Overweight and Obesity Epidemic in America – Part VII: Health Risks Associated With Being Overweight Or Obese

Suggested Citation: Garko, M.G. (2011, April). Overweight and obesity epidemic in America – Part VII: Health risks associated with being overweight or obese. Health and Wellbeing Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.

Overweight and Obesity Epidemic in America – Part VII: Health

Risks Associated With Being Overweight Or Obese

Michael G. Garko, Ph.D.

Host – Let’s Talk Nutrition

Introduction

The overweight-obesity epidemic is not just an aesthetic problem, causing many who are either overweight or obese to be self-conscious about their appearance. Rather, it is a health crisis creating and increasing health risks, which promote morbidity and mortality, and, thereby, undermine the quality and longevity of life.

Within the context of overweight and obesity, the use of the term “epidemic” is not without significant meaning. Specifically, it refers to the ever increasing rates of overweight and obesity in the United States and around the globe, which began in the 1980s in the United States and continues unabated today throughout America and the world (Hill, 2006). Thus, it is not hyperbole to assert that the overweight-obesity epidemic is among the most serious health threats to American society, generally, and children, adolescents and adults, specifically.

The solution to the overweight-obesity epidemic lies partly in knowing its prevalence among adults, children and adolescents (see Garko, 2010a & 2010b) and the risk factors and causes associated with overweight and obesity (see Garko, 2010c, 2011a, 2011b & 2011c). In order to resolve the problem or at least abate it, it is also important to understand its health risks. Having a grasp of the gravity of the problem in terms of how it affects health and wellbeing can serve to inform and motivate governmental agencies, private sector businesses and health organizations and individuals to help resolve the crisis of the unabating creation and development of an obesogenic American society beset with significant levels of morbidity and disability and premature death.

The April, 2011, issue of Health and Wellbeing Monthly takes a brief look at the overweight-obesity epidemic from the perspective of some of the more important ways it puts the health of individuals at risk.

Overweight and Obesity Defined

The term “overweight” refers to an excessive amount of body weight, which can be constituted of muscle tissue, bone, adipose or fat tissue and water, while the term “obesity” refers to an excessive amount of adipose or fat tissue (see National Institute of Diabetes and Digestive and Kidney Diseases, 2010).

Body Mass Index (BMI) is used to measure the amount of body fat/adipose tissue based on a person’s height and weight. Specifically, BMI is expressed as a person’s weight in kilograms divided by height in meters squared (kg/m2). Individuals with a BMI of 18.5 0 24.9 are classified as being of normal weight. People with a BMI of 25.0-29.9 are classified as being overweight, while those with a BMI of 30 or more are classified as obese and those with a BMI more than or equal to 40.0 are classified as extremely obese (see Ogden and Carroll, 2010).

Health Risks Associated With Being Overweight or Obesity

The overweight-obesity epidemic has created a set of health risks, which threaten to decrease life expectancy in the United States by as much as five years, erasing the gains in health and longevity which have taken decades to achieve (see Olshansky, et al. 2005). The health risks associated with being overweight and obese also increase morbidity and mortality associated in varying degrees with different diseases and disorders (e.g., cardiovascular diseases and disorders, diabetes mellitus, gallstones, osteoarthritis, sleep apnea, cancer, gynecological-related problems and psychosocial health issues).[1]

The health risks discussed below are by presented by category of disease and in alphabetical order and not by severity or contribution to morbidity or mortality.

Cardiovascular Diseases and Disorders

Overweight and obesity affect cardiovascular health in a variety of ways. The morbidity and mortality associated with cardiovascular diseases and disorders caused by overweight and obesity is well established and significant. The occurrence of cardiovascular problems (e.g., coronary heart disease, heart attack, congestive heart failure, sudden cardiac death, angina or chest pain and abnormal heart rhythm) is increased in overweight or obese individuals with a BMI > 25.

