Obesity Comorbidities
What is obesity and what are the complications?
Obesity is primarily the result of an imbalance between energy intake and energy expenditure. It is defined as an unhealthy, excessive accumulation of body fat that puts both your body and nervous system under tremendous stress, increasing the risk for many unwanted health outcomes.
In Abingdon, chiropractic care can play a crucial role in managing the complications associated with obesity. These complications often lead to comorbidities, where individuals may experience more than one condition simultaneously, which is associated with worse health outcomes.
As a trusted chiropractor in Abingdon, we frequently see that obesity is linked with several comorbidities, including cardiovascular disease, type 2 diabetes, depression, sleep apnea, osteoarthritis, back pain, and even several forms of cancer.
Many individuals who struggle with obesity also experience issues related to mood, self-esteem, quality of life, and body image.
Research suggests that between 20% and 60% of people with obesity also suffer from psychiatric illnesses such as anxiety disorders, mood disorders, depression, personality disorders, and eating disorders.
Fortunately, weight loss is typically associated with improvements in psychosocial status and quality of life, and the role of chiropractic treatment in Abingdon can be instrumental in supporting these health goals.
This demonstrates several conditions that are associated with obesity.
This picture shows the scales and stadiometer that are required for measuring weight and height for BMI measurements.
Understanding Body Mass Index (BMI)
Body Mass Index (BