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Obesity means an excessive accumulation of body fat. A body weight that exceeds the average body weight in standardized tables by 20 percent means obesity, except in highly muscular people.

A body weight that exceeds the average body weight in standardized tables by 20 percent means obesity, except in highly muscular people.

Image: Obesity is generally caused by overeating food and not exercising enough.

Obesity can be defined as mild (20-40 percent excess body weight), moderate (41-100 percent excess body weight), or extreme (more than 100 percent excess body weight). The latter is present in 0.5 percent of overweight people.

Obesity in adults

Data obtained from measurements of a sample of the Slovenian population show that less than half of the people (45 percent) have an average body weight, while the rest are overweight or obese. Obesity is also a big problem in other developed countries and is still growing. In the USA, for example, it is estimated that 31 percent of men and 35 percent of women are obese. The frequency of obesity varies according to age: it is more common in older people than in younger people.

Causes

Obesity occurs when the body receives more calories than it needs. Environmental factors and heredity influence body weight, but the mechanisms of these influences are not fully understood. One possible explanation is that body weight is set as a thermostat. If adjusted to a higher level, a person loses or maintains the desired body weight.

Genetic factors: Recent research has shown that genetic factors influence body weight up to about 33 percent, but their influence is more pronounced in some people and less pronounced in others.

Socioeconomic factors affect obesity, especially in women. In the USA, for example, obesity is twice as common in women from lower socioeconomic classes. Why socioeconomic factors have a pronounced effect on women's weight is unknown. One explanation is that women from the upper classes have more resources for healthy eating and recreation.

Mental factors: until recently, emotional disorders were classified as significant causes of obesity, but today, it is believed that emotional disorders are caused by prejudice against fat people. Negative self-image is one of the biggest problems of overweight young girls, which leads to a marked lack of self-confidence and difficulties in integrating into the social environment.

Developmental factors: an increase in the size and number of fat cells contributes to more excellent fat stores in the body. People who were overweight in childhood can have up to five times more fat cells than people of average weight. Since the number of cells can no longer decrease, weight loss can only decrease the amount of fat in each cell.

Exercise: Lack of exercise in modern, affluent societies is one of the most important reasons for the increased number of obese people. In the USA, for example, obesity is more than twice as typical as it was in 1900, even though the amount of calories consumed per day is 10 percent lower. People with a sedentary occupation need significantly fewer calories. Increasing physical activity in normal-weight people causes them to eat more, but may not have this effect in obese people.

Hormones: hormonal disorders are rarely the cause of obesity.

Brain damage: In rare cases, damage to the brain, especially the hypothalamus, can cause obesity.

Drugs: Drugs that cause weight gain include corticosteroids (prednisone) and many antidepressants, as well as other drugs used in psychiatry.

Two causes of obesity that are provoked by stress and emotional upset are more common: binge eating and night eating syndrome. Binge eating is similar to bulimia, except that the bursts of excessive eating or the pain are not followed by self-induced vomiting. A person consumes too many calories. Night feeding syndrome is characterized by a lack of appetite in the morning, followed by hunger towards the end of the day, excessive feeding, and insomnia at night.

Symptoms

The accumulation of fat under the diaphragm and in the chest area causes difficulty in breathing and shortness of breath even with the slightest exertion. Breathing problems can seriously disrupt sleep and cause periodic cessation of breathing (nocturnal apnea) and excessive daytime sleepiness.

Image: Behavioral adaptations can help manage obesity.

Obesity causes orthopedic problems: pain in the lower part of the spine and worsening of osteoarthritis, especially in the hips, knees, and ankles. Skin changes are expected. Because obese people have a small body surface area relative to their weight, they cannot dissipate heat efficiently, and they sweat much more than people of an average weight. Swelling of the legs and ankles, which is common in obese people, is caused by the accumulation of a tiny to moderate amount of fluid.

Complications

Obese people are more at risk of morbidity or mortality from most diseases, injuries, and accidents, and the risk increases with increasing body weight. The risk is also related to the area where fat accumulates. In men, fat accumulates on the abdomen (circumferential obesity), and in women, on the buttocks and thighs (lower body obesity).

Circumferential obesity is associated with a higher risk of coronary artery disease along with three other risk factors:

high blood pressure,
type II diabetes (which usually occurs in old age) and
increased concentration of fats (lipids) in the blood.

It is not known why peripheral obesity is so dangerous, but we do know that losing weight in these people significantly lowers the risk of developing coronary disease and also has a beneficial effect on blood pressure and blood glucose. Losing weight can even make it possible to discontinue diabetes medications.

Some forms of cancer are more common in overweight people: breast, uterine, and ovarian cancer in women and colon, rectal, and prostate cancer in men. Menstrual cycle disorders and gallstones are also three times more common in people who are overweight.