Coronary heart disease. It is established in the literature that overweight, obesity and abdominal/visceral fat are correlated to coronary heart disease (CHD) by way of such cardiovascular risk factors as high levels of total cholesterol, high levels of low density lipoprotein cholesterol (LDL), low levels of high density lipoprotein cholesterol (HDL), high triglyceride levels, high fibrinogen and insulin levels and hypertension (high blood pressure). In short, overweight and obese individuals are statistically more likely to run the risk of possessing the mentioned cardiovascular risk factors, which in turn, increase the risk for CHD (see National Heart, Lung, and Blood Institute, 1998).

Congestive heart failure. Based on a number of studies, overweight and obesity are recognized as being independent risk factors for congestive heart failure (CHF). CHF is a condition where the heart is unable to pump a sufficient amount of blood to the cells, tissues and organs of the body. Severe obesity is a recognized predictor of CHF. If obese people suffer from Type 2 Diabetes or hypertension (two factors correlated positively with increasing weight gain) or both, they increase their risk for CHF.

Obesity can cause structural and functional changes to the heart. Structurally, it can cause an enlargement of the ventricles of the heart, especially the left ventricle (i.e. ventricular dilatation) and a growth of the walls of the heart, whereby, the overall size and volume of heart are increased (i.e., eccentric hypertrophy). Functionally, obesity can cause diastolic dysfunction (i.e., ventricles become relatively “stiff” like a thick rubber balloon making it difficult for them to relax and re-fill completely in between heart beats) caused by eccentric hypertrophy and systolic dysfunction (i.e., left ventricle unable to eject/empty blood from chamber caused by excessive stress to the walls of the heart, leading to what is called “obesity cardiomyopathy.” Cardiomyopathy is a chronic disease of the heart muscle (i.e., myocardium). The heart muscle becomes enlarged, thickened or stiffened, which weakens it and causes it to be unable to pump blood effectively, resulting in irregular heartbeats (arrhythmias) and possibly heart failure.

Hypertension. High blood pressure (i.e., hypertension) is operationalized as a mean systolic pressure of ≥ 140 mm Hg or mean diastolic pressure ≥ 90 or taking anti-hypertensive medication. It has been established with cross-sectional and prospective studies that there is a direct and independent correlation between high blood pressure and an increase in BMI. Specifically, hypertension is twice as likely to occur in adults who are obese compared to individuals of healthy weight(see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

As it turns out, obesity and high blood pressure are co-morbid risk factors for the development of cardiovascular disease. According the National Heart, Lung, and Blood Institute’s (1998) report on overweight and obesity in adults, the pathophysiology essential to the development of high blood pressure as it pertain to obesity consists of sodium retention (i.e., kidneys holding on to sodium, expanding blood volume) and related increases in vascular resistance (i.e., resistance to blood flow which must be overcome to move it through the circulatory system, especially the arterioles), blood volume (i.e., total amount of blood including red bloods and plasma) and cardiac output (i.e., volume of blood pumped by the heart).

These particular cardiovascular-related irregularities associated with obesity are thought to stem from a combination of increased sodium retention, increased sympathetic nervous system activity of the heart (i.e., acceleration of heart rate, constriction of blood vessels and raising of blood pressure), changes in the rennin angiotensin aldosterone system (i.e., increased activity of kidneys re-absorbing sodium and water into the blood, raising the body’s volume of fluid, which increases blood pressure) and increased insulin resistance (i.e. skeletal muscle taking up less sugar from the blood, leading to high blood sugar levels and type 2 diabetes, which is linked to high blood pressure).

It is important to know that weight loss leads to an improvement of the mentioned cardiovascular abnormalities (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Dyslipidemia. Dyslipidemia is an abnormal concentration of lipids and lipoproteins in the blood. It is marked by high total cholesterol, high triglycerides, low high-density lipoprotein cholesterol (HDL or good cholesterol), high low-density lipoprotein cholesterol (LDL or bad cholesterol) and small dense low-density lipoprotein particles.  Generally speaking, there is a significant body of research showing that obesity is associated with dyslipidemia, which is associated with less than optimal cardiovascular health leading to coronary heart disease, especially when it comes to elevated levels of LDL-cholesterol and small, dense LDL-particles.

