Obesity natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Complications

Health consequences can be categorized by the effects of increased fat mass (osteoarthritis, obstructive sleep apnea, social stigmatization) or by the increased number of fat cells (diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease).[1][2] Increases in body fat alter the body's response to insulin, potentially leading to insulin resistance. Increased fat also creates a proinflammatory state, increasing the risk of thrombosis.[2]

Medical field Condition Medical field Condition
Cardiology Dermatology
Endocrinology and Reproductive medicine Gastrointestinal
Neurology Oncology[13]
Psychiatry Respirology
Rheumatology and Orthopedics Urology and Nephrology

Prognosis

Excessive body weight is associated with various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, obstructive sleep apnea, certain types of cancer, and osteoarthritis.[1] As a result, obesity has been found to reduce life expectancy.[1]

Morbidity

Obesity increases the risk of many physical and mental conditions. These comorbidities are reflected predominantly in metabolic syndrome.[1] Metabolic syndrome being a combination of medical disorders, which includes diabetes mellitus type 2, high blood pressure, high blood cholesterol, and high triglyceride levels.[23]

Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a sedentary lifestyle. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with type 2 diabetes. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.[24]

Mortality

Obesity is one of the leading preventable causes of death worldwide.[25] [26][27] Large scale American and European studies have found that mortality risk varies with BMI; the lowest risk is found at a BMI of 22.5–25 kg/m2[28] in non smokers and at a BMI of 24–27 kg/m2 in current smokers and increases with changes in either direction.[29][30] Obesity increases the risk of death in current and former smokers as well as in those who have never smoked.[30] A BMI of over 32 has been associated with a doubled mortality rate among women over a 16-year period[31] and obesity is estimated to cause an excess 111,909 to 365,000 death per year in the United States.[27][1] Obesity on average reduces life expectancy by six to seven years.[32][1] A BMI of 30–35 reduces life expectancy by two to four years[28] while severe obesity (BMI > 40) reduces life expectancy by 20 years for men and five years for women.

Obesity Survival Paradox

Although the negative health consequences of obesity in the general population are well supported by the available evidence, health outcomes in certain subgroups seem to be improved at an increased BMI, a phenomenon known as the obesity survival paradox.[33] The paradox was first described in 1999 in overweight and obese people undergoing hemodialysis,[33] and has subsequently been found in those with heart failure, and peripheral artery disease (PAD).[34]

In people with heart failure, those with a BMI between 30.0–34.9 had lower mortality then those with a normal weight. This has been attributed to the fact that people often lose weight as they become progressively more ill.[35] Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, risk of further events is increased.[36][37] Even after cardiac bypass surgery, no increase in mortality is seen in the overweight and obese.[38] One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event.[39] Another found that if one takes into account chronic obstructive pulmonary disease (COPD) in those with PAD the benefit of obesity no longer exsists.[34]

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 Haslam DW, James WP (2005). "Obesity". Lancet. 366 (9492): 1197–209. doi:10.1016/S0140-6736(05)67483-1. PMID 16198769.
  2. ↑ 2.0 2.1 Bray GA (2004). "Medical consequences of obesity". J. Clin. Endocrinol. Metab. 89 (6): 2583–9. doi:10.1210/jc.2004-0535. PMID 15181027.
  3. ↑ Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ (2007). "Obesity and thrombosis". Eur J Vasc Endovasc Surg. 33 (2): 223–33. doi:10.1016/j.ejvs.2006.10.006. PMID 17185009. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Yosipovitch G, DeVore A, Dawn A (2007). "Obesity and the skin: skin physiology and skin manifestations of obesity". J. Am. Acad. Dermatol. 56 (6): 901–16, quiz 917–20. doi:10.1016/j.jaad.2006.12.004. PMID 17504714. Unknown parameter |month= ignored (help)
  5. ↑ Hahler B (2006). "An overview of dermatological conditions commonly associated with the obese patient". Ostomy Wound Manage. 52 (6): 34–6, 38, 40 passim. PMID 16799182. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 6.2 Arendas K, Qiu Q, Gruslin A (2008). "Obesity in pregnancy: pre-conceptional to postpartum consequences". J Obstet Gynaecol Can. 30 (6): 477–88. PMID 18611299. Unknown parameter |month= ignored (help)
  7. ↑ Anand G, Katz PO (2008). "Gastroesophageal reflux disease and obesity". Rev Gastroenterol Disord. 8 (4): 233–9. PMID 19107097.
  8. ↑ Harney D, Patijn J (2007). "Meralgia paresthetica: diagnosis and management strategies". Pain Med. 8 (8): 669–77. doi:10.1111/j.1526-4637.2006.00227.x. PMID 18028045.
  9. ↑ Bigal ME, Lipton RB (2008). "Obesity and chronic daily headache". Curr Pain Headache Rep. 12 (1): 56–61. doi:10.1007/s11916-008-0011-8. PMID 18417025. Unknown parameter |month= ignored (help)
  10. ↑ Sharifi-Mollayousefi A, Yazdchi-Marandi M, Ayramlou H; et al. (2008). "Assessment of body mass index and hand anthropometric measurements as independent risk factors for carpal tunnel syndrome". Folia Morphol. (Warsz). 67 (1): 36–42. PMID 18335412. Unknown parameter |month= ignored (help)
  11. ↑ Beydoun MA, Beydoun HA, Wang Y (2008). "Obesity and central obesity as risk factors for incident dementia and its subtypes: A systematic review and meta-analysis". Obes Rev. 9 (3): 204–18. doi:10.1111/j.1467-789X.2008.00473.x. PMID 18331422. Unknown parameter |month= ignored (help)
  12. ↑ Wall M (2008). "Idiopathic intracranial hypertension (pseudotumor cerebri)". Curr Neurol Neurosci Rep. 8 (2): 87–93. doi:10.1007/s11910-008-0015-0. PMID 18460275. Unknown parameter |month= ignored (help)
  13. ↑ Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003). "Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults". N. Engl. J. Med. 348 (17): 1625–38. doi:10.1056/NEJMoa021423. PMID 12711737. Unknown parameter |month= ignored (help)
  14. ↑ 14.0 14.1 14.2 Poulain M, Doucet M, Major GC; et al. (2006). "The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies". CMAJ. 174 (9): 1293–9. doi:10.1503/cmaj.051299. PMC 1435949. PMID 16636330. Unknown parameter |month= ignored (help)
  15. ↑ Adams JP, Murphy PG (2000). "Obesity in anaesthesia and intensive care". Br J Anaesth. 85 (1): 91–108. doi:10.1093/bja/85.1.91. PMID 10927998. Unknown parameter |month= ignored (help)
  16. ↑ Choi HK, Atkinson K, Karlson EW, Curhan G (2005). "Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study". Arch. Intern. Med. 165 (7): 742–8. doi:10.1001/archinte.165.7.742. PMID 15824292. Unknown parameter |month= ignored (help)
  17. ↑ Tukker A, Visscher T, Picavet H (2008). "Overweight and health problems of the lower extremities: osteoarthritis, pain and disability". Public Health Nutr: 1–10. doi:10.1017/S1368980008002103. PMID 18426630. Unknown parameter |month= ignored (help)
  18. ↑ Molenaar EA, Numans ME, van Ameijden EJ, Grobbee DE (2008). "[Considerable comorbidity in overweight adults: results from the Utrecht Health Project]". Ned Tijdschr Geneeskd (in Dutch; Flemish). 152 (45): 2457–63. PMID 19051798. Unknown parameter |month= ignored (help)
  19. ↑ Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D'Andrea F, D'Armiento M, Giugliano D (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA. 291 (24): 2978–84. doi:10.1001/jama.291.24.2978. PMID 15213209.
  20. ↑ Hunskaar S (2008). "A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women". Neurourol. Urodyn. 27 (8): 749–57. doi:10.1002/nau.20635. PMID 18951445.
