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How Does Obesity Affect My Health? (Continued)

1. Cardiovascular Disease

Cardiovascular disease is the number 1 cause of death in the U.S., accounting for the loss of well over 700,000 lives per year. The American Heart Association considers obesity to be a major risk factor for cardiovascular disease. Studies have found that as levels of obesity increase so does the risk for cardiovascular disease and associated death.

Weight gain alters both the structure and function of the cardiovascular system. An enlargement (hypertrophy) of the major pumping chamber of the heart (the left ventricle) is common with obesity. The enlarged heart results from the extra workload imposed upon the heart by the increased needs of the larger body. Over time, this condition can lead to congestive heart failure which, if left unattended, can be fatal. Studies estimate that approximately 15% of individuals with morbid obesity are in congestive heart failure.

The enlarged heart can also cause irregular heartbeats or arrythymias. Irregular heartbeats, in turn, are a primary cause for sudden death. Individuals who are morbidly obese have a higher incidence of arrythymias and up to a 40-fold increased risk of sudden death. Sudden death, as well as congestive heart failure, also result from heart damage incurred by a blockage of the vessels that supply the heart with oxygen and nutrients, a condition known as coronary artery disease.

Coronary artery disease (CAD) claims over a half million lives annually. The disease occurs when the coronary arteries (vessels) that supply blood to the heart become clogged by plaque formed in the arteries (atherosclerosis) or by a blood clot that occurs when the plaque is damaged (atherothrombosis). When this happens, the affected portion of the heart dies because it does not receive enough oxygen and nutrients from the blood. This may cause angina (pain or pressure in the chest), a heart attack, and death. Studies have found that obesity is not only an independent risk factor for CAD and associated mortality but also contributes significantly to the development of other major CAD determinants, i.e. hypertension, lipid abnormalities, chronic inflammation, oxidative stress, and diabetes.

Hypertension is a major risk factor for CAD and, in addition, is a cause for, and an effect of, structural and functional cardiovascular abnormalities responsible for cardiac failure or sudden death. Studies suggest that greater than 75% of hypertension may be attributable to obesity and that the risk for hypertension increases in proportion to body fatness. Some studies have reported that more than half of obese individuals are hypertensive.

Lipid abnormalities are another major risk factor for CAD. Obesity is associated with elevated blood lipids (triglyceride), reduced levels of the good (anti-heart disease) cholesterol carrier, HDL, and alterations in the composition and size of LDL, another cholesterol carrier that significantly increases the risk for heart disease. Studies, including our own, have found that individuals who are obese, compared to their leaner counterparts, have higher blood levels of LDL cholesterol, lower levels of HDL, and greater triglyceride production. Such alterations in lipids may explain, in part, why obesity increases one’s risk for CAD and stroke.

2. Cancer

Cancer is the second leading cause of death in this country, responsible for over 600,000 deaths per year, with over 90,000 of these deaths attributable to obesity. A long-term study supported by the American Cancer Association and involving nearly a million participants found that serious obesity, defined as 140% (or above) ideal body weight, is associated with an increased risk of all types of cancer (33% and 55% greater risk for males and females, respectively). The study showed that the risk of specific forms of cancer is even higher. For females, obesity is associated with a high risk of endometrial, cervical, ovarian, breast and gallbladder cancer and for males, a high risk of prostate and colon cancer.

3. Cerebrovascular Disease

Cerebrovascular disease including stroke is the 3rd leading cause of death in the U.S. A stroke is a ‘brain attack’ that occurs when a vessel or artery supplying a particular area of the brain becomes clogged or breaks, interrupting blood flow to the affected area of the brain and causing death of the tissue. Obesity puts a strain on the entire circulatory system and, in this way, increases stroke risk. Obesity also is responsible for the development of other conditions that increase the risk for a stroke, such as heart disease, hypertension, lipid abnormalities, diabetes, and obstructive sleep apnea.

4. Respiratory Disorders
Respiratory disorders are the 4th. leading cause of death in the U.S. Studies have found that the obese are more susceptible to respiratory infections than are their non-obese counterparts. The obese are also more susceptible to obstructive airway diseases, such as asthma. The incidence of asthma with obesity has been reported to be increased by approximately 2-fold in adults and up to 5-fold among children.

Obesity is believed to be a major cause for a very serious and potentially deadly, breathing disorder known as obstructive sleep apnea. This disorder occurs when fat in the neck, throat, and tongue obstruct air passageways during sleep, causing ‘apnea’ which is a temporary absence of breathing. An individual with this breathing disorder may have hundreds of apnea episodes each night. Obstructive sleep apnea causes exceptionally low tissue and blood levels of oxygen and is associated with systemic hypertension, pulmonary hypertension, heart failure, sudden cardiac death and stroke.

5. Diabetes
Diabetes is the 5th leading cause for death in the U.S. The disease is associated with an increased risk for amputations, cardiovascular disease, stroke and blindness, kidney disease, hypertension, lipid abnormalities, circulatory and nerve defects, hard-to-heal infections, impotence, and more. Diagnosis of diabetes is believed to reduce an individual’s lifespan by as much as 35%.

Obesity is a primary cause for Type 2 or non-insulin-dependent diabetes, a form of diabetes involving a resistance to insulin rather than a lack of. Type 2 diabetes accounts for 90 to 95% of all diabetes cases and 80% to 90% of patients with this form of diabetes are obese. As levels of obesity increase so does the risk of Type 2 diabetes. An individual with mild obesity may have a 2-fold greater risk of developing Type 2 diabetes, as compared to someone who is lean, whereas a severely obese person may have up to a 10-fold higher risk.

6. Accidents

Accidents are the 6th leading cause of death in the U.S. As discussed above, obesity contributes to the development of sleep apnea which, in turn, interrupts normal sleep cycles, causing headaches, depression, fatigue, and daytime sleepiness. An individual with obstructive sleep apnea often falls asleep during the day which, in some occupations, could be particularly hazardous. Imagine the consequences of a bus driver falling asleep while on the job? A heavy machinery operator? A surgeon? A pilot?

Joint diseases, such as gout and arthritis, are other ways that obesity increases the risk for accident mortalities. Gout is an inflammation of joints caused by elevated levels of uric acid, and studies have shown a positive association between increases in body weight and levels of uric acid in the blood. Weight gain also causes wear-and-tear on weight-bearing joints, such as the knees, hips, lower back and ankles. Such wear-and-tear often causes arthritis. Excessive joint pain, caused by either gout or arthritis, could increase the risk for falling.

Additional consequences of obesity that could act to impair one’s degree of mobilization and increase the risk for accidents (and death from such) include disc herniation and lumbar spine abnormalities such as scoliosis, kyphosis, or hyperlordosis. Pseudotumor cerebri (intracranial hypertension) is yet another condition worsened, or caused, by obesity. Such condition is associated with disorientation and visual impairment, which could significantly increase the risk of accidental death.

7. Pneumonia and Flu

The 7th. leading cause of death is pneumonia and flu and the obese are likely to be more susceptible to these diseases than would someone who is lean. Obesity significantly reduces the immune system’s ability to protect and fight against viral and bacterial invasion.

8. Alzeheimer’s Disease

Alzeheimer’s Disease is the 8th. major cause of death in the U.S., and studies find that obese individuals are at greater risk for developing this debilitating disease.

9. Kidney Disease

Kidney disease is the 9th. leading reason for death. Conditions caused by obesity, including hypertension, diabetes, and congestive heart failure, are major contributors to renal failure.

10. Septicemia

Septicemia is the 10th. leading cause of mortality. The condition is a serious infection that rapidly progresses to septic shock and death. Studies show that the obese, particularly the morbidly obesity, are at much higher risk for septicemia than are individuals whose body size is normal.

11. Suicide

12. Fatty Liver Disease

There are yet other obesity-associated co-morbidities that are life-threatening. Fatty liver disease, the 12th major cause of death in the U.S. is far more prevalent among individuals who are obese than lean. Inflammation of the liver, a condition known as non-alcoholic steatohepatitis or NASH, occurs in about 1% to 3% of the normal weight population but as many as 60% of individuals with morbid obesity. NASH, over time, can, eventually, progress to cirrhosis and cause liver failure.
Obesity also increases the risk of certain maternal complications, such as pre-eclampsia and eclampsia, that may endanger the life of both mother and child. Stillborn births and miscarriages are far more prevalent among females who are obese. Furthermore, obesity increases the risk for other health problems, such as gestational diabetes, that adversely influence pregnancy outcome.

Various gastrointestinal complications are caused, or worsened, by obesity and some of these may be quite serious and even life-threatening, if left unattended. Such complications include gallstones, gastroesophageal reflux disease (GERD), gastritis and acute pancreatitis.

Obesity may be responsible for other health-related defects that are not life-threatening but reduce life quality, such as urinary stress incontinence, urinary infections, menstrual irregularity in females, hypogonadism in males, sex hormone abnormalities, and infertility. Quality of life, self-esteem, and overall sense of well-being are also dramatically compromised by the social and psychological burdens of obesity which, in turn, can negatively influence health status or even lead to suicide, the 11th. major cause of death in the U.S.

From the above discussion, it is apparent that obesity ‘kills’, contributing to all of the major diseases responsible for death in this country. Weight loss, even small amounts, i.e. 5 to 10%, improve these conditions and, the massive weight loss that accompanies bariatric surgery not only improves but even cures many of these deadly diseases. Weight loss surgery ‘cures’ diabetes, hypertension, lipid abnormalities, infertility, depression, GERD, gastritis, sleep apnea, left ventricular hypertrophy, and cardiac arrest in more than 90% of cases and dramatically reduces the risk for coronary artery disease, stroke, cancer, accidents, Alzheimer’s Disease, kidney disease, septicemia, and more.

Along with the resolution or improvement of life-threatening obesity-related diseases with weight loss is a highly significant increase in longevity. A recent Canadian study, for instance, involving a large number of morbidly obese bariatric surgical patients and their non-surgical morbidly obese controls found that weight loss with surgery reduces the risk for death by nearly 90%.

In summary, obesity is a killer because obesity causes or contributes significantly to those diseases and conditions responsible for most of the deaths in the U.S. However, this apparent ‘mother’ of death can be contained by weight loss with resolution or improvement of disease states, reduced risk for major illnesses, and a significant extension in longevity.

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