Obesity is technically defined as having a BMI of more than 30. BMI is an index that reflects the body weight in kilograms divided by the height of the individual in meters squared. Obese patients usually present with higher anthropometric measurements which include waist circumference, hip circumference, and thigh circumference. The neck circumference is also an effective parameter in determining the risk for sleep apnea in most obese patients [9]. Joint deformities may frequently be observed for it bears the weight of the unusually large body mass.

• Weight Gain

  The most common reason for significant weight gain is a high-calorie diet and decreased physical activity. However, apart from environmental factors, genetic predisposition plays a crucial role in the pathomechanism of obesity. [ncbi.nlm.nih.gov]

  […] with weight gain. [doi.org]

  gain are strong risk factors for gout in men, while weight loss is protective. [dx.doi.org]

• Fatigue

  Smith and Dorothy Williams, Obesity in Urban Women: Associations with Sleep and Sleepiness, Fatigue and Activity, Women's Health Issues, 24, 4, (e447), (2014). M. Dresler, V.I. Spoormaker, P. Beitinger, M. Czisch, M. Kimura, A. Steiger and F. [doi.org]

  Symptoms are widespread muscle pain and “tender points,” and can include fatigue, sleep problems, depression, bladder and bowel irritability and cognitive difficulties. [arthritis.org]

  Start slowly and progress gradually to avoid injury, excessive soreness, or fatigue. Over time, build up to 30-60 minutes of moderate to vigorous exercise every day. People are never too old to start exercising. [medicinenet.com]

• Coronary Atherosclerosis

  […] are associated with angiographic progression of atherosclerosis in non-grafted coronary arteries. 102 Therefore, abnormalities of glucose metabolism with features of the MetS could modulate the extent of atherosclerosis within the coronary artery tree [dx.doi.org]

  Stop smoking Coronary Artery Disease Persons with diabetes mellitus are at increased risk for accelerated and advanced atherosclerosis that increases the risk for coronary artery disease that can lead to myocardial ischemia and myocardial infarction. [library.med.utah.edu]

• Noncompliance

  Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg 2005 ;15: 546 - 551 Citing Articles (1519) Letters Article Figures/Media [dx.doi.org]

• Buffalo Hump

  Cushing syndrome typically causes fat to accumulate in the face, making it look full (called moon face), and behind the neck (called a buffalo hump). Polycystic ovary syndrome affects about 5 to 10% of women. [msdmanuals.com]

• Sleep Apnea

  Obesity is a well-recognized risk factor for obstructive sleep apnea. [ncbi.nlm.nih.gov]

• Snoring

  You may have: Trouble breathing Snoring Skin problems including stretch marks Joint and back pain Doctors can tell if you're obese by: Calculating your BMI (body mass index) Measuring how thick the fat is on your waist and on the back of your upper arm [merckmanuals.com]

  It also causes heavy snoring. Respiratory problems associated with obesity occur when added weight of the chest wall squeezes the lungs and causes restricted breathing. Sleep apnea is also associated with high blood pressure. [stanfordhealthcare.org]

  Barthel and Marshall Strome, SNORING, OBSTRUCTIVE SLEEP APNEA, AND SURGERY, Medical Clinics of North America, 83, 1, (85), (1999). Jeffrey R. [doi.org]

  Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obes Relat Metab Disord 2001;25:669-75. [ PubMed ] 64. Valencia-Flores M, Orea A, Castano VA, et al. [ncbi.nlm.nih.gov]

• Dyspnea

  Phrenic nerve paralysis from brachial plexus blocks can cause clinically significant dyspnea in obese patients. Brachial plexus catheters can be used effectively for these patients with some modification to routine management. [ncbi.nlm.nih.gov]

  Patients with obesity frequently report dyspnea and wheezing and are therefore often given therapy for asthma without objective diagnostic confirmation by pulmonary function testing. 16 An accurate diagnosis is important because dyspnea related to other [cmaj.ca]

• Overeating

  However, the prevalence of a (self-reported) BMI over 40 (about 100 pounds (45 kg) overweight) increased by 50% and the prevalence of a BMI over 50 increased by 75%, two and three times faster, respectively. [ncbi.nlm.nih.gov]

  As of 2000, the number of obese adults has increased to over 300 million. [who.int]

• Increased Appetite

  They alter the function of your body and brain, reducing metabolic rate or increasing appetite ( 14, 15 ). Summary Some medications may promote weight gain by reducing the number of calories burned or increasing appetite. [healthline.com]

  Lack of sleep: The perennial habit of shortened sleeping time may alter one’s hormones that advertently increases appetite and cravings for high caloric meals and beverages. [symptoma.com]

  But studies show that exercise increases appetite, causing people to consume more calories. Exercise also expends far fewer calories than most people think. [well.blogs.nytimes.com]

  Sleeplessness results in hormonal changes that increase appetite and cravings for energy-dense foods. Stopping smoking usually results in weight gain. Nicotine decreases appetite and increases the metabolic rate. [msdmanuals.com]

• Hypertension

  Abstract Although obesity is clearly identified as a risk factor for hypertension, the association between its different metabolic phenotypes and hypertension remains unclear. [ncbi.nlm.nih.gov]

  Hypertension, diuretic use, and incident gout After we adjusted for potential confounders, including diuretic use, the RR of gout for men with hypertension as compared with men without hypertension was 2.31 (95% CI, 1.96-2.72) ( Table 4 ). [doi.org]

• Striae Distensae

  Obesity is a chronic disease that may lead to skin problems, including acanthosis nigricans, skin tags, hyperandrogenism, striae distensae, plantar hyperkeratosis, and candidal intertrigo. [ncbi.nlm.nih.gov]

• Increased Sweating

  Skin disorders are common; increased sweat and skin secretions, trapped in thick folds of skin, are conducive to fungal and bacterial growth, making intertriginous infections especially common. [msdmanuals.com]

• Intertrigo

  Obesity is a chronic disease that may lead to skin problems, including acanthosis nigricans, skin tags, hyperandrogenism, striae distensae, plantar hyperkeratosis, and candidal intertrigo. [ncbi.nlm.nih.gov]

  […] hypoventilation syndrome Musculoskeletal Slipped capital femoral epiphysis (SCFE) Tibia vara (Blount disease) Neurological Idiopathic intracranial hypertension Psychosocial Distorted peer relationships Poor self-esteem [19] Anxiety Depression Skin Furunculosis Intertrigo [en.wikipedia.org]

• Arthritis

  But if you like long odds, put your money on arthritis. It’s not as commonly known, but obesity in some cases raises the risk of getting a certain type of arthritis; in all cases, obesity makes arthritis worse. [arthritis.org]

  Arthritis Rheum 46, 675 – 682. 29. [dx.doi.org]

  * Compared with metropolitan residents, nonmetropolitan residents have a higher prevalence of obesity-associated chronic diseases such as diabetes (1), coronary heart disease (1), and arthritis (2). [ncbi.nlm.nih.gov]

• Back Pain

  They never keep their hands down by their sides because they’d be leaving their face The 8 Best Decompression Belts for Back Pain [Updated May 2019] Chronic back pain can make life more difficult. You’ll want to find relief in any way you can. [easoobesity.org]

  Obesity is associated with low back pain in general 20 - 22 and with disability and health insurance claims for back pain on the job. 33, 34 This association is confirmed in our data, with the back being a common body site of injury and with pain or inflammation [doi.org]

  You may have: Trouble breathing Snoring Skin problems including stretch marks Joint and back pain Doctors can tell if you're obese by: Calculating your BMI (body mass index) Measuring how thick the fat is on your waist and on the back of your upper arm [merckmanuals.com]

• Low Back Pain

  Obesity is associated with low back pain in general 20 - 22 and with disability and health insurance claims for back pain on the job. 33, 34 This association is confirmed in our data, with the back being a common body site of injury and with pain or inflammation [doi.org]

  The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet 2005; 88 :271-5. [ PubMed ] [ Google Scholar ] 46. Haakstad L, Bo K. Exercise in pregnant women and birth weight: a randomized controlled trial. [ncbi.nlm.nih.gov]

• Knee Pain

  O’Reilly, SC, Muir, KR & Doherty, M ( 1996 ) Screening for pain in knee osteoarthritis: which question? Ann Rheum Dis 55, 931 – 933. 34. [dx.doi.org]

• Amenorrhea

  CASE DESCRIPTION: We describe an unusual case of a young girl who presented with clinical triad of obesity, primary amenorrhea and central cord syndrome. [ncbi.nlm.nih.gov]

