By Dr. Kevin Wang
Obesity: Part II
First, I'd like to respond to a letter sent to me after Part I was published. A reader said my column was offensive to people that are overweight and that some of my facts were wrong. She directed me to a website that promotes "the advancement of fat acceptance."
"Due to widespread prejudicial medical treatment and harassment by health care professionals, such as the ignorance displayed by Dr. Wang in his offensive article," she wrote, "many fat people do not receive adequate preventative health care, and frequently delay seeking treatment when there is a medical problem. It appears to me that the true 'Raging Epidemic' here is fat-phobia and ignorance."
In response, I do understand the issues with body image and the problems associated with this type of discrimination. However, that wasn't the intent of my column. Being overweight does have health complications and all studies show there's an increased risk of several conditions that can be treated (or made better) with weight loss. By no means do I ask my patients to become celebrity-esque thin, but I stress that losing even just five pounds can significantly improve your health. I would not be doing my job as a physician (and doing a disservice to the community) if I didn't inform my patients, and the readers of BTL, of the risks of any health concerns.
In Part I, I defined obesity as a calculation taking your weight and height. The American Heart Association has stated that waist circumference also plays a role. Men who have a waist circumference greater than 40 inches and women with a waist circumference greater than 35 inches are at increased risk of the conditions that I wrote about in Part I and the conditions I will describe below.
A problematic condition that might not be on top of some people's list is fatigue. This is primarily attributable to something called Obstructive Sleep Apnea (OSA). Sleep apnea can occur in people with large tonsils, but OSA also occurs due to the extra weight in the neck and chest region. When you start falling asleep, the muscles in your neck start to relax and the extra weight on your chest and neck start to close off the trachea. When that happens, you start snoring, then stop breathing a bit. Your brain, sensing the loss of oxygen, wakes you up. In severe cases, one could wake up hundreds times throughout the night. This results in a non-restful sleep. The result is extreme fatigue during the day, daytime sleepiness and a slower metabolism (which makes losing weight even harder!).
Diagnosis of OSA is made from the patient's history with complaints of fatigue during the day, snoring at night and a non-rejuvenating sleep. To confirm our diagnosis, patients are sent off for a "sleep study" where they are observed sleeping. Treatment consists of fitting with a mask that helps to keep the airway open and maintain good oxygen flow. The mask takes some getting used to. But even after just one day of use, patients notice a huge increase in energy.
Another condition that obesity increases the risk of is osteoarthritis (or just plain arthritis). Joints most affected include the knees and ankles. The arthritis is a result of the excess weight and the direct trauma associated with it. There are some temporary solutions such as joint injections, pain relievers and over-the-counter options like chondroitin sulfate and glucosamine. These can help relieve pain if the arthritis is mild to moderate. A more permanent solution involves weight loss but if the damage is too severe, it doesn't always help.
Lastly, the most important part of the body affected includes the cardiovascular system. There's an increased risk of coronary artery disease even if there's a weight increase within the "normal" range. This, combined with the increased risk of high blood pressure, diabetes and cholesterol, will increase your risk of having angina (chest pain due to blocked arteries to the heart) and a heart attack.
Another dangerous condition is heart failure. Your heart has to work harder to pump your blood. Your body compensates by thickening the muscle around the heart, but it's a temporary solution. Soon, the muscle becomes so thick that the heart muscle weakens and can't circulate the blood. Your heart may also go into a flutter rhythm from the muscle changes. This pools the blood in your heart and keeps it still. This can make your blood clot and, if it forms in the wrong place, it might send a clot out to your lungs or your brain resulting in a stroke.
With the next column, I'll discuss healthy ways to lose weight, including proper diet, exercise and keeping your motivation strong! As with anything I discuss, please discuss your health concerns and see your primary care physician to discuss ways to improve your health.
