What are the health effects of obesity in the body?

Obesity is a common health problem that affects an estimated 1 in 4 adults in the UK.

Here to provide an expert insight into obesity, including its classification, health risks, and treatment, is Dr Sobia Arshad, leading consultant endocrinologist.

What is defined as obesity?

Obesity is often confused for being overweight, but the two are very different.

There is a very clear definition for obesity, which is the measurement of a person’s weight and kilograms divided by their height in meters square. The result is a score, also known as a person's body mass index (BMI).

What are the different classifications?

There are different classifications for obesity, depending on how high the BMI is.

The classifications are as follows:

• A BMI of 30 or above is defined as obesity
• A BMI between 30 and 35 is defined as moderate obesity
• A BMI above 40 is defined as severe obesity
• A BMI between 50 and 60 is defined as very, very severe obesity

The higher the BMI, the more severe the obesity is.

What are the health risks associated with obesity?

Obesity is the combination of fat cells; this refers to not only fat cells under the skin, but also fat cells in organs. As a result, fat cells can accumulate in any organ in the body, including the heart, the lungs, the kidneys, or the ovaries. An organ with extra fat cells will lack its own cells, leading to the disease of that organ. Obesity can thus affect all of the organs in the human body, putting a person’s entire health system at risk.

Can patients with obesity benefit from bariatric surgery, and what are the indications for the procedure?

Absolutely. What I tell my patients is that they must first understand that obesity is a disease. With a disease, first-line management starts with diet and lifestyle changes. If these are not effective, then management progresses to medical therapies. If these do not work, then surgery may be considered. The same is true for obesity.

If a person’s BMI is between 30 and 35, then lifestyle changes can work. However, if a person’s BMI is between 40 and 60, then lifestyle changes will not work. People will thus have to consider medical therapies and surgery, such as bariatric surgery.

Bariatric surgery is most beneficial for people who have a BMI above 40 where lifestyle changes and medical therapy have not been successful. This type of surgery is the only way to lose up to 40 to 50 per cent of body weight.

It is important to know is that if a person’s weight is around 200 to 300 kilograms (and I have seen patients with this weight), then their ideal healthy weight is 100 kilograms less. Given that 100 kilograms cannot be lost only with diet and lifestyle, one needs to seriously think about seeking medical and surgical help in this case.

How can patients maintain a healthy weight after treatment?

It all depends on the kind of treatment that patients have received. With simple lifestyle changes and calorie restriction, weight reduction can be achieved, but it is not sustainable.

What I tell my patients is that the body sees food and calories like money. Just like how no man says, “I have enough money, I do not want any more money”, the body does not say, “I do not need any more food.” Everything that a person consumes is stored in the body’s bank (that is, the liver) or is converted into cholesterol. The body will not lose it.

Thus, if a person has lost weight with diet and lifestyle changes, then it is extremely hard (almost impossible) to maintain and sustain that significant weight loss in the long-term. On the other hand, if a person has received medical therapy, then as long as treatment is continued, weight loss will be maintained.

Of the options, bariatric surgery is the most successful way to lose up to 40 to 50 per cent of body weight and sustain this weight loss several years after surgery. Although there may be some weight gain, a person's weight will not return to square one.

What is your role in bariatric pathway?

As an endocrinologist, my responsibility is to: identify that obesity is a disease; tell my patients what treatment options are available; and ensure that a patient’s obesity has not been caused by a trigger or a secondary cause. Endocrine conditions like Cushing’s syndrome, hypothyroidism, and polycystic ovary syndrome, for example, can all impact a person’s weight.

If there is a trigger and a reversible cause for obesity, then I can help to manage and treat it. However, if there is no trigger, then my job is to tell patients what treatment options are available. These may include bariatric surgery, medical therapies, or newer injectable treatments.

If a patient has a very high BMI and I feel that bariatric surgery is the only pathway, then my duty is to refer this patient to bariatric surgeons for a consultation after having performed all the necessary assessments.

What are the complications of obesity and why should people have a treatment?

Obesity is a disease that affects every organ of the human body where fat cells have accumulated. This can occur, for example, in the heart, the lungs, and the kidneys, leading to a fatty liver or liver failure. If fat cells accumulate in the neck, the neck can become swollen, which can lead to airway problems and sleep apnoea.

In addition, fat cells also produce many hormones that are not needed, including opposite sex hormones. For example, if male patients have multiple extra fat cells in the body which produce female hormones (such as oestrogen), then this could lead to gynaecomastia. If female patients have multiple extra fat cells in the body, then this could lead to hirsutism. Fat could also affect their ovaries and interfere with their reproductive function, causing infertility. Every aspect of life is affected by obesity.

Above all, obesity reduces life expectancy due to the health complications that the disease leads to. Thus, it is extremely important to identify that obesity is a disease and to seek treatment for it.

If you wish to receive support and treatment from a healthcare professional for obesity, do not hesitate to visit Dr Arshad’s Top Doctors profile today.