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A front and side view of a morbidly obese male torso. Stretch marks of the skin are visible along with gynecomastia.
What is it ?
   Obesity is a health problem ,with an excess of body fat that imparts health risks and adverse effect on health. Over 20% excess body weight over ideal weight for age,sex and height is considered as health risk .

What are the main causes of obesity ?
  Obesity results when intake of calories exceeds the normal limit( normal utilisation by the body ) .This can happen by the following ways -
  1. Overeating .
  2. Sedentary lifestyle and lack of activity .
  3. Genetic factors - recently, two obesity genes have been found : ob gene and its protein product leptin ;& db gene and its protein product leptin receptor .
  4. Fatty and carbohydrate rich diet than protein rich diet .
  5. Psychiatric illness - some physical and mental illnesses & the pharmaceutical substances used to treat them can increase the risk of obesity .
  6. Social status and factors .
  7. Some infectious agents like viruses ( not clearly understood; study is going on ) .
  8. Some diseases like hypothyroidism , Cushing's disease , insulinoma and hypothalamic disorders may result to secondary obesity .
How this disorder is classified ?
   Obesity can be classified and defined by the Body Mass Index( BMI ) and further evaluated in terms of fat distribution via the waist-hip ratio and total cardiovascular risk factors .
< 18.5underweight
18.5–24.9normal weight
30.0–34.9class I obesity
35.0–39.9class II obesity
≥ 40.0  class III obesity
Pathophysiology :
   Many hormonal mechanisms are involved in the regulation of appetite and food intake ,storage pattern of adipose tissues , and development of insulin resistance . Leptin , ghrelin , insulin , orexin , PYY 3-36 , CCK , adiponectin and adipokinins are the main regulators of obesity .Leptin and ghrelin are considered to be complementary in their influence on appetite . Ghrelin produced by the stomach modulating short term appetite control & leptin is produced by adipose tissues to signal fat storage reserves in the body , and mediates the long term appetite controls . They control appetite through their actions on the CNS . Deficiency in leptin signaling ,either via leptin deficiency or leptin resistance , leads to overeating and may account for some genetic and accuired forms of obesity .

Morphologic features :
1. Increased fat stores in the subcutaneous tissues, skeletal muscles, internal organs(like kidneys , liver and omentum ).
2. Increase in both size and number of fatty tissues ( hypertrophy and hyperplasia ) .

Changes that may occur in various medical aspects :
  1. Atherosclerosis
  2. Hypertension
  3. Type 2 diabetes mellitus
  4. Hyperlipoproteinaemia
  5. Fatty liver disease
  6. Cholelithiasis
  7. Hypoventilation syndrome
  8. High blood pressure
  9. Congestive heart faliure
  10. Ischemic heart diseases and angina
  11. Cellulitis
  12. Acanthosis
  13. Streach marks
  14. Complications during pregnancy
  15. Menstrual disorders
  16. Infertility
  17. Obstructive sleep apnoea
  18. Breast , ovarian , esophageal, liver , gall bladder , cervical, prostatic , kidney , pancreatic , endometrial - cancer .
  19. Depression
  20. Social stigmatization
Epidemiology :
A map of the world with countries colored to reflect the percentage of men who are obese. Obese males have higher prevalence (above 30%) in the U.S. and some Middle Eastern countries, medium prevalence in the rest of North America and Europe, and lower prevalence (<5%) in most of Asia and Africa.

World obesity prevalence among males
     <5%     5–10%     10–15%     15–20%     20–25%     25–30%
     30–35%     35–40%     40–45%     45–50%     50–55%     >55%
A map of the world with countries colored to reflect the percentage of women who are obese. Obese females have higher prevalence (above 30%) in the U.S. and some Middle Eastern countries, medium prevalence in the rest of North America and Europe, and lower prevalence (<5%) in most of Asia.

World obesity prevalence among females
     <5%     5–10%     10–15%     15–20%     20–25%     25–30%
     30–35%     35–40%     40–45%     45–50%     50–55%     >55%
   Before the 20th century, obesity was a rare medical complication; in 1997 the WHO formally recognized obesity as a global epidemic. As of 2005 the WHO estimates that at least 400 million adults (9.8%) are obese, with higher rates among women than men. The rate of obesity also increases with age at least up to 50 or 60 years old and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity. Once considered a problem only of high-income countries, obesity rates are rising worldwide and affecting both the developed and developing world. These increases have been felt most dramatically in urban settings. The only remaining region of the world where obesity is not common is sub-Saharan Africa .

The cardboard packaging of two medications used to treat obesity. Orlistat is shown above under the brand name Xenical in a white package with the Roche logo in the bottom right corner ( the Roche name within a hexagon). Sibutramine is below under the brand name Meridia. The package is white on the top and blue on the bottom separated by a measuring tape. The A of the Abbott Laboratories logo is on the bottom half of the package.
Management & treatment of obesity :
  1. Behavioural therapy and changing the sedentary lifestyle .
  2. Controlling the diet .
  3. Doing regular appropiate exercise .
  4. Medication - with orlistat or sibutramine by medical professionals .
  5. Bariatric surgery - as any surgical methods may have complications , surgury is only recommended for severely obese people ( BMI > 40 ) who have failed to lose weight following dietary modification and pharmacological treatment .
References :
  1. Robbons and Cotran's Pathologic basis of disease - Kumar , Abbass , Fausto ,9th edition
  2. Textbook Of Pathology - Harsh Mohan , 6th edition
  3. Harrison's Principles of Internal medicine , 13th edition
  4. en.wikipedia.org ( for text referances )
  5. www.wikimedia.org ( for images )
  6. National library of medicine(NLM), USA govt.
  7. Centres for Disease Control (CDC) , USA govt.
  8. Kushner, Robert (2007). Treatment of the Obese Patient (Contemporary Endocrinology). Totowa, NJ: Humana Press. pp. 158
  9. Kanazawa M, Yoshiike N, Osaka T, Numba Y, Zimmet P, Inoue S (December 2002). "Criteria and classification of obesity in Japan and Asia-Oceania". Asia Pac J Clin Nutr 11 Suppl 8: S732–S73

© 2019 by Partha Sarathi(Director)