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Health impacts of Obesity

April 2015
Pakistan Journal of Medical Sciences Online 31(1):239-42

DOI:10.12669/pjms.311.7033

Source
PubMed

License
CC BY 3.0

Authors:

Shirin Djalalinia

Ministry of Health and Medical Education

Mostafa Qorbani

Tehran University of Medical Sciences

Niloofar Peykari

Ministry of Health and Medical Education

Roya Kelishadi

Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences

The aim of this communication is to provide some evidence linking the overweight/obesity and their impacts on different dimensions of health. We reviewed the related studies published from 1990 up till now through PubMed Central/Medline, which provide evidence linking obesity with health related issues. It is a risk factor for metabolic disorders and leads to serious health consequences for individuals and burden for the health care system as a whole. Literature search showed that it is related to at least 18 co-morbidities which are attributable to overweight and obesity. Moreover obese individuals more often suffer from significant joint pains, disorders and it also has social as well as psychological impairments. It is high time that countries facing the problems of obesity initiate some intervention measures to monitor and control this growing epidemic.

The most common consequences of obesity on the main domain of health.

…

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[Epub ahead of print]

Open Access

1 Pak J Med Sci 2015 Vol. 31 No. 1 www.pjms.com.pk

INTRODUCTION

The dramatic increase in the prevalence of

overweight and obesity in most countries has

been of great concern globally.1-3 This is estimated

to be the cause of more than 3.4 million deaths,

4% of Years of Life Lost (YLL), and at least 4% of

Disability-Adjusted Life Years (DALYs) all around

the word.2 However, despite the urgency of this

problem, there are still some noticeable gaps in

what is known about this subject. For instance

prevalence of obesity is most often estimated

based on surveys or population studies. Not only

Correspondence:

Roya Kelishadi, MD,

Child Department of Pediatrics,

Child Growth and Development Research Center,

Research Institute for Primordial Prevention

of Non-communicable Disease,

Isfahan University of Medical Sciences,

P.O Box: 81465-1148,

Isfahan, Iran.

E-mail: kelishadi@med.mui.ac.ir

* Received for Publication: July 14, 2014

* 1st Revision Received: September 15, 2014

* 2nd Revision Received: September 22, 2014

* Final Revision Accepted: November 26, 2014

Brief Communication

Health impacts of obesity

Shirin Djalalinia1, Mostafa Qorbani2,

Niloofar Peykari3, Roya Kelishadi4

SUMMARY

The aim of this communication is to provide some evidence linking the overweight/obesity and their

impacts on different dimensions of health. We reviewed the related studies published from 1990 up till

now through PubMed Central/Medline, which provide evidence linking obesity with health related issues.

It is a risk factor for metabolic disorders and leads to serious health consequences for individuals and

burden for the health care system as a whole. Literature search showed that it is related to at least 18

co-morbidities which are attributable to overweight and obesity. Moreover obese individuals more often

suffer from signicant joint pains, disorders and it also has social as well as psychological impairments. It

is high time that countries facing the problems of obesity initiate some intervention measures to monitor

and control this growing epidemic.

KEY WORDS: Overweight, Obesity, Health Impact.

doi: http://dx.doi.org/10.12669/pjms.311.7033

How to cite this:

Djalalinia S, Qorbani M, Peykari N, Kelishadi R. Health impacts of obesity. Pak J Med Sci 2015;31(1):---------.

doi: http://dx.doi.org/10.12669/pjms.311.7033

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

that data on prevalence and trends are based on

measurements of weight rather than the body fat.4

This increase in body mass presents public health

challenges because of attractive physical appearance

of thin bodies, and poor health outcomes of

overweight and obesity.1,3 Health condition of

obese persons’ is most often worse than people with

normal weight and the life span of obese people is

on average is shorter by two years.5

PHYSICAL HEALTH IMPACTS

Some of the co-morbidities related to overweight

and obesity include cancers (cancers of breast,

endometrial, ovarian, colorectal, esophageal,

kidney, pancreatic, prostate), Type 2 diabetes,

hypertension, stroke, Coronary Artery Disease,

Congestive Heart Failure, asthma, chronic back

pain, osteoarthritis, pulmonary embolism,

gallbladder disease, and also an increased risk of

disability. All this leads to more than three million

deaths worldwide annually.3,6

There is also consistent association between

overweight and obesity in childhood and

adolescence with increased risk of both premature

morbidity and mortality particularly cardio-

metabolic morbidity.7

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2 Pak J Med Sci 2015 Vol. 31 No. 1 www.pjms.com.pk

Shirin Djalalinia et al.

It is estimated that in industrialized countries,

disability due to obesity-related cardiovascular

diseases will increase, under an increasing trend.2,8

The main reason being increased survival of these

patients with cardiovascular diseases in these

countries. Moreover because of insufcient insulin

supply in these countries, disability due to obesity-

related and type 2 diabetes will also increase due to

arteriosclerosis, nephropathy and retinopathy.8 Yet

another related health problem due to increasing

prevalence of obesity will be the number of

years that patients suffer from obesity-related

morbidity and disability which would also increase

signicantly.8

Studies have conrmed that obesity is a major

public health problem which results in decreased

life expectancy especially in younger age groups.1,2

BMI itself, even without considering the other

anthropometric measures (e.g., waist circumference,

waist-to-hip ratio), is a strong predictor for overall

mortality. This estimation includes both values,

above and below the expected level of about

22.5-25 kg/m2. Above this dened range the

progressive increase in mortality is mainly related

to cardiovascular disease. At the range of 30-35 kg/

m2, mostly, median survival is reduced by 2-4 years;

whereas at 40–45 kg/m2, it is reduced by 8-10 years.

The expected increase in mortality below 22.5 kg/

m2 is not clearly explained.9

Studies also conrm that overweight and obesity

is a major problem for minority population than

for whites, in poor as compared to the rich and in

women as compared to men.10

Overweight and obesity also carry a considerable

health burden and will have a signicant impact

on health expenditures.6 Obesity has a strong

association with the occurrence of chronic medical

problems, impairment of health-related quality of

life, and increasing the health care and medication

spending,6,10,11 the related health care costs for

obesity-related problems, for both individuals and

health care systems, are substantial.12

Fig.1: The most common consequences of obesity on the main domain of health.

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3 Pak J Med Sci 2015 Vol. 31 No. 1 www.pjms.com.pk

IMPACT ON MENTAL HEALTH

Relationship between obesity and mental health

disorders is not clear.13 However, overweight is a

stigma and the obesity discrimination can lead to

some mental disorders. Scientic evidence lays

emphasize on an increasing risk of low self-esteem,

mood disorder, motivational disorders, eating

problems, impaired body image, interpersonal

communication problems and all these directly or

indirectly affect the quality of life.10,14

On the other hand in some cases, experiencing the

obesity discrimination has lead to the development

of psychopathology and poor health behavior

that through a vicious cycle, will enhance their

overeating, bulimia, or other related problems.14

Some studies have revealed that obesity in

both men and women increase the risk of poorer

sexual health.15 Obese individuals, attribute this to

their appearance and their weight, and encounter

frequent difculties in their sexual activities.15,16

Sexual activity and sexual health outcomes such

as sexual satisfaction, unintended pregnancy, and

abortion have been mentioned as relevant issues.15,16

Sexual quality of life is particularly impaired for

obese women who are also faced with complexity

of the therapeutic procedures. 15

As such we need to emphasize on more

comprehensive population based studies to nd out

the impact of overweight and obesity on different

aspects of mental health including mood disorders,

communication problems, self satisfaction and its

effects on sexual health besides different aspects of

quality of life.15,16

IMPACT ON SOCIAL ASPECTS

Consequences of obesity-related physical co-

morbidity includes psychological impairments and

stigmatization experienced by obese patients.14,17

The overweight stigma and attributable

discrimination is documented in all the key areas

of living, including growth and development,

educational process, employment structure, and

provision of health care.18 The obese individuals

are most often ridiculed by their teachers,

physicians, and public. At times they also

suffer from discrimination, ridicule, social bias,

rejection, and humiliation.14,18 Even specic obesity

diagnostic or therapeutic procedure such as related

anthropometric assessments could potentially

affect their care givers professional attitude and

subsequent clinical evaluation and service provision

for obese persons when they are seeking care.18

Weight-related discrimination, by itself is related

to poor health behavior such as pathological

overeating, binge eating or even sedentary life

and decreased physical activity that in turn leads

to greater weight gain. This vicious cycle, again

strengthens the risk of exposure to weight-related

discrimination.18

SPIRITUAL ASPECTS

Studies on obesity and its consequences on

spiritual health are very limited. Exploratory

evaluation on the relationship between emotional

eating and spiritual well-being showed that lower

levels of spiritual well-being is correlated with

higher levels of emotional eating specially in

women. There is some evidence that, emotional

eating contributes to impaired nutritional behaviors

such as higher caloric intake, binge eating, and

bulimic eating desires. Some other studies have

emphasized on the important role of education

which leads to better spiritual perception.19,20

POLICY CONSIDERATIONS

Considering the importance of health risks

of overweight and obesity and its increasing

prevalence all over the world there is a need for

well dened programs on control and prevention

which should be a priority on the political health

agenda.8 If this increase in its prevalence continues,

it could lead to serious health related outcomes

and consequences. However, so far only a few

comprehensive preventive programs have been

developed with little reported success.

The contributions of promoting physical activity,

changes in food types and calorie consumption,

detecting and controlling the eating behavioral

impairments, and other related factors of overweight

and obesity prevalence are some of the issues which

need further research.2,14,20

CONCLUSION

Overweight, obesity and their impacts in different

dimensions of health must be considered as one of

the most important public health priority. There is

a need for comprehensive strategies for prevention

and control of this epidemic.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge the

contributions made by researchers from Non-

Communicable Diseases Research Center and

Growth and Development Research Center.

Health impacts of obesity

[Epub ahead of print]

4 Pak J Med Sci 2015 Vol. 31 No. 1 www.pjms.com.pk

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de Girolamo G, et al. Obesity and mental disorders in the

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15. Kaneshiro B, Jensen JT, Carlson NE, Harvey SM, Nichols

MD, Edelman AB. Body mass index and sexual behavior.

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Horm Res. 2008;36:260-270.

18. Carr D, Friedman MA. Is obesity stigmatizing? Body weight,

perceived discrimination, and psychological well-being in

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19. Hawks SR, Goudy MB, Gast JA. Emotional eating and

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Educ. 2003;34(1):30-33.

20. O’Dea JA. Prevention of child obesity: ‘First, do no harm’.

Health Educ Res. 2005;20(2):259-265.

Authors’ Contributions:

SD: Designed and prepared the rst draft of

manuscript.

MQ & NP: Participated in review and manuscript

writing.

RK: Did review and nal approval of manuscript.

SD, MQ, NP & RK: Gave approval to the nal

version of the manuscript.

RK: Takes the responsibility and is accountable for

all aspects of the work in ensuring that questions

related to the accuracy or integrity of any part of the

work are appropriately investigated and resolved.

Shirin Djalalinia et al.

Authors:

1. Shirin Djalalinia, MSc PhD Candidate

Non-communicable Diseases Research Center, Endocrinology and

Metabolism Population Sciences Institute, Tehran University of

Medical Sciences, Tehran, Iran, and Endocrinology and Metabolism

Research Center, Endocrinology and Metabolism Research

Institute, Tehran University of Medical Sciences, Tehran, Iran, and

Development of Research & Technology Center, Deputy of Research

and Technology, Ministry of Health and Medical Education,

Tehran, Iran.

2. Dr. Mostafa Qorbani, PhD

School of Medicine, Community Medicine Department Alborz

University of Medical Sciences, Karaj, Iran, and Non-communicable

Diseases Research Center, Endocrinology and Metabolism Population

Sciences Institute, Tehran University of Medical Sciences,

Tehran, Iran.

3. Niloofar Peykari, MSc PhD Candidate

Non-communicable Diseases Research Center, Endocrinology and

Metabolism Population Sciences Institute, Tehran University of

Medical Sciences, Tehran, Iran, and Endocrinology and Metabolism

Research Center, Endocrinology and Metabolism Research

Institute, Tehran University of Medical Sciences, Tehran, Iran, and

Development of Research & Technology Center, Deputy of Research

and Technology, Ministry of Health and Medical Education,

Tehran, Iran.

4. Prof. Roya Kelishadi, MD

Child Department of Pediatrics, Child Growth and Development

Research Center, Research Institute for Primordial Prevention of

Non-communicable Disease, Isfahan University of Medical Sciences,

Isfahan, Iran.

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Feb 2011
LANCET

Excess bodyweight is a major public health concern. However, few worldwide comparative analyses of long-term trends of body-mass index (BMI) have been done, and none have used recent national health examination surveys. We estimated worldwide trends in population mean BMI. We estimated trends and their uncertainties of mean BMI for adults 20 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9·1 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean BMI by age, country, and year, accounting for whether a study was nationally representative. Between 1980 and 2008, mean BMI worldwide increased by 0·4 kg/m(2) per decade (95% uncertainty interval 0·2-0·6, posterior probability of being a true increase >0·999) for men and 0·5 kg/m(2) per decade (0·3-0·7, posterior probability >0·999) for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2·0 kg/m(2) per decade (posterior probabilities >0·99) in nine countries in Oceania. Male BMI increased in all but eight countries, by more than 2 kg/m(2) per decade in Nauru and Cook Islands (posterior probabilities >0·999). Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33·9 kg/m(2) (32·8-35·0) for men and 35·0 kg/m(2) (33·6-36·3) for women in Nauru. Female BMI was lowest in Bangladesh (20·5 kg/m(2), 19·8-21·3) and male BMI in Democratic Republic of the Congo 19·9 kg/m(2) (18·2-21·5), with BMI less than 21·5 kg/m(2) for both sexes in a few countries in sub-Saharan Africa, and east, south, and southeast Asia. The USA had the highest BMI of high-income countries. In 2008, an estimated 1·46 billion adults (1·41-1·51 billion) worldwide had BMI of 25 kg/m(2) or greater, of these 205 million men (193-217 million) and 297 million women (280-315 million) were obese. Globally, mean BMI has increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially between nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries. Bill & Melinda Gates Foundation and WHO.

Health implications of obesity

Article

Jun 1991

Xavier Pi-Sunyer

The health risks of obesity increase with its severity and reach significance at a weight > 20% above optimal, by using life insurance tables, or at a body mass index > 27. Risks include hypertension, insulin resistance and diabetes mellitus, cardiovascular disease, hypertriglyceridemia, low high-density-lipoprotein cholesterol, and, in some studies, high totaland low-density-lipoprotein cholesterol. There is an increased mortality from endometrial cancer in women and from colorectal cancer in men. Chronic hypoxia and hypercapnia, sleep apnea, gout, and degenerative joint disease can occur with more severe obesity. The distribution of body fat is directly related to these health risks. Abdominal obesity is more dangerous than gluteal-femoral obesity because the amount of intraabdominal fat seems to determine much of the increased peril; therefore, risks of cardiovascular disease, stroke, hypertension, and diabetes increase with abdominal obesity, even independently of total fat mass.

Canada

Article

Sep 2008

Karen Birmingham

Officials in the Canadian Province of Newfoundland and Labrador are in the midst of a public inquiry to uncover how hundreds of breast cancer patients received faulty hormone receptor test results between 1997 and 2005. As many as 386 patients have had their results changed after retesting 1,023 cases. Of the ten most recently discovered errors, four of the patients are living and six are deceased. Three gynecologic oncologists have recently resigned from the province’s largest health board, continuing an exodus that began earlier this year. They are the only doctors in the province performing the specialty, and their absence will cause enormous hardship, leaving about 1,200 patients in the lurch. Record-keeping is one of the problems that will be revised when the inquiry makes its recommendations in 2009.

The incidence of co-morbidities related to obesity and overweight: A systematic review and metaanalysis

Article

Jan 2009
PUBLIC HEALTH

Erratum to Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013

Article

Aug 2014

National, Regional, and Global Trends in Body-Mass Index Since 1980: Systematic Analysis of Health Examination Surveys and Epidemiological Studies with 960 Country-Years and 9·1 Million Participants