Patients that are seen to be obese with BMI of more than 30 are subjected to a more detailed clinical interview with emphasis on metabolic habits and genetic predispositions, and a meticulous physical examination inclusive of the standard anthropometric measurements for comparison. The following ancillary tests are done on an obese patient:

• BMI measurement: The body mass index is an accurate measure of the relative risk of one on cardiovascular diseases. This can also be used as a monitoring index in weight reduction regimens. 
• Vital signs: The blood pressure readings, pulse rate and respiratory rate may be adversely affected by the obese conditions.
• Blood tests: Obese patients may be at risk with other concomitant medical illnesses. Blood cholesterol, blood sugar levels, thyroid function tests, and liver function test may be imperatively monitored for any abnormalities.
• Electrocardiograph: This tool will involve electrodes placed on the chest to determine the condition of the heart impulses because cardiovascular risk is always higher in obesity.

• Left Axis Deviation

  ECG Changes That May Occur in Obese Individuals ↑Heart rate ↑PR interval ↑QRS interval ↑or ↓QRS voltage ↑QT c interval ↑QT dispersion ↑SAECG (late potentials) ST-T abnormalities ST depression Left axis deviation Flattening of the T wave (inferolateral [dx.doi.org]

• Hypertriglyceridemia

  Obese women pregnancy runs on the background of hypertriglyceridemia and type IV hyperlipoproteinemia. [ncbi.nlm.nih.gov]

  Contribution of abdominal obesity and hypertriglyceridemia to impaired fasting glucose and coronary artery disease. Am J Cardiol 2002 ;90: 15 - 18 Citing Articles (729) Letters Article Figures/Media [dx.doi.org]

  Chen JH, Pan WH, Hsu CC, Yeh WT, Chuang SY, Chen PY, Chen HC, Chang CT, Huang WL (2013) Impact of obesity and hypertriglyceridemia on gout development with or without hyperuricemia: a prospective study. [doi.org]

• Leucine Increased

  Leucine increases protein anabolism and decreases protein breakdown. [worldgastroenterology.org]

• Insulin Increased

  Dysregulation of these hormones is associated with overeating (or hyperphagy) and with tissue resistance to insulin, increasing the risk of type II diabetes. [britannica.com]

The general goal in the treatment of obesity is to achieve the healthy weight level. Weight reduction regimens are dependent on the level of obesity [10]. The following treatment tools are usually implored on obese patients:

• Dietary modification
• Regular exercise 
• Behavioral and attitude change
• Weight loss medications
• Weight reduction surgery (Bariatric surgery)

Recent researches in endocrinology and metabolic sciences have implicated obesity to increase the mortality and morbidity of patients with comorbid cardiovascular diseases [8]. Obesity is also associated with a significant increase of all-cause mortality and morbidity rating. Furthermore, obese patients with body mass index (BMI) of more than 28 are associated with an almost two fold risk of cardiac diseases and cerebral stroke.

Obesity occurs as a combination of several contributing factors. The following factors are established to be contributory to the development of obesity among susceptible patients:

• Genetics: Patients born from an obese family iare likely to be obese.
• Hormonal influence: This includes intrinsic and exogenous hormones.
• Inactivity: Prolonged inactivity or sedentary lifestyle burns lesser dietary calories than what is actually taken in leading to obesity.
• Unhealthy eating habits: An exclusively carnivorous diet and by eating excessive portions in a meal may predispose one to weight development problems in the future.
• Lack of sleep: The perennial habit of shortened sleeping time may alter one’s hormones that advertently increases appetite and cravings for high caloric meals and beverages.
• Pregnancy: Hormonal induction during pregnancy leads to weight gain among expectant mothers. 
• Medications: Some medications intrinsically increase the weight and boost the appetite. An example of these includes corticosteroids, anti-diabetics, anti-depressants, and beta blockers.
• Medical issues: Some medical conditions predisposes one to be obese. These medical conditions includes Cushing syndrome, Prader-Willi syndrome, and hypothyroidism. 

In the United States, more than 90 million of the population including men, women, and children are noted to be obese. Prevalence rate of obesity are even more pronounced in some minority groups like the Prima Indians, Afro-Americans, and the Latin Americans [3]. Obese and overweight individuals account for 1 out of 5 deaths in the United States today [4].

The worldwide prevalence of obesity has been steadily increasing especially in the northern hemisphere and Europe. Today, approximately 22% of the female and 15% of the male are obese in Europe [5]. Because women physiologically have a higher fat content than male, obesity has a greater predilection to women than in men. Conservatively, the currently global estimates suggests that 7% of the world population are obese. Obese children are most likely to obese when the reach adulthood.

There are practically two types of obesity in relation to adipocyte (fat cells) development, the hypercellular obesity, and the hypertrophic obesity. Hypertorphic obesity is associated with the increasing size of adipocytes found in majority of cases like the android abdominal obesity. This is the type of obesity found in adulthood that is easily responsive to weight reduction treatments.

The hypercellular obesity type usually occurs among obese individual that starts out as an obese adolescent and may also occur among the severely obese adult patients. Recent researches are unearthing the possibilities that certain adipocytes in the body may functionally serve as an endocrine gland that regulates weight gain [6]. The involvement of insulin in the control the olfactory senses during the actual act of eating has been intensively investigated in the pathogenesis of obesity [7].

The main goal in the prevention of obesity is practically very similar to the approach in weight reduction programs for the obese patient. One is regularly encourage to do exercises and monitor one’s weight and BMI. Dietary restriction of unhealthy foods should be practiced and an avid monitoring of the calories ingested daily should be in place.

Obesity is revered to be a complex medical condition involving excessive amounts of body and visceral fats. Obesity does not only distort the overall physique of the person, but it also increases the risk of one for diseases like diabetes, heart diseases, and hypertension [2]. Recent trends on weight reduction have shown dramatic decrease in the relative health risk associated with obesity. There are many options available today to address the obesity problem, these includes weight losing pills, exercises, dietary modifications, and bariatric surgery.

Definition

Obesity is a broad term that is used to describe a complex medical condition involving excessive amounts of body and visceral fats.

Cause

The cause of obesity can vary from genetic causes to hormonal influence, it can also be due to physical inactivity, as a side effect of excessive usage of few medications, secondary to few medical conditions, post pregnancy, and due to lack of proper sleep.

Symptoms

The symptoms of obesity can vary widely from breathlessness, muscle and joint pains, feeling tired often, irregular periods in females, varicose veins, and skin infections.

Diagnosis

Diagnosis includes detailed clinical history and physical examination, anthropometric measurements, blood tests to rule out secondary medical conditions, and ECG.

Treatment

Treatment includes treatment of secondary medical conditions, weight loss programs, dietary modifications, exercise, weight loss medications, and bariatric surgery.

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2. Nainggolan L. FDA Approves Bupropion/Naltrexone (Contrave) for Obesity. Medscape Medical News. Accessed November 15, 2014.
3. Yaemsiri S, Slining MM, Agarwal SK. Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003-2008 Study. Int J Obes (Lond). Aug 2011; 35(8):1063-70.
4. Masters RK, Reither EN, Powers DA, Yang YC, Burger AE, Link BG. The Impact of Obesity on US Mortality Levels: The Importance of Age and Cohort Factors in Population Estimates. Am J Public Health. Aug 15 2013.
5. Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K. Waist and hip circumferences, and waist-hip ratio in 19 populations of the WHO MONICA Project. Int J Obes Relat Metab Disord. Feb 1999; 23(2):116-25.
6. Martinelli CE, Keogh JM, Greenfield JR, Henning E, van der Klaauw AA, Blackwood A, et al. Obesity due to melanocortin 4 receptor (MC4R) deficiency is associated with increased linear growth and final height, fasting hyperinsulinemia, and incompletely suppressed growth hormone secretion. J Clin Endocrinol Metab. Jan 2011; 96(1):E181-8.
7. Ketterer C, Heni M, Thamer C, Herzberg-Schäfer SA, Häring HU, Fritsche A. Acute, short-term hyperinsulinemia increases olfactory threshold in healthy subjects. Int J Obes (Lond). Aug 2011; 35(8):1135-8.
8. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. Oct 27 1999; 282(16):1530-8.
9. Li C, Ford ES, Zhao G, Croft JB, Balluz LS, Mokdad AH. Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, 2005-2006. Prev Med. Jul 2010; 51(1):18-23.
10. Jolly K, Lewis A, Beach J, et al. Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial. BMJ. Nov 3 2011; 343:d6500.