelated metabolic risk factors which
The extent of obesity may be measured using predispose the affected individual to
various techniques, such as bioelectrical cardiovascular disease (CVD), DM and
impedance, hydrostatic weighing, dual energy atherogenic dyslipidemia.
X-ray absorptiometry (DEXA), air-displacement
plethysmography, and so on. But the most Obesity may also be associated with respiratory
popular, convenient and inexpensive measures problems like ‘obstructive sleep apnea’ and
are perhaps the anthropometric measurements. ‘obesity hypoventilation syndrome’. Obese
Two indices are particularly noteworthy in this individuals generally exhibit reduced chest wall
regard – body mass index (BMI) and waist compliance, increased work of breathing,
circumference (WC). BMI, which provides a decreased total lung capacity and functional
measure of relative weight adjusted for height, residual capacity.
gives an estimate of leanness of the body and Obesity can impair the functioning of hepato-
thus reflects the extent of overall or generalized biliary system, as well. Obese individuals have a
obesity. On the other hand, WC is a measure of higher incidence of gall bladder stones,
central or abdominal obesity, which indicates the particularly cholesterol gallstones. Obese and
extent of visceral fat surrounding the internal overweight individuals are also at risk of
organs in the abdominal region around the waist. developing fatty changes in liver, a condition
termed non-alcoholic fatty liver disease
Health consequences of obesity:
(NAFLD). A healthy liver contains little or no
Obesity is a chronic medical condition. It can fat. NAFLD occurs when fat molecules
lead to several untoward health effects, accumulate inside liver cells, frequently a
involving different organ systems. Obesity is an consequence of obesity and excess fat tissue in
important risk factor for hypertension (high the abdomen. In advanced stages, NAFLD can
blood pressure), coronary heart disease lead to serious liver injury, including cirrhosis
(responsible for heart attacks) and (where the liver shrinks, becomes scarred and
cerebrovascular diseases (responsible for permanently damaged, subsequently causing
strokes). It is strongly linked with dyslipidemia liver failure).
or derangements in lipid profile (such as

 
 

Obesity is thought to increase the risk of cancer generalized obesity, abdominal obesity and
and cancer-associated mortality too. In males, combined (i.e. both generalized and abdominal)
this includes cancer of the oesophagus, colon, obesity, respectively. Further, a recent
rectum, pancreas, liver and prostrate; while in systematic review compiling data from 52
females it includes cancer of the gall bladder and studies available from 16 states of India
biliary tract, breasts, endometrium, cervix and revealed a combined prevalence of 19.3% for
ovaries. In addition, obesity can lead to childhood overweight and obesity (i.e. roughly
gynaecological problems like abnormal menses one in every 5 children). This is considerably
and infertility. higher than the earlier reported prevalence of
16% in 2001. This is of concern because
Further, obesity is associated with problems of childhood obesity is a precursor to obesity and
bones and joints like osteoarthritis and gout. It other associated disorders in adulthood.
can lead to skin problems as well, viz.
acanthosis nigricans (manifested by darkening These statistics aside, obesity in Indians has
and thickening of the skin folds on the neck, some peculiar features too. For instance, the
elbows and interphalangeal spaces), enhanced international cut-off points for anthropometric
friability of skin, and increased risk of fungal indices of obesity (BMI and WC) are not
infections. applicable for Indians and other south Asians
(Pakistani, Bangladeshi and Sri Lankans). The
To summarize, the adverse effects of obesity on recommended range for these indices in these
health are multiple. It can compromise the populations is much lower than Western
normal physiology of different organ systems populations (Table 1). This is because people
and produce far-reaching effects. from Indian subcontinent are prone to develop
obesity associated morbidities at lower levels of
Obesity – the Indian scenario:
BMI and WC values as compared to other ethnic
India is currently undergoing a major groups. Further, Indians also have an increased
epidemiological transition, where nutritional tendency to accumulate subcutaneous and intra-
deficiencies and infectious diseases, which were abdominal fat. Thus, Indians are at greater risk
once the dominant health problems, are now to develop obesity associated non-
being replaced by obesity and obesity associated communicable diseases like DM and CVD.
conditions like diabetes, CVD, etc., largely due Infamously dubbed as the ‘diabetes capital’ and
to demographic and lifestyle changes. ‘heart disease capital’ of the world, Indians tend
Improvements in sanitation, nutrition, infectious to deposit more fat in ectopic sites (e.g. liver) as
disease control and advances in critical care well. Thus, conditions like NAFLD are also
have led to an enhancement of overall life highly preponderant in Indians. Moreover even
expectancy. On the negative side though, these as neonates, Indian babies have smaller lean
improved standards of living have brought about mass, but higher abdominal obesity in
a detrimental shift towards inappropriate dietary comparison to Caucasian babies – a phenotype
patterns and a reduction of physical activities; referred to as ‘thin-fat Indian baby’.
hence the rising prevalence of obesity. The
trends are alarming. A recently conducted phase-
wise study by the Indian Council of Medical
research (ICMR) revealed very high prevalence
of both generalized and abdominal obesity.
Projections for the whole country indicated 135,
153 and 107 million individuals with
 