Diagnosis and treatment

Although excess body weight is visible, it is assessed based on measured weight and height by calculating the body mass index (BMI): weight in kilograms divided by the square of height expressed in meters. A BMI value above 25 means overweight, and above 30 means obesity, which needs to be treated.

Paradoxically, women are eight times more likely than men to seek medical help due to obesity in the lower part of the body (which has a low-risk level). Untreated obesity worsens over the years, and the long-term success of treatment is often disappointing, as most people gain weight again within three years. Opinions about the harmfulness of weight fluctuations are not substantiated and should not hinder overweight people from deciding to lose weight.

The basic condition for weight loss is consuming fewer calories than the individual's daily requirement. Losing weight under professional supervision is possible in three ways: self-help, where people with similar problems share their experiences; counseling in non-clinical programs run by lay counselors; and counseling in clinical programs run by professionally trained counselors and medical staff.

Video content: Lecture: obesity is a chronic disease.

Treatment aims at a permanent change in lifestyle, with a greater share of exercise and the introduction of healthy eating habits. Successful weight loss programs teach people about safe, gradual changes in eating habits, which encourage the consumption of complex carbohydrates (fruits, vegetables, bread, and pasta) and lower fat consumption. For people who are mildly overweight, only a moderate calorie and fat intake restriction is sufficient.

Programs that recommend a low-calorie diet (800 or fewer calories per day) are suitable for moderately obese people who want to lose weight quickly. Medical supervision is required. Enthusiasm for such weight loss is somewhat waning because it is expensive and because people often gain weight again after they stop dieting. Some doctors prescribe weight loss drugs that reduce weight by about 10 percent in 6 months. A specific body weight can only be maintained by taking pills regularly.

In the case of extreme obesity (100% excess weight), treatment can also be surgical. Usually, the operation reduces the size of the stomach, which means that significantly less food is consumed at one time. In this way, approximately half of the excess weight is lost at first quickly and then gradually over the next two years. The new body weight can be successfully maintained. Self-esteem, general well-being, ability to work, and integration into the social environment improve.

Surgical interventions are reserved only for the highly obese; operations are performed in centers with appropriate experience and good results of similar operations. Complications during surgery can be expected in approximately 10 percent, and deaths are less than 1 percent.

Adolescent obesity

Factors that influence overweight in adolescence are similar to those in adulthood. Usually, an adolescent with mild obesity gains weight rapidly and becomes markedly obese within a few years. Most have poor self-esteem, do not exercise enough, and become socially isolated. Parents often do not know how to help such teenagers. Otherwise, there are obesity treatment options for adolescents as well, but there are few specially adapted programs. In rare cases of extreme obesity, surgery is considered.

Figure: the prevalence of obesity varies by age.

Behavioral adaptations can help adolescents manage obesity. Such adaptations include reducing caloric intake (allowed by a balanced diet), permanent changes in eating habits, and an increase in physical activity—e.g., walking, cycling, swimming, or dancing. Professional counseling helps young people overcome their problems and low self-esteem.

Questions and answers

How common is obesity in Slovenia?

22.8% of adult (age 18 and over) women and 21.6% of adult men live with obesity. Slovenia's prevalence of obesity is lower than the regional average, which is 25.3% for women and 24.9% for men^[1].

What is the most significant risk factor for obesity?

Obesity is generally caused by overeating food and not exercising enough. Suppose you consume large amounts of energy, especially fats and sugars, but do not use the energy through exercise and physical activity. In that case, the body will store much excess energy as fat^[2].

Does obesity affect men or women more?

The prevalence of overweight and obesity varies significantly between men and women within and between countries, and overall, more women than men are obese^[3].

Which disease is most common in obese people?

Obesity increases the risk of developing diabetes and high blood pressure, which are the most common causes of chronic kidney disease. Even if you don't have diabetes or high blood pressure, obesity can increase your risk of developing chronic kidney disease and accelerate its progression^[4].

What is the most effective way to reduce body weight and obesity?

The most effective way to reduce weight and obesity is to combine a healthy diet, regular physical activity, behavioral changes, and, if necessary, medical interventions or treatments. A healthy diet is based on eating foods with high nutritional value and reducing calorie intake, mainly processed and sweet foods.

Video content: Obesity in children | Nutritionist Mojca Cepuš.

Regular physical activity includes at least 150 minutes of moderate aerobic exercise per week, such as walking, cycling, swimming, and muscle-strengthening exercises. Behavioral changes such as setting realistic goals, monitoring food intake and physical activity, and seeking support from family, friends, or professionals play a crucial role.

In some cases, medical interventions such as weight loss drugs or surgery may also be helpful^[5].

Sources and references

Country Nutrition Profiles: https://globalnutritionreport.org
Obesity: https://www.nhsinform.scot
Global Gender Disparities in Obesity: https://www.sciencedirect.com
Health Risks of Overweight & Obesity: https://www.niddk.nih.gov
Lifestyle Modification Approaches for the Treatment of Obesity in Adults: https://www.ncbi.nlm.nih.gov