Article

Feb 2011

Background: Excess bodyweight is a major public health concern. However, few worldwide comparative analyses of long-term trends of body-mass index (BMI) have been done, and none have used recent national health examination surveys. We estimated worldwide trends in population mean BMI. Methods: We estimated trends and their uncertainties of mean BMI for adults 20 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9·1 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean BMI by age, country, and year, accounting for whether a study was nationally representative. Findings: Between 1980 and 2008, mean BMI worldwide increased by 0·4 kg/m(2) per decade (95% uncertainty interval 0·2-0·6, posterior probability of being a true increase >0·999) for men and 0·5 kg/m(2) per decade (0·3-0·7, posterior probability >0·999) for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2·0 kg/m(2) per decade (posterior probabilities >0·99) in nine countries in Oceania. Male BMI increased in all but eight countries, by more than 2 kg/m(2) per decade in Nauru and Cook Islands (posterior probabilities >0·999). Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33·9 kg/m(2) (32·8-35·0) for men and 35·0 kg/m(2) (33·6-36·3) for women in Nauru. Female BMI was lowest in Bangladesh (20·5 kg/m(2), 19·8-21·3) and male BMI in Democratic Republic of the Congo 19·9 kg/m(2) (18·2-21·5), with BMI less than 21·5 kg/m(2) for both sexes in a few countries in sub-Saharan Africa, and east, south, and southeast Asia. The USA had the highest BMI of high-income countries. In 2008, an estimated 1·46 billion adults (1·41-1·51 billion) worldwide had BMI of 25 kg/m(2) or greater, of these 205 million men (193-217 million) and 297 million women (280-315 million) were obese. Interpretation: Globally, mean BMI has increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially between nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries. Funding: Bill & Melinda Gates Foundation and WHO.

Emotional Eating and Spiritual Well-Being: A Possible Connection?

Article

Feb 2003

The purpose of this exploratory study was to evaluate the relationship between emotional eating and spiritual well-being. It was found that among college women lower levels of spiritual well-being correlated with higher levels of emotional eating (r = -0.22, p = 0.0015). In other studies emotional eating has been found to contribute to higher caloric intake, binge eating, and bulimic eating attitudes. A better understanding of the correlates of emotional eating may lead to health education strategies for preventing or managing overweight, obesity, and eating disorders--which may be some of the major public health issues of the future. Implications for health education are discussed, and research needs are suggested. (Contains 1 table.)

The Epidemiology of Obesity

Article

Jun 2007

In the United States, obesity among adults and overweight among children and adolescents have increased markedly since 1980. Among adults, obesity is defined as a body mass index of 30 or greater. Among children and adolescents, overweight is defined as a body mass index for age at or above the 95th percentile of a specified reference population. In 2003-2004, 32.9% of adults 20-74 years old were obese and more than 17% of teenagers (age, 12-19 y) were overweight. Obesity varies by age and sex, and by race-ethnic group among adult women. A higher body weight is associated with an increased incidence of a number of conditions, including diabetes mellitus, cardiovascular disease, and nonalcoholic fatty liver disease, and with an increased risk of disability. Obesity is associated with a modestly increased risk of all-cause mortality. However, the net effect of overweight and obesity on morbidity and mortality is difficult to quantify. It is likely that a gene-environment interaction, in which genetically susceptible individuals respond to an environment with increased availability of palatable energy-dense foods and reduced opportunities for energy expenditure, contributes to the current high prevalence of obesity. Evidence suggests that even without reaching an ideal weight, a moderate amount of weight loss can be beneficial in terms of reducing levels of some risk factors, such as blood pressure. Many studies of dietary and behavioral treatments, however, have shown that maintenance of weight loss is difficult. The social and economic costs of obesity and of attempts to prevent or to treat obesity are high

The Sociology of Obesity

Article

Jan 2008
FRONT HORM RES

The current obesity epidemic is largely driven by environmental factors, including nutritional transition towards refined and fatty foods with the growing production of energy-dense food at relatively low cost, increased access to motor vehicles, mechanisation of work and sedentary lifestyles. These influences in modern society are modified by individual characteristics. Ultimately, energy intake in excess of caloric expenditure causes obesity, but why this occurs in some but not all individuals is not known. Obesity is more prevalent in the lower socioeconomic classes but even so, there is a varying relation of socioeconomic status with obesity between countries at different stages of development and, even in the Western world, socioeconomic gradients with respect to obesity are both heterogeneous and in transition. Potential mechanisms for an effect of obesity on subsequent social status have been proposed, the most obvious being related to the stigmatisation experienced by the obese. Obesity seems to be causally related to mood disturbances, whereas there is no conclusive evidence that the reverse is true. When considering psychological aspects of obesity, depressive symptoms are more likely to be consequences, rather than causes of obesity. Copyright (c) 2008 S. Karger AG, Basel.