Obesity-associated morbidity

Obesity has a number of medical complications which negatively impact peoples' quality of life and are costly to treat.

Gynecomastia as seen in an obese male.

Whether or not obesity should be considered a disease on its own, it is also an important risk factor for many chronic physical and mental illnesses. The generally accepted view is that being overweight causes similar health problems to obesity, but to a lesser degree.

Cardiological

Ischemic heart disease

Obesity is associated with cardiovascular diseases including angina and myocardial infarction. A 2002 report concluded that 21% of ischemic heart disease is due to obesity while a 2008 European consensus puts the number at 35%.

Congestive heart failure

Having a BMI greater than 30 doubles one's risk of congestive heart failure.

High blood pressure

More than 85% of those with hypertension have a BMI greater than 25. The risk of hypertension is 5 times higher in the obese as compared to those of normal weight. A definitive link between obesity and hypertension has been found using animal and clinical studies, which have suggested that there are multiple potential mechanisms for obesity-induced hypertension. These mechanisms include the activation of the sympathetic nervous system as well as the activation of the renin–angiotensin-aldosterone system. The association between hypertension and obesity has been also well described in children.

Abnormal cholesterol levels

Obesity is associated with increased LDL cholesterol (bad cholesterol) and lowered HDL cholesterol (good cholesterol).

Deep vein thrombosis and pulmonary embolism

Obesity increases one's risk of venous thromboembolism by 2.3 fold.

Dermatological

Stretch marks on the abdomen.

Obesity is associated with the incidence of stretch marks, acanthosis nigricans, lymphedema, cellulitis, hirsutism, and intertrigo.

Endocrine

Diabetes mellitus

One of the strongest links between obesity and disease is that with type 2 diabetes. These two conditions are so strongly linked that researchers in the 1970s started calling it “diabesity”. Excess weight is behind 64% of cases of diabetes in men and 77% of cases in women.

Reproductive system

Polycystic ovarian syndrome (PCOS)

Due to its association with insulin resistance, the risk of PCOS increases with adiposity. In the US approximately 60% of patients with PCOS have a BMI greater than 30.

Infertility

Obesity leads to infertility in both men and women. This is primarily due to excess estrogen interfering with normal ovulation in women and altering spermatogenesis in men. It is believed to cause 6% of primary infertility. A review in 2013 came to the result that obesity increases the risk of oligospermia and azoospermia in men, with an of odds ratio 1.3. Being morbidly obese increases the odds ratio to 2.0.

Complications of pregnancy

Obesity is related to many complications in pregnancy including: haemorrhage, infection, increased hospital stays for the mother, and increased NICU requirements for the infant. Obese women have more than twice the rate of C-sections compared to women of normal weight. Obese women also have increased risk of preterm births and low birth weight infants.

Birth defects

Those who are obese during pregnancy have a greater risk of have a child with a number of congenital malformations including: neural tube defects such as anencephaly and spina bifida, cardiovascular anomalies, including septal anomalies, cleft lip and palate, anorectal malformation, limb reduction anomalies, and hydrocephaly.

Intrauterine fetal death

Maternal obesity is associated with an increased risk of intrauterine fetal death.

Gastrointestinal

Gastroesophageal reflux disease

Several studies have show that the frequency and severity of GERD symptoms are higher in those who are obese.

Neurological

Stroke

Ischemic stroke is increased in both men and women who are obese.

Dementia

Those who are obese have a rate of dementia 1.4 times greater than those of normal weight.

Multiple sclerosis

Women that are obese at age 18 have a greater than twofold increased risk of MS.

Oncological

Many cancers occur at increased frequency in those who are overweight or obese. A study from the United Kingdom found that approximately 5% of cancer is due to excess weight. These cancers include:

• breast, ovarian
• esophageal, colorectal
• liver, pancreatic
• gallbladder, stomach
• endometrial, cervical
• prostate, kidney
• non-Hodgkin's lymphoma, multiple myeloma

Al high body mass index (BMI) is associated with a higher risk of developing ten common cancers including 41% of uterine cancers and at least 10% of gallbladder, kidney, liver and colon cancers in the UK.

Psychiatric

Depression

File:Relationship between bmi and suicide.png

Risk of suicide decreases with increased body mass index in the United States.

Obesity has been associated with depression. The relationship is strongest in those who are more severely obese, those who are younger, and in women. Suicide rate however decreases with increased BMI.

Social stigmatization

In the United States, young women who are overweight complete 0.3 year less school, are 20% less likely to get married, and make $6,710 less than their normal weight counterparts.

Respirological

Obstructive sleep apnea

Obesity is a risk factor for obstructive sleep apnea.

Obesity hypoventilation syndrome

CPAP machine commonly used in OHS

Obesity hypoventilation syndrome is defined as the combination of obesity, hypoxia during sleep, and hypercapnia during the day, resulting from hypoventilation. Based on its definition it occurs only in the obese.

Chronic lung disease

Obesity is associated with a number of chronic lung diseases, including asthma and COPD. It is believed that a systemic pro-inflammatory state induced by some causes of obesity may contribute to airway inflammation, leading to asthma.

Rheumatological and orthopedic

Gout

Compared to men with a BMI of 21–23, men with a BMI of 30–35 have 2.3 times more gout, and men with a BMI of greater than 35 have 3.0 times more gout. Weight loss decreases these risks.

Poor mobility

There is a strong association between obesity and musculoskeletal pain and disability

Osteoarthritis

Increased rates of arthritis are seen in both weight-bearing and non-weight-bearing joints. Those with a BMI greater than 26.4 had rate of osteoarthritis of the knees 6 times greater than those with a BMI of less than 23.4, well rates of osteoarthritis in the hand was about 1.5 times greater.

Low back pain

Obese individuals are twice to four times more likely to have lower back pain than their normal weight peers.

Urological and nephrological

Erectile dysfunction

One third of obese men with erectile dysfunction who lose weight experience an improvement in their sexual functioning.

Urinary incontinence

Urge, stress, and mixed incontinence all occur at higher rates in the obese. The rates are about double that found in the normal weight population. Urinary incontinence improves with weight lost.

Chronic renal failure

Obesity increases one's risk of renal failure by three to four times.