 

Obesity Cut-offs for Cut-offs for other changes, improved standards of living and easy
indices Asian Indians populations access to nutrition. In fact, studies in animal
models suggest that multigenerational
BMI Normal BMI: Normal BMI: 18.5 – undernutrition leads to foetal metabolic
(kg/m2) 18.0 – 22.9 24.9
programming such that subsequent nutrient
recuperation does not reverse these metabolic
Overweight: 23.0 Overweight: 25.0 –
– 24.9 29.9 changes, but increases the risk of obesity and
diabetes instead. Epigenetic modifications in
Obesity: > 25 Obesity: > 30 crucial positions of the genome are thought to
underlie these changes.
WC (cm) Abdominal Abdominal obesity:
obesity: males: > males: > 102, Future perspectives:
90, females: > 80 females: > 88
Future challenges to biomedical researchers
Table 1. Cut-offs for BMI and WC working on obesity are two-pronged. The first
challenge is to come up with an integrative
While heredity, environmental influences and understanding of the biological mechanisms
behavioural factors all seem to play important involved in obesity predisposition and causation.
roles and work in tandem in the Indian context, a Relevant lines of investigation in this context
comprehensive explanation for the same is include identifying susceptible genetic loci,
lacking. An interesting approach in that direction finding hitherto unknown environmental and
is examining the ‘thrifty genotype’ and ‘thrifty behavioural triggers, dissecting the gene-
phenotype’ hypotheses. The former attributes environmental interactions and relevant
the rising burden of obesity and diabetes to epigenetic changes, and characterizing the
thrifty genes, which enhanced chances of neurobiological regulation of appetite and
survival in the past when food supplies were caloric homeostasis completely. The second
scarce and intermittent, but have become challenge is developing effective strategies for
detrimental in the modern conditions of plentiful preventing and treating obesity. Although there
food and sedentary lifestyles. On the other hand, are a number of options for tackling obesity,
the ‘thrifty phenotype’ hypothesis subscribes to ranging from lifestyle management (dietary
the view that the seeds for obesity and modification and exercise), pharmacological
associated complications are sown right during agents and bariatric surgeries, the results are
the intra-uterine period. It suggests that foetal often disappointing. Thus, it is not unsurprising
undernutrition leads to persistent metabolic to find people relating to one another the
and/or structural changes in the developing experience of “gaining weight is so easy, but
foetus (foetal origins of disease) – a phenotype losing weight is so hard”. Exploring newer
that can sustain in the face of thrifty nutrition. avenues of obesity management (e.g. non-
Such a phenotype is advantageous if the exercise activity thermogenesis, shortly NEAT)
nutrition stays poor in the post-natal period, but is necessary. It is imperative that researchers,
leads to obesity, insulin resistance and diabetes physicians, policy-makers, and various stake-
if food supply is surplus. This proposition is holders join their hands and gear their efforts to
particularly attractive for the Indian scenario. address these challenges. With rapid
This is because people in the Indian urbanization and improved standards of living, it
subcontinent have faced famines and may be expected that the burden of obesity and
undernutrition for multiple generations in the the looming threat of its associated health
past, but now undergoing major lifestyle consequences will increase even further.

 
  

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