  21. ↑ Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O (2006). "Obesity and risk for chronic renal failure". J. Am. Soc. Nephrol. 17 (6): 1695–702. doi:10.1681/ASN.2005060638. PMID 16641153.
  22. ↑ Makhsida N, Shah J, Yan G, Fisch H, Shabsigh R (2005). "Hypogonadism and metabolic syndrome: Implications for testosterone therapy". J. Urol. 174 (3): 827–34. doi:10.1097/01.ju.0000169490.78443.59. PMID 16093964. Unknown parameter |month= ignored (help)
  23. ↑ Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab. 89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029.
  24. ↑ Seidell 2005 p.9
  25. ↑ Barness LA, Opitz JM, Gilbert-Barness E (2007). "Obesity: genetic, molecular, and environmental aspects". Am. J. Med. Genet. A. 143A (24): 3016–34. doi:10.1002/ajmg.a.32035. PMID 18000969. Unknown parameter |month= ignored (help)
  26. ↑ Mokdad AH, Marks JS, Stroup DF, Gerberding JL (2004). "Actual causes of death in the United States, 2000" (PDF). JAMA. 291 (10): 1238–45. doi:10.1001/jama.291.10.1238. PMID 15010446. Unknown parameter |month= ignored (help)
  27. ↑ 27.0 27.1 Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB (1999). "Annual deaths attributable to obesity in the United States". JAMA. 282 (16): 1530–8. doi:10.1001/jama.282.16.1530. PMID 10546692. Unknown parameter |month= ignored (help)
  28. ↑ 28.0 28.1 Whitlock G, Lewington S, Sherliker P; et al. (2009). "Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies". Lancet. 373 (9669): 1083–96. doi:10.1016/S0140-6736(09)60318-4. PMID 19299006. Unknown parameter |month= ignored (help)
  29. ↑ Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW (1999). "Body-mass index and mortality in a prospective cohort of U.S. adults". N. Engl. J. Med. 341 (15): 1097–105. doi:10.1056/NEJM199910073411501. PMID 10511607. Unknown parameter |month= ignored (help)
  30. ↑ 30.0 30.1 Pischon T, Boeing H, Hoffmann K; et al. (2008). "General and abdominal adiposity and risk of death in Europe". N. Engl. J. Med. 359 (20): 2105–20. doi:10.1056/NEJMoa0801891. PMID 19005195. Unknown parameter |month= ignored (help)
  31. ↑ Manson JE, Willett WC, Stampfer MJ; et al. (1995). "Body weight and mortality among women". N. Engl. J. Med. 333 (11): 677–85. doi:10.1056/NEJM199509143331101. PMID 7637744.
  32. ↑ Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L (2003). "Obesity in adulthood and its consequences for life expectancy: A life-table analysis" (PDF). Ann. Intern. Med. 138 (1): 24–32. PMID 12513041. Unknown parameter |month= ignored (help)
  33. ↑ 33.0 33.1 Schmidt DS, Salahudeen AK (2007). "Obesity-survival paradox-still a controversy?". Semin Dial. 20 (6): 486–92. doi:10.1111/j.1525-139X.2007.00349.x. PMID 17991192.
  34. ↑ 34.0 34.1 "Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale". Am Fam Physician. 67 (12): 2573–6. 2003. PMID 12825847. Unknown parameter |month= ignored (help)
  35. ↑ Habbu A, Lakkis NM, Dokainish H (2006). "The obesity paradox: Fact or fiction?". Am. J. Cardiol. 98 (7): 944–8. doi:10.1016/j.amjcard.2006.04.039. PMID 16996880. Unknown parameter |month= ignored (help)
  36. ↑ Romero-Corral A, Montori VM, Somers VK; et al. (2006). "Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies". Lancet. 368 (9536): 666–78. doi:10.1016/S0140-6736(06)69251-9. PMID 16920472.
  37. ↑ Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA (2008). "Body mass index and mortality in heart failure: A meta-analysis". Am. Heart J. 156 (1): 13–22. doi:10.1016/j.ahj.2008.02.014. PMID 18585492. Unknown parameter |month= ignored (help)
  38. ↑ Oreopoulos A, Padwal R, Norris CM, Mullen JC, Pretorius V, Kalantar-Zadeh K (2008). "Effect of obesity on short- and long-term mortality postcoronary revascularization: A meta-analysis". Obesity (Silver Spring). 16 (2): 442–50. doi:10.1038/oby.2007.36. PMID 18239657. Unknown parameter |month= ignored (help)
  39. ↑ Diercks DB, Roe MT, Mulgund J; et al. (2006). "The obesity paradox in non-ST-segment elevation acute coronary syndromes: Results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative". Am Heart J. 152 (1): 140–8. doi:10.1016/j.ahj.2005.09.024. PMID 16824844. Unknown parameter |month= ignored (help)

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