What are the associated obesity risk factors? Animals eat impulsively because they are conditioned to do it for survival. For all life on the planet Earth, food is not a choice. It is a daytime job of survival. The hardest thing for an animal in the wilderness is to gain weight. There is no overabundance in nature because as soon as there is, the number of animals will increase and the new balance will be achieved. This will again create a situation of constant hunger.

However, in a modern technologically driven society, there is no scarcity. This is the reason why the hardest thing for us is to diet. For most of our evolution, we were slim in a state of constant hunger as any other animal. This was the case for all of our ancestor species and that means the time period of 50 million years. The obesity epidemic today is a maladaptation that is caused by the overabundance of food. This is the new normal and the old normal of dying from starvation is a thing of the ancient past. The problem is that ”ancient” is not really ancient in evolutionary terms. Evolution works for millions of years. The obesity epidemic is therefore more than just a cosmetic issue. It is a health issue that we have to cope with and as a consequence, we will have risk factors that will be associated with it. Being overweight is not a cultural acceptance issue it is a health issue that will never be going to go away.

What are the associated obesity risk factors? The body fat percentage (BFP) measures the total fat that you have. Body mass index measures total mass depending on tallness and are different from Body fat percentage. If we have greater muscle mass or larger bones, we will have a higher BMI, so it tells us nothing about fat percentage.

For example, there is the so-called “skinny fat” body type, where you have a high BMI and high BFP or in other words, you are obese and at the same time, you have low muscle mass. Or you can have a high BMI and low BFP like bodybuilders do. Body fat percentage in the leanest athletes is typically at levels of about 6–13% for men or 14–20% for women, this means full six-pack abs and a general shredded look.

Also, there is something called visceral fat, and that is fat that we cannot see. The fat we may be capable of touching on our arms and legs is subcutaneous fat. This internal visceral fat encloses essential organs like the liver, heart, and kidneys and is called organ fat, intra-abdominal fat, or visceral fat. When you are overweight you have more fat inside than you might think. In essence, if we are obese we will have more fat inside than outside. A growing belly can be the result of both types of fat.

Carrying a large quantity of visceral fat is associated with stroke, heart disease, insulin resistance, osteoarthritis, gout, sleep apnea, asthma, breast cancer, and colorectal cancer. Individuals with a body mass index (BMI) of 30 or higher are considered obese. The term obesity is used to describe individuals who have a weight that can start to cause them health problems and is significantly above their ideal healthy weight. The term morbid obesity is used for individuals that have problems in their regular daily activities due to excessive weight gain. It is a form of disability. Nearly 70% of American adults are either overweight or obese.

Excess weight may increase the risk for many health problems, including:

1. Type 2 diabetes
2. High blood pressure
3. Heart disease and strokes
4. Certain types of cancer
5. Sleep apnea
6. Osteoarthritis
7. Fatty liver disease
8. Kidney disease
9. Pregnancy problems (high blood sugar, high blood pressure)

When we talk about risk factors associated with obesity we mean only the diseases that exercise weight is going to create just by itself. In reality, the situation is very different because people that are obese usually at the same time have a very unhealthy diet. It is possible to gain a lot of weight on a nutritionally optimized whole food diet but in reality, extracted sugar and fat and other refined products make a big chunk of calories that creates the excessive caloric intake in the first place.

Having excessive weight in a more realistic condition also means having high cholesterol, high saturated fat, low mineral, low vitamin, low phytochemical and antioxidant, and high pro-inflammatory nutrient-deprived diet. Most of the people that read this will have a hard time understanding that we have in reality a situation where most obese people are also malnourished at the same time. In nutrition, there is a term “junk food” or “empty calorie”. It is similar to the “skinny fat” phenomenon.

Nutrition deficiency affects most of the population at the same time when the population is overweight. Nutritional deficiencies are a wide topic, especially because the land that is used to produce food is depleted and which means that crops will be depleted and that means that animal feed will be deleted. On top of that food is refined and the end result is hypercaloric addictive food filled with calories and nothing much else. In situations where obese people want to go on a calorie-restricted diet and are already malnourished and deficient in most of the essential and non-essential nutrients, we could have a situation that will create a wide range of diseases and all of that diseases will not be directly correlated to obesity but in a sense they are. Eating organic food has much less to do with pesticide residues or with genetically modified organisms but much more to do with low quality eroded land where these food are grown. In organic farming using synthetic fertilizers is forbidden.

Heart disease and stroke

Besides carrying large amounts of visceral fat hypercaloric diet also in practice means a higher load of nutrients that our body is also not adapted well to metabolizing. A good example of this is cholesterol. In herbivore species, because they do not eat meat the cholesterol is produced by the liver and they do not need to eat it for their entire life. But when we start to overeat then our body will not be able to metabolize it and that will create additional deposits on blood vessels that will create an increase in risk factors from cardiovascular disease. Obesity on top of that independently just by weight creates increasing pressure on the heart muscle. The increased pressure and all of the cholesterol deposits then create pressure in small or for that measure even larger blood vessels that can be clogged. This will then lower the blood flow and as a response body will increase pressure to increase flow or some of the organs can be left without blood supply. An increase in pressure and deposited fat on the lining and inflammation then can lead to cascading bad effects. Stroke for example is the same disease as a heart attack with a different outcome. Obesity will create a higher risk of stroke. There are actually two main types of stroke, ischemic stroke, and hemorrhagic stroke. In the first one, there will be clogging of the artery and in another type, the artery will burst open. Both of them are associated with obesity.

Excess estrogen, low testosterone, and low growth hormone

Adipose tissue is not a dead organ that sits there and does nothing. It is actually an active organ that has enzymes and is metabolically active. For example, fat cells have enzymes that will metabolize testosterone into estrogen. The enzyme is called aromatase. In breast cancer or in bodybuilding for example one of the goals is to reduce estrogen by blocking its conversion from testosterone by taking aromatase inhibitors. Testosterone is produced at the first instance and only then this enzyme changes it to estrogen. Both are very important hormones and the body needs them both. Unnaturally high levels of fat deposits will create an unnatural level of estrogen and will lower testosterone and that will have cascading effects on the rest of the body (1).

It is a condition known as hypogonadism (low testosterone) and it usually comes with old age. One of the longevity treatments for the elderly is something known as testosterone replacement therapy which puts the testosterone levels in the elderly in a range of young adults. This can help with muscle wasting, libido, energy and motivation, bone density, and so on. Having low testosterone for both genders is something everyone will want to avoid.

One of the effects will be an increased risk of cancers that are estrogen-responsive such as breast cancer. (2)

Also, higher estrogen has a wide range of cascading bad effects for itself. One would be polycystic ovarian syndrome. Having disrupted and out of balance levels of androgenic hormones is not just a question of having acne or bodybuilding. It is a serious health issue that affects the quality of life and can create serious diseases.

Disruption in androgenic hormones will also increase infertility (13). Obesity is associated with subfertility and more than 40% of women seeking obesity surgery do that primarily because they want to have a baby. Infertility in obese patients is correlated to androgen hormone excess on top of insulin resistance. (3)

Fat tissue will also suppress the production of growth hormone (4). Growth hormone deficiency influences a person’s height and helps build bone and muscle. The growth hormone also affects metabolism (the rate at which we burn kilojoules for energy) and will burn fat at a higher rate. One of the strategies of professional athletes is to take a growth hormone to burn fat and build muscle. As for longevity treatment in the elderly, it can also help with a wide range of issues just by itself. A low level of growth hormone can cause a decrease in muscle mass and strength, very low energy levels, reduced bone density, elevated triglyceride levels, and cholesterol, it will affect collagen production and will create dry and thin skin and balding, anxiety and depression, decrease in sexual function.

Fatty liver disease

Obesity is associated with a spectrum of liver abnormalities, known as nonalcoholic fatty liver disease (NAFLD). Most NAFLD patients are asymptomatic on clinical presentation, even though some may present fatigue, dyspepsia, and dull pain, a general feeling of being unwell and vague discomfort. Treatment for NAFLD involves weight reduction through lifestyle modifications, anti-obesity medication, and bariatric surgery. It is estimated that 75% of obese individuals are at risk of developing a simple fatty liver. A simple fatty liver is far from a “simple” condition. Up to 23% of obese individuals are at risk of developing fatty liver with inflammation. Almost 10% of children may have NAFLD, due in large part to an alarming increase in childhood obesity. In morbidly obese individuals number is 95%. In the picture, you can see how fat goes internally into the cells of the organs. The liver is swollen due to exercise fat intake. In this case, it is done deliberately by force-feeding with a tube. The practice is known as gavage.

There is also a “spillover” effect where fat cells after a point could not keep all the fat inside them and the fat leeches out to the bloodstream (5). Fat will then interfere with insulin signaling inside the cells and will increase the resistance of the cells to insulin creating diabetes type 2. Higher blood sugar levels will also suppress growth hormones (6). Lipotoxicity also at the same time has the ability to directly kill insulin-producing cells in the pancreas and increase the risk of diabetes type 1 (7).

Joint problems (osteoarthritis)

Unlike muscle tissue, the cartage is unable to adapt to the ever-increasing load of weight to the same extent. Cartilage cannot grow to become more resilient because in that case the movement would be obstructed. The consequence is that when we have an ever-larger increase in weight gain that is not congruent with our evolution there is a line where the joints are going to take severe damage in time (8). Obese people will have higher pressure on cartilage and it will wear down over time. There is no difference between being forced to carry bags of cement or being forced to carry excessive fat tissue.  There will be physical damage. Then when cartage wears down the inflammation will start or in other words osteoarthritis. Symptoms will include pain, tenderness, swelling, stiffness, grating sensation, and loss of flexibility. This is on top of the loss of flexibility that just excessive weight will cause. In cases of morbid obesity, some people are unable to leave the bad and are unable to stand on their own and this is because of weight on top of any issues that might exist due to arthritis. Osteoarthritis is not an autoimmune disease like rheumatoid arthritis and it is caused just by physical damage to the joints. It is the most common form of arthritis. And it is a “one-way street”.

Sleep apnea

Excessive pressure will also put a lot of strain on muscle tissue that is responsible for breathing and at the same time will obstruct breathing pathways. The narrowest part of that pathway is in the back of our throat and while we are awake that pathway is relatively open. But when we go to sleep the muscles relax and excessive weight will put pressure on them. That will cause closing by narrowing of the opening. This will interrupt breathing and will lower our oxygen intake basically this is a form of suffocation. This can cause not just snoring but interrupted sleep patterns, cardiovascular disease, and premature death. Especially if there is a combination with some other disease that causes swelling like allergies for example or smoking or taking sedatives. Most of the people that are obese have this to some extent and the real problem is that a big chunk of people will have this for a long time before they realize that they have it.  When you’re awake, muscles keep. But when you sleep, those muscles relax, allowing the opening to narrow. In Western countries prevalence is estimated at around 2% of women and 4% of men (9).

Kidney disease

Why weight gain affects kidneys is largely unknown. There are theories but so far there is no clear answer. It might be a consequence of increased inflammation and oxidative stress, insulin resistance, and hypertension (10). As fat goes everywhere it will go to the kidney as well and will create damage by raising inflammation. It is known as a fatty kidney (11). The problem with kidneys is that unlike the liver they cannot regenerate themselves. Once the damage is done it will remain for the rest of the life. Having excessive weight will increase the damage and losing weight afterward will not reverse the damage that has already been done. It will also increase the risk of kidney cancer.

Obesity also creates inflammation in the body as a general rule. This means that if we are obese we will have to take a much higher level of antioxidant-rich anti-inflammatory food than someone who is not because we will have a higher level of chronic inflammation that will have a cascading effect and none of them are good. From cancer risk to cardiovascular risk. When inflammation rises the response of the body will be to increase cortisol production by the adrenal glands as it is the main anti-inflammatory hormone of the body. But then that can create high cortisol levels or in other words Cushing’s syndrome. Cortisol is also a stress hormone that puts the body in flight or fight mode and is correlated to different conditions from insomnia, anxiety, and also it is a catabolic hormone that will catabolize muscle mass.  

By now you understand that this is just the list of diseases that are directly associated with just excessive weight gain. In real life, this list should be widened because most people that are obese are not on the whole food plant-based nutrient-rich anti-inflammatory, antioxidant-rich, nutrient-dense diet.

Sources:

Passages selected from a book: “Go Vegan? Review of Science: Part 1” [Milos Pokimica]

1. Endocrine Changes in Obesity Sharleen Sidhu, MD, Tanvi Parikh, MD, , and Kenneth D Burman, M.D.
2. Obesity and adverse breast cancer risk and outcome: Mechanistic insights and strategies for intervention doi: 10.3322/caac.21405
3. Obesity & osteoarthritis Indian J Med Res. 2013 Aug; 138(2): 185–193.
4. Growth hormone in obesity. Int J Obes Relat Metab Disord. 1999 Mar;23(3):260-71.
5. Spillover of Fatty Acids During Dietary Fat Storage in Type 2 Diabetes doi: 10.2337/db12-1407
6. Effects of growth hormone on glucose metabolism. Horm Res. 1991;36 Suppl 1:32-5.
7. What Is Lipotoxicity? doi: 10.1007/978-3-319-48382-5_8.
8. Obesity & osteoarthritis Indian J Med Res. 2013 Aug; 138(2): 185–193
9. Obesity and Obstructive Sleep Apnea doi: 10.1513/pats.200708-137MG
10.  Obesity and Kidney Disease doi: 10.1177/2054358117698669
11.  Fatty kidney, hypertension, and chronic kidney disease: the Framingham Heart Study doi: 10.1161/HYPERTENSIONAHA.111.175315
12.  Cortisol, obesity and the metabolic syndrome: A cross-sectional study of obese subjects and review of the literature doi: 10.1002/oby.20083
13.  Obesity and infertility. Curr Opin E3ndocrinol Diabetes Obes. 2007 Dec;14(6):482-7.
14. Obesity and cardiovascular disease in women https://doi.org/10.1038/s41366-020-0548-0

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