Understanding obesity: What is it and how is it treated?

Obesity is an incredibly complex yet treatable chronic disease that impacts millions of people worldwide. It is often a lifelong battle for people who struggle to lose weight. It is associated with higher risk factors for disease and comes with a significant social stigma and treating obesity isn't a simple or quick fix for anyone.

Obesity is associated with a high body mass index in both adult obesity and childhood obesity. We constantly hear we are in the midst of an obesity epidemic — but what does that actually mean?

Read on as we start by defining obesity, and explore the causes of obesity and the risk factors and health complications that come from this chronic disease.

What is obesity?

Obesity is defined as a person who has excess body fat [1]. The NHS estimates in the UK, 1 in 4 adults and 1 in 5 children aged 10-11 are obese. Obesity is considered to be a chronic health condition.

The World Health Organisation notes that worldwide obesity rates have close to tripled since 1975. Obesity or being overweight is linked to more deaths globally than being underweight [2].

How is obesity classified?

Obesity is most commonly classified using the body mass index (BMI) which uses your height and weight to determine whether you fall into a healthy weight. You can calculate your body mass index using the NHS BMI healthy weight calculator [3].

Generally speaking:

• A healthy weight range BMI calculation is between 18.5 to 24.9
• A BMI score over 30 is considered obese
• For Black, Asian and other ethnic groups a score of 27.5+ is considered obese

It is worth noting that the body mass index does not calculate muscle mass, which weighs more than fat, or bone or other bodily tissue. BMI is based on body weight, not body fat percentage, which is why it is often considered too simplistic to be the only measure of obesity [4].

Another way to measure obesity is to look at your waist circumference. You can measure your waist (the midway point between the bottom of your ribs and the top of your hips) and divide it by your height.

This method gives insight into the amount of visceral fat mass around your midsection, which is associated with a higher risk of some health conditions [5].

What are the causes of obesity?

Obesity was first thought to be caused by an energy imbalance — that is, a person consumes more calories than they expend. While this is partially true in some cases, we now know there are more causes of obesity than simply eating too much and moving too little [6].

They include:

Genetics

Your genetics can directly cause a person's weight gain or can contribute to weight gain.

Health conditions

Pre-existing health conditions from hormones such as PCOS, an underactive thyroid or Cushing syndrome can cause obesity.

Medications

Certain medications such as the pill, anti-depressants, corticosteroids and seizure medicines can all cause weight gain.

Environmental factors

Where you live and your personal economic circumstances can impact your ability to exercise and ability to access affordable nutritionally dense food like fruit and vegetables. Being super busy and time-poor can also result in eating more processed, calorie-dense foods high in sugar.

Lifestyle factors

Many of us have a fairly sedentary lifestyle with less physical activity due to working in office jobs, lengthy commutes and less time for exercise. This can be a reason obesity occurs.

Stress

When we feel stressed we may fall into emotional eating. Stress also causes a biological response with increased levels of cortisol, which creates a surge of energy and more cravings for sweet, fatty and salty foods.

Lack of sleep

The hormones that help regulate appetite and how our body uses energy are released when we sleep. Lack of good quality sleep can stunt or prevent weight loss and result in excess weight.

Poor diet

This can mean an abundance of high-calorie food without nutritional benefits. A poor diet often occurs from a lack of affordable healthy foods as well as a lack of education or knowledge in how to create a healthy diet.

Some research has shown other factors for obesity may be related to birth factors such as maternal smoking, maternal nutrition or a particularly high or low birth weight.

Who is at risk of obesity?

The Health Survey of England found age groups of 45-74 were most likely to be overweight or obese, and men were more likely than women to be overweight or obese [7]. Other risk factors for obesity in the survey included coming from a low socioeconomic area or having less formal education.

People with a family history of obesity are also at higher risk of developing obesity and obesity-related complications. Low and middle-income families are also at risk of a double burden of malnutrition and obesity, from the affordability of energy-dense low-nutrition foods [2].

How is obesity diagnosed?

The most common way to be diagnosed as overweight, obese or severely obese is to see your general practitioner or healthcare professional. If you are assessed to have a BMI above a normal weight for your height, gender and ethnicity, you may be considered to be obese.

Healthcare professionals involved in your obesity diagnosis or treatment may ask you about your personal and medical history, as well as your current diet, waist circumference and any reasons for sudden weight gain.

What are the complications associated with obesity?

People with a high body mass index of over 30 may be at higher risk of negative health effects. We know from extensive research that generally obesity reduces life expectancy by an average of 3-10 years, depending on how severe obesity is.

Obesity-related complications from excessive weight gain or long-term weight gain come with an increased risk of developing one or a number of co-morbid conditions.

Cardiovascular disease

Obese children are reported to be 3 times more likely to have high blood pressure (hypertension). Other obesity-related complications include high cholesterol, which can lead to coronary heart disease, heart failure and stroke.

Inflammation

Obesity is associated with chronic inflammation which is often associated with an increased risk of cancer and infectious disease.

Fertility

Obesity in men is associated with a reduced sperm count and increased rates of erectile dysfunction. Obese women are more likely to have reduced fertility, pregnancy complications, and loss [7]. They are also a higher risk factor for developing Polycystic Ovarian Syndrome (PCOS).

Gastrointestinal problems

Non-alcoholic fatty liver disease is the most common cause of chronic liver disease. Obesity is a risk factor for developing NAFLD, as well as digestive diseases like GERD and more serious conditions like pancreatitis, digestive organ cancers or gallstones.

Metabolic syndrome

A combination of diabetes, obesity and high blood pressure can lead to metabolic syndrome, a combination of serious health conditions.

Overweight and obesity are also risk factors for kidney disease or impaired renal function, both directly and indirectly. Developing type 2 diabetes, hypertension or heart disease can all contribute to developing chronic kidney disease.

How is obesity treated?

The main treatment for obesity is losing weight. However, treating obesity is rarely simple. It requires a holistic approach that encompasses a caloric deficit with support, lifestyle changes and expert advice.

To lose weight you must be in a caloric deficit — that is eating less high-calorie foods and more nutritionally dense foods that are lower in calories.

That's where a program like Juniper’s Weight Reset Programme can help you to achieve sustained weight loss. We use scientifically-backed medicine to help you lose weight, while our health coaching and behavioural change measures help you keep it off in the long term.

We understand that there isn't a one-size-fits-all approach to weight loss, which is why we support you with individualised health coaching and access to a private community of other people on the same journey.

Keep in mind that even moderate weight loss of 3% of your total body fat percentage can significantly reduce your risk of developing obesity-related complications like heart disease and type 2 diabetes [8]. But, patients on the class of medication included in the Weight Reset Program tend to lose 10-15% of their body weight in a year [9].

Weight gain, being overweight or obesity does not have to define you. With the right support and education, you can start the sustainable journey to better health outcomes today.