According to the World Health Organization (WHO), obesity has almost tripled globally since 1975. Per the World Obesity Atlas 2023 report, approximately 38% of the world's population had obesity or were overweight in 2020 with a projected increase to 51% of the world's population by 2035.
Obesity alone was projected to increase from 14% of the world’s population in 2020 to 24% in 2035, affecting almost 2 billion adults, children, and adolescents. As such, obesity is a growing global healthcare concern.
What is Obesity?
The WHO defines obesity as the abnormal or excessive accumulation of fat leading to impaired health and well-being.
One method of determining if an individual has obesity is through the calculation of the person’s body mass index (BMI). This calculation takes a person’s weight in kilograms and divides it by the square of the person’s height in meters (kg/m2).
Calculating an adult’s BMI determines the following BMI classifications:
Underweight range: BMI is less than 18.5.
Normal range: BMI falls between 18.5 and 25.
Overweight range: BMI falls between 25 and 30.
Obesity range: BMI is greater than 30.
Obesity can be further subdivided into 3 classes:
Class 1: BMI falls between 30 and 35.
Class 2: BMI falls between 35 and 40.
Class 3: BMI is greater than 40.
It is important to note that BMI calculation is only a screening tool, and it doesn’t necessarily determine the degree of body fat or a person’s level of health. For example, elite bodybuilders who regularly train to increase lean muscle mass may have higher BMIs, but these elevated BMIs are not truly reflective of increased body fat levels because (in this unique case) the increased weight of the lean muscle mass increases the bodybuilder’s BMI.
Therefore, alternative methods that assess body composition, such as the Lipometer, skinfold caliper measurements, bioelectrical impedance, body density scans, total body water estimation, and dual-energy X-ray absorptiometry, can provide more accurate determinations of an individual’s body fat percentage compared to BMI calculations after an initial BMI screening.
What are the Risk Factors for Developing Obesity?
Numerous factors contribute to the increased risk of developing obesity—some of which are not necessarily within a person’s control. These risk factors include the following:
Genetics as researchers have identified at least 15 genes that increase risk for obesity
Health conditions, such as polycystic ovarian syndrome (PCOS) and metabolic syndrome
Medications, such as antidepressants, antipsychotics, beta-blockers for high blood pressure, birth control, steroids for inflammatory or autoimmune conditions, and insulin for diabetes
Lifestyle factors, such as lack of physical activity, unhealthy eating behaviors, and lack of quality sleep
Environmental factors, such as excessive amounts of long-term and even short-term stress, occupation, lack of access to sidewalks and green open spaces, higher accessibility to fast-food restaurants in the neighborhood, food industry practices, and marketing
How Does Obesity Affect People?
The health consequences of obesity are complex and abundant, including both physical, mental, and social effects.
Physical Effects Associated with Obesity
Physical effects of obesity include increased risk for developing or worsening other comorbid health conditions, such as:
Cardiovascular disease, such as coronary heart disease, hypertension, atrial fibrillation, heart failure
Neurodegenerative diseases, such as Alzheimer’s disease (AD), dementia, and Parkinson’s disease (PD)
Osteoarthritis
Respiratory diseases, such as increased susceptibility to pneumonia, asthma, and sleep apnea
Stroke
Type 2 diabetes mellitus (T2DM)
Worsening of autoimmune conditions, such as rheumatoid arthritis (RA), inflammatory bowel disease (IBD), multiple sclerosis (MS), type 1 diabetes (T1D), and autoimmune thyroid conditions especially Hashimoto thyroiditis
Mental Effects Associated with Obesity
In addition to the potentially debilitating and life-threatening physical consequences of obesity, the mental effects of obesity can also significantly impair an individual’s well-being, leading to
Social anxiety, which in turn may increase stress, inflammation, and insulin resistance that further accelerate weight gain
Social Stigma Associated with Obesity
Social stigmas associated with obesity can further contribute to these mental effects of obesity. Weight stigma describes the social devaluation and denigration of an individual due to their excess body weight.
Individuals with obesity often experience discrimination, mistreatment, prejudice, stereotypes, and negative attitudes in places, including workspaces, educational institutions, and healthcare facilities. Individuals with BMIs of 35 or higher are more likely to report institutional, interpersonal, and employment discrimination.
Children and adolescents with obesity are also more likely to experience weight-related victimization and bullying at school, including verbal victimization, physical victimization, and exclusion from social groups and activities.
Results from a survey published in 2021 indicated that 56% to 61% of 13,996 adults across 6 countries reported a history of weight stigma. Around two-thirds of these individuals reported that their weight stigma experiences involved interactions with doctors. Consequently, weight-related stigmatization in healthcare increased the likelihood of individuals with higher body weight to avoid routine healthcare visits due to the fear of provider judgment, lack of respect, less active listening, and provision of lower quality care. Avoidance of healthcare providers for fear of weight-related bias may also exacerbate the root problem, accelerating weight gain due to lack of proper and respectful healthcare guidance and weight management strategies.
What Treatments are Available for Obesity?