With respect to total serum cholesterol, overweight and obesity are correlated with an increase in total cholesterol, with hypercholesterolemia (i.e., high levels of cholesterol in the blood) increasing as BMI increases. It is interesting to note that total cholesterol levels are higher in persons with predominant abdominal obesity operationalized as a waist-to-hip circumference ratio of ≥0.8 for women and ≥ 1.0 for men. In terms of high triglycerides, cross-sectional and longitudinal studies show an association between high triglycerides and BMI for men and women and all age groups. Obesity is associated with elevated triglycerides. With respect to low HDL-cholesterol, increases in BMI are associated with decreased HDL-cholesterol levels. When it comes to LDL-cholesterol levels, studies indicate that the connection between total serum cholesterol and coronary heart disease is accounted for mostly by LDL-cholesterol and an increase in LDL-cholesterol is associated with an increase in BMI. Finally, small, dense LDL particles are especially damaging to the arteries and are in greater proportion with those suffering from high triglycerides, along with insulin resistance syndrome associated with abdominal obesity (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Cancer

There is a significant amount of meaningful research establishing a connection between obesity and cancer. Generally speaking, studies show that obesity increases the risk for colon cancer, postmenopausal breast cancer, endometrial cancer, gallbladder cancer, kidney cancer and prostate cancer. Women who gain more than 20 pounds from 18 years of age to midlife tend to double their risk of postmenopausal breast cancer than those women who keep their weight stable (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Diabetes Mellitus

More than 80% of individuals who suffer from type 2 diabetes are either overweight or obese. Prospective studies conducted in Norway, Sweden, Israel and the United States reveal that with increased weight gain there is an increased risk of developing type 2 diabetes. For example, a U.S. study showed that 27% of new cases of type 2 diabetes were associated with weight gain in adulthood of 11 lb or more. In fact, gaining 11-18 pounds doubles an individual’s risk of developing type 2 diabetes compared to those who have not gained weight. Further, studies show that excess abdominal fat is a significant risk factor for type 2 diabetes (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007)

Gallstones

People tend to increase their risk for gallstones with an increase in weight. For example, with a BMI above 40 the risk for gallstones or cholecystectomy runs as high as 20% per 1,000 women annually compared with 3% per 1,000 women who have a BMI < 24. With respect to men, other research data indicate that the prevalence of gallstones rose from 4.6% in the first quartile of BMI to 10.8% in the fourth quartile of BMI (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Gynecological-Related Issues

Generally speaking, obesity is heavily implicated women’s reproductive health. It creates complications and health risks for the mother and child. For example, obesity during pregnancy is associated with increased morbidity and mortality for mother and child. It poses an increased risk for hypertension and gestational diabetes. Obesity during pregnancy gives rise to high birth weights, which create difficulties during labor and delivery resulting in an increase in induction and Caesarean section. It is also associated with an increased risk for birth defects, especially neural tube defects such as spina bifida. In addition to complications during pregnancy, obesity in premenopausal women is associated with irregular menstrual cycles and amenorrhea (i.e., absence of a a menstrual period in women of reproductive age) (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Osteoarthritis

The research makes it clear that overweight and obese individuals increase their risk for the development of osteoarthritis. In fact, for every two pounds of weight gained, there is a 9% to 13% increased risk of developing osteoarthritis.  Studies reveal an association between increased weight and osteoarthritis of the knee and that the risk is stronger in women than in men. For example, a study of twin middle-aged women estimated that for every kilogram increase of weight there was an increased risk of developing osteoarthritis from 9% to 13% (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Premature Death

Obesity is responsible for an estimated 300,000 deaths annually. It is associated with premature death. The risk of death rises with an increase in weight, with mortality beginning to rise with a BMI ≥ 25. Those with a BMI ≥ 30 run a 50% to 100% increased risk for premature death from all causes, especially cardiovascular disease, than those with a healthy weight. It is reported that even a 10 to 20 pound weight gain for a person of average height increases the risk of death, especially for adults 30-64 years of age (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Sleep Apnea

