There is a “pandemic” of obesity in civilized developed countries all over the world. Of course, obesity is no a classic disease, it is rather a complex metabolic condition that is associated with many complications. Obesity can be defined as abnormally heavy weight with excessive content of body fat tissue.


However, not every kind of obesity is similarly dangerous. There are basically two types of obesity according to the shape of the body – the “apple” type and “pear” type.


Pear type obesity is typical for women and the majority of fat tissue is stored in and around the hips. Apple obesity usually occurs in men and it means the concentration of fatty tissue in the abdominal area. The fat is located around internal organs (visceral fat) and under the skin (subcutaneous fat). The visceral fat can not be seen, but it is especially this fat tissue that is metabolically most dangerous and causes various health complications including cardiovascular diseases and type 2 diabetes.


The fundamental problem is nothing more than higher energy intake and lower energy output. The condition is usually caused by overeating and lack of physical exercise. There is probably some role of genetics and rarely, the situation may be influenced by hormonal disorders (Cushing's syndrome, underactive thyroid gland, acromegaly, etc.). We should also not forget long-term usage of corticosteroids.



Manifestation and complications

Obesity is not only a cosmetic problem. Obese people usually suffer from the so-called metabolic syndrome that includes high cholesterol level, atherosclerosis, hypertension, cardiovascular diseases and type 2 diabetes. Excessive weight also damages joint, especially the joints of lower extremities (such as hip and knee) leading to premature arthritis.


The diagnosis of obesity may be easily stated usually just by looking at the patient. The objective calculation is a little bit harder; we usually use the BMI value. BMI, or Body Mass Index, is a value of patient's weight divided by square of his height. In metric system, BMI unit is kg / m2 and the value of BMI above 30 means obesity. Of course, BMI is not totally precise and the BMI of a sportsman with excessive musculature may be similar to BMI of a typically fat person. Therefore, it is wise to evaluate the condition not only from BMI, but also from other values such as the amount of fat tissue


The amount of fat tissue may be measured by a special scale that sends a weak electrical impulse to the patient's body and evaluates the fat tissue according to electric resistance of the body. Fat is a poor conductor of electricity and higher body fat increases the resistance.


It was also found out that the risk of obesity is closely associated with the circumference of the abdomen and this value is often measured.


The diagnosis of obesity should be followed with measuring the blood pressure, checking serum cholesterol levels and glycemia (glucose serum level). It is also wise to examine the levels of thyroid hormones to exclude an influence of underactive thyroid gland.


The basic therapy is very simple, but also very unpopular - proper diet and a lot of physical exercise. It must be emphasized that the diet must be comprehensive, long-term and should be consulted with a specialist. The physical exercise does not need to be exhausting, it is quite sufficient to ordinary walk half an hour a day. This exertion has a huge effect not only on the weight loss, but also on prevention of cardiovascular diseases. People with damaged joints may prefer swimming or cycling. If there is present any primary causative factor of obesity (such as underactive thyroid gland), it is necessary to treat it, if possible.


The pharmacotherapy focuses on drugs decreasing the appetite, or preventing the absorption of fat from the intestine. However, the drugs may have serious side effects and should be taken only when prescribed by a doctor.


Surgical intervention is the last option. There are two main types of operative approaches. One option is to surgically connect the patient's stomach to the large intestine (thus partially bypassing the small intestine where the nutrients are absorbed). The advantage is that the patient may eat normally and despite that, the weight fall down. On the other hand, the patient may suffer from diarrhea and the lack of certain nutrients (vitamins and minerals). The other option is the so-called gastric banding surgery. The intervention means introducing a tightening band around the stomach, so it gets shape of an hourglass with smaller upper part. The main consequence is loss of appetite. The results are perfect and the patient can drop the weight of 40-50 kg. The disadvantage is that the patient must strictly reduce the volume of digested food. Some patients “cheat” by eating caloric liquid food (whipped cream) and thus minimizing effect of the banding. The surgical intervention is not indicated to everyone and the patient should be initially examined by a gastroenterologist and psychologist to evaluate potential benefits and risks.


Liposuction, i.e. the removal of subcutaneous fat tissue, is rather a cosmetic intervention. The most harmful fat is stored near inner organs and this fat tissue is not affected by the procedure. Therefore, liposuction has practically no significant therapeutic effect.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources