Excessive Obesity - Epidemic of the 21st Century

Obesity constitutes a chronic disease characterized by excessive accumulation of adipose tissue in the body. It can manifest as a primary disorder (simple obesity) or as a complication of other diseases (secondary obesity). The classification of obesity is based on the BMI scale (body mass index), which divides it into several levels: level I – 30 to 34.9 kg/m2, level II – 35 to 39.9 kg/m2, level III – 40 to 49.9 kg/m2, extremely massive obesity – 50 to 59.9 kg/m2, and super extremely massive obesity – 60 kg/m2 and above. There is also another classification that takes into account the distribution of adipose tissue. Based on this, the following types of obesity can be distinguished: gynoid (hip and thigh) obesity, which is more common in women and is characterized by fat deposition in the hip, thigh, and buttock area, and android (abdominal) obesity, which is characterized by fat deposition in the abdominal area and upper body parts such as arms and neck. The latter is the most dangerous type of obesity, as fat accumulates around vital organs such as the liver, heart, pancreas, and diaphragm.

To determine obesity, the WHR (Waist-Hip Ratio) is often used, which determines not only the occurrence but also the type of obesity. It can be calculated by dividing the waist circumference by the hip circumference. Obesity is diagnosed when the WHR in women exceeds 0.7 and in men 0.9. Visceral obesity is recognized when the WHR in women is at least 0.85 and in men 1.0. On the other hand, gynoidal obesity occurs below these values. Another reliable indicator is the measurement of the body circumferences. If the waist circumference in men is more than 102 cm and in women more than 88 cm, it indicates abdominal obesity. Another diagnostic method is the measurement of the thickness of the skin-fat folds with a special device called a fold meter. The thickness of the fat layers can be measured, for example, on the triceps, thighs, under the shoulder blade, and around the navel. Based on this, the percentage of fat in the body can be roughly determined. A more advanced and accurate method, often used in nutritional counseling practices, is body composition analysis based on electrical bioimpedance (BIA). This is done with a specialized scale or device that has electrodes. As different body tissues conduct electricity to varying degrees, the current flowing through them can represent the amount of muscle, fat, bone, and other tissues. Obesity is usually diagnosed when the fat tissue in women exceeds 30% of body weight and in men 25%.

Overweight and obesity are two of the biggest health challenges of the 21st century. In the last 20 years, the number of people with overweight or obesity has tripled, resulting in serious health consequences. Europe and the United States have the highest rates of overweight and obesity, with more than half of the adults in Europe being overweight or obese. The statistics for children are particularly alarming, with approximately 20% of children in Europe having excess body mass, of which one-third are also obese. The situation in Poland is also concerning, with 51% of Poles being overweight and 17% being obese, mainly affecting men and older people. Poland has one of the highest rates of massive obesity, with an estimated 1.5 million people qualifying for bariatric surgery. The statistics for Polish children are also alarming, with over 15% of children and adolescents being overweight or obese. Given the alarming results, it is important to raise awareness about the problem of overweight and obesity and to combat it with prophylaxis, social campaigns, education of the youngest and their parents, providing children with access to healthy food in schools and kindergartens, and free dietary consultations in family clinics.

The disease is usually multifaceted. We can classify it as a genetic, environmental, psychological, and other problem. They are the most common problems for people with obesity. Not only are they genetic and environmental factors that play a role, but also psychological and hormonal aspects. The main cause of obesity is an excess of energy and food intake combined with insufficient physical activity. The main reason for the accumulation of excess fat is the dependence on sweets, snacks, soft drinks, and alcohol. It's not only what we eat, but also how we eat that affects our health and body composition. If we eat in a hurry or do not pay attention to our meals, our appetite can increase and we tend to eat more often. Obesity is statistically most common in developed countries where access to food is easy and food advertising is widespread, especially for children who are susceptible to their influence. Our modern life is very sedentary due to technological progress. There are also other problems such as a decrease in the quality of food due to the high content of preservatives, flavor enhancers, and food colorings. In addition to food and lifestyle factors, there are also indirect causes of obesity such as hormonal disorders (including hypothyroidism), congenital metabolic diseases, rare genetic syndromes, or drugs. There are also problems with appetite regulation, such as low leptin levels and high ghrelin levels. Leptin is a hormone produced by fat tissue that provides the brain with information about the energy status. Although people with obesity have higher leptin levels, their brain does not respond to it, which leads to a feeling of hunger and a desire to consume more calories. Insulin resistance is similar and causes problems with hyperglycemia and difficulties in losing weight. Ghrelin is called the hunger hormone because it is mainly produced in the stomach and leads to a constant feeling of hunger in people with obesity, regardless of whether they consume too many calories. Aging can also influence the development of obesity due to hormonal changes that increase the tendency towards obesity. In men, the testosterone level decreases with age, which leads to a loss of muscle mass. In women, hormonal changes (estrogens) can slow down the metabolism. Stress, toxins, and lack of sleep can also contribute to the development of obesity as they lower the leptin level and increase the ghrelin and cortisol levels, which lead to a stronger feeling of hunger. Psychological aspects also play a role in the development of obesity as eating can help to cope with stress and improve mood, as after eating snacks endorphins are released. Sweets strongly stimulate the areas of the brain responsible for pleasure and reward, which leads to a food addiction.

A diet for an obese person, like with other conditions, should be selected individually. Although energy balance is important, it does not always make sense to count calories. The body is a complex machine, therefore many aspects should be taken into consideration when losing weight. However, there are a few principles that can be useful. First of all, a diet should be rich in vitamins and minerals, high-quality protein, various types of fatty acids in the right proportion, and a significant amount of water-soluble fiber from vegetables and fruits. It is best to process food as little as possible and read labels on packaging carefully. Another rule is to reduce the number of meals and extend the breaks between them. The popular saying about consuming five meals a day is not always effective. Although metabolism accelerates after a meal, glucose and insulin levels also rise, and insulin is a hormone that promotes energy storage. Scientific studies have shown that people who eat less frequently are less hungry and have lower blood sugar levels. Some nutrition systems, such as intermittent fasting and the ketogenic diet, fit into this model and can be an alternative to conventional diets for many people. Intermittent fasting involves eating meals only within a certain time frame, known as the feeding window. The ketogenic diet is based on a significant restriction of carbohydrates, with energy obtained mainly from fat and protein. The basis of nutrition should be vegetables (the more, the better). A universal rule is also the restriction of simple sugars in favor of complex carbohydrates. Sweets should be avoided, as well as juices, sweet drinks, white bread, and pastries. Instead, you can introduce whole-grain products, oatmeal, cereals, rice, or sweet potatoes. Protein sources are fish and seafood, eggs, meat, and to a lesser extent legumes. The quality of fats is also very important. There is usually a lack of anti-inflammatory omega-3 fatty acids and an excess of pro-inflammatory omega-6 fatty acids. The best sources of omega-3 fatty acids (EPA and DHA) are fatty fish and cod liver oil. For heat treatment, coconut oil, clarified butter, or lard are suitable. For cold dishes such as salads and raw vegetables - native olive oil, linseed oil, rapeseed oil, camelina oil, or black cumin oil. Avoid margarine and oils in plastic bottles. It is also important to remember that the body needs water. Often we feel hungry, although our body actually demands water.

A single dietary change or introduction of physical activity often does not yield the desired results. Only a comprehensive approach to the problem of obesity can bring lasting success. Therefore, therapy should be conducted under the supervision of a doctor, dietitian, trainer, physical therapist, and psychologist. What can you do on your own to increase your chances of losing unnecessary kilograms? Certainly, you should get proper rest, limit toxins (e.g. choose toothpaste without fluoride instead of aluminum foil), and get friendly with the cold. Cold therapy has many proven benefits, including improving circulation and increasing the amount of brown adipose tissue (BAT) in the body, which increases energy expenditure and helps reduce white adipose tissue (WAT). Another important issue is gut microflora. Research has shown that an imbalance in the gut microbiota can increase the risk of obesity, especially when the ratio of Bacteroides bacteria to Firmicutes bacteria is disrupted. Microorganisms play a role in digesting nutrients, regulating the absorption of cholesterol and carbohydrates, and producing short-chain fatty acids that nourish the intestinal mucosa. Overweight people usually have a deficiency of health-promoting bacterial strains and an overgrowth of pathogenic bacteria and yeast. Therefore, it is important to restore the balance of gut microbiota, e.g. by taking probiotics and prebiotics.

Untreated obesity can lead to serious health consequences. Many of these complications are associated with cardiovascular diseases, such as hypertension, atherosclerosis, varicose veins, coronary artery disease, myocardial infarction, and stroke. Particularly dangerous is an excess of visceral fat tissue, which usually results in insulin resistance and type 2 diabetes. It can also cause gallstones, fatty liver disease, gastroesophageal reflux disease, and respiratory problems, such as sleep apnea and asthma. Obesity also increases the risk of oncological changes, such as colorectal cancer, gallbladder cancer, pancreatic cancer, liver cancer, endometrial cancer, breast cancer, and ovarian cancer. Fat tissue also has endocrine functions, so an excess can cause hormonal disturbances, such as fertility problems. Adipose individuals often have a deficiency of calcium and vitamin D, which can lead to osteoporosis. Additionally, a high body weight can lead to damage to the joints of the hip, knee, and spine, which can lead to disabilities. Obesity is not only a physical problem, but also a psychological one. The disease can make functioning in society difficult, leading to feelings of isolation, limitations in professional activity, or loss of social contacts. It can also lead to depression, guilt feelings, and anxiety disorders. The treatment of obesity complications is costly, which makes the situation even more difficult.

Obesity presents as a highly complex health issue that is increasingly becoming a prevalent challenge. To curtail this spreading issue, emphasis must be placed on prevention. By understanding the factors contributing to obesity, we can endeavor to eradicate those within our control. If we are already dealing with this disease, treatment should be holistic, necessitating that we maintain a suitable lifestyle - proper diet, sleep, physical activity, stress management, reduction of toxins, and restoration of gut flora balance.