Obesity has been shown to create breathing problems. Obesity, especially upper body obesity, is a risk factor for sleep apnea (i.e., interrupted breathing while sleeping). Most people suffering from sleep apnea have a BMI > 30. Anatomically speaking, men and women who snore and have a large neck girth are likely to suffer from sleep apnea. Specifically, men with a neck circumference ≥17 inches and women with a neck circumference ≥16 inches run a higher risk for sleep apnea. Sleep apnea is not without its health consequences. For example, sleep apnea can result in arterial hypoxemia, recurrent arousals from sleep, increased sympathetic tone, pulmonary and systemic hypertension and cardiac arrhythmias (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Premature Death

Obesity is responsible for an estimated 300,000 deaths annually. It is associated with premature death. The risk of death rises with an increase in weight, with mortality beginning to rise with a BMI ≥ 25. Those with a BMI ≥ 30 run a 50% to 100% increased risk for premature death from all causes, especially cardiovascular disease, than those with a healthy weight. It is reported that even a 10 to 20 pound weight gain for a person of average height increases the risk of death, especially for adults 30-64 years of age (see National Heart, Lung, and Blood Institute, 1998; U.S. Department of Health and Human Services, 2007).

Conclusion

The health risks associated with overweight and obesity are becoming entrenched consequences populating the landscape of an American society becoming more obesogenic with literally each passing day. Cardiovascular diseases and disorders (e.g., coronary heart disease, congestive heart failure, hypertension and dyslipidemia), cancer, diabetes mellitus, gallstones, gynecological-related issues, osteoarthritis, premature death and sleep apnea are among the health risks putting the health and well-being of American children and adults into jeopardy.

References

Garko, M.G. (2010a, October). Overweight and obesity in America – Part I: Disturbing statistics and trends. Health and Wellbeing Monthly. Retrieved  March 1, 2011, from www.letstalknutrition.com.

Garko, M.G. (2010b, November). Overweight and obesity epidemic in America – Part II: Prevalence and trends among children and adolescents. Health and Wellbeing Monthly. Retrieved March 1, 2011, from www.letstalknutrition.com.

Garko, M.G. (2010c, December). Overweight and obesity epidemic in America – Part III: The immediate cause. Retrieved March 1, 2011, from www.letstalknutrition.com.

Garko, M.G. (2011a, January). Overweight and obesity epidemic in America – Part IV:  What risk factors and causes are and why it is important to know about them. Retrieved March 1, 2011, from www.letstalknutrition.com.

Garko, M.G. (2011b, February). Overweight and obesity in America – Part V: Non-Modifiable Risk Factors. Health and Wellbeing Monthly. Retrieved March 1, 2011, from www.letstalknutrition.com.

Garko, M.G. (2011c, March). Overweight and obesity in America – Part VI: Modifiable Risk Factors. Health and Wellbeing Monthly. Retrieved March 1, 2011, from www.letstalknutrition.com.

Hill, J.O. (2006). Understanding and addressing the epidemic of obesity: An energy balance perspective. Endocrine Reviews 27(7):750 –761. DOI: 10.1210/er.2006-0032. Retrieved March 1, 2011, from http://edrv.endojournals.org/cgi/reprint/27/7/750

United States Department of Health and Human Services (2007). Overweight and obesity: Health Consequences. Retrieved March 1, 2011, from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.htm

Suggested Citation: Garko, M.G. (2011, April). Overweight and obesity epidemic in America – Part VII: Health risks associated with being overweight or obese. Health and Wellbeing Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.

 

 


[1] The discussion on the health risks associated with being overweight or obese borrows heavily from National Heart, Lung, and Blood Institute’s report entitled, Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity In Adults: The Evidence Report and from U.S. Department of Health and Human Services, Office of the Surgeon General (see References for this article for citations).