Treatment for obesity should take a personalized approach depending on each person’s unique needs, comorbid health conditions, and response to treatments. Treatment options for obesity include the following:
Lifestyle interventions, such as diet modification and regular physical activity
Cognitive-behavioral therapy (CBT)
Pharmacotherapy
Surgical interventions
Lifestyle Interventions
Lifestyle modifications can be an effective intervention if obesity is associated with poor lifestyle habits, such as unhealthy eating and lack of regular physical activity. The United States (US) Preventive Services Task Force recommends that primary care providers screen all adults for obesity and prescribe an intensive, multicomponent lifestyle intervention involving at least 14 or more in-person counseling sessions over a 6-month period. This program should focus on dietary modifications, physical activity levels, and behavioral therapy to improve accountability and encourage development of healthy habits and choices.
Diet
For individuals in many developed nations, food is cheap, abundant, highly processed with sugar, saturated fat, and salt, and served in increasing portion sizes, contributing to the obesity epidemic. This toxic food environment is further encouraged by aggressive marketing schemes and drastic changes to meal preparation and consumption at home to accommodate busy schedules and lack of time.
A comprehensive lifestyle intervention for obesity includes dietary recommendations aimed at reducing body weight by 5% to 10% and maintaining this weight target long-term. Trained nutritionists and dietitians with experience assisting individuals with obesity to manage their weight through dietary changes can recommend low-calorie (1200-1500 kcal/day for women or 1500-1800 kcal/day for men) or reduced-calorie diets and develop meal plans with a customized macronutrient composition based on the individual’s preference as well as current health status.
Exercise
Individuals with obesity are strongly encouraged to participate in 150 minutes or more per week of regular aerobic physical activity, such as brisk walking, in order to lose 5% to 10% of their current body weight and between 200 and 300 minutes per week of aerobic physical activity to maintain this weight loss.
Cognitive Behavioral Therapy
As an integral component of the lifestyle intervention plan, behavioral therapy incorporates daily monitoring of food intake and physical activity levels through apps or paper diaries as well as weekly monitoring of weight to encourage individuals with obesity to stay the course as they observe positive and objective signs of weight loss as well as subjectively begin to feel better about themselves.
Behavioral therapy can provide a structured and targeted program as well as regular feedback from a trained provider to promote behavioral changes through goal setting, problem solving, strategies to control urges/stimuli, and prevention of relapsing into former habits.
Cognitive behavioral therapy (CBT) may also benefit individuals who experience the negative mental effects of obesity, including depression, eating disorders, and social anxiety. CBT is regarded as the preferred first-line intervention among the psychological approaches in the treatment of obesity.
Pharmacotherapy
In cases of obesity where lifestyle interventions prove to be unsuccessful strategies in weight reduction, pharmacologic management of weight may be a beneficial treatment option.
As of 2023, the US Food and Drug Administration (FDA) has approved of the following medications for the treatment of obesity:
Short-term use
Diethylpropion, an oral medication sold under the brand names, Depletite #2, Radtue, and Tenuate®
Phentermine, an oral medication sold under the brand names, Adipex® and LomairaTM
Long-term use
Bupropion-naltrexone, an oral medication sold under the brand name, Contrave®
Gelesis 100, an oral medication sold under the brand name, Plenity®
Liraglutide, a medication injected underneath the skin sold under the brand name, Saxenda®, specifically for obesity
Orlistat, an oral medication sold under the brand names, Alli® and Xenical®
Phentermine-topiramate, an oral medication sold under the brand name, QsymiaTM
Semaglutide, a medication injected underneath the skin sold under the brand name, Wegovy®, specifically for obesity
Setmelanotide, a medication injected underneath the skin sold under the brand name, Imciveree®
Tirzepatide, sold under the brand name, ZepboundTM, specifically for obesity
Many of these medications, such as liraglutide, semaglutide, and tirzepatide, are GLP-1 agonists, which have demonstrated effectiveness in treating insulin resistance and reducing blood sugar concentrations in people with diabetes or prediabetes in addition to slowing down the gastric system to treat obesity.
Surgical Interventions
When lifestyle modifications and medications are unable to assist individuals with obesity in reducing their weight, another potential intervention to consider includes bariatric surgery. Diverse surgical procedures have been developed, specifically to aid individuals with obesity in effective weight loss and management.
Types of bariatric surgeries that have enabled individuals with obesity to achieve healthy, long-term weight loss and improve obesity-related medical conditions include the following:
Laparoscopic sleeve gastrectomy—a minimally invasive surgical procedure that frees the stomach from the surrounding organs and uses surgical staples to reduce the size of the stomach by 80%
Roux-en-Y gastric bypass (RYGB)—a procedure that bypasses the larger portion of the stomach that no longer allows for the storage or digestion of food
Placement of an adjustable gastric band (AGB)—a surgery in which a silicone device is placed around the top part of the stomach to decrease the amount of food a person is able to eat
Biliopancreatic diversion with duodenal switch (BPD/DS)—a surgical procedure in which a tube-shaped stomach pouch is created, and the initial section of the small intestine is not used for digestion of food
Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S)—a procedure similar to the laparoscopic sleeve gastrectomy with the added step of dividing the first part of the small intestine (duodenum) and connecting the stomach instead to the last part of the small intestine (the ileum), thus decreasing digestion and absorption of food during its transit through the gastrointestinal tract
Key Takeaways
Just as obesity as a health condition does not have a singular cause, neither should treatment for obesity be administered in a “one-size-fits-all” approach. Treatment of individuals with obesity should be tailored to each person’s unique needs, take a holistic approach, and promote a culture of health and well-being without stigmatizing these individuals for a condition that may not always be caused by their personal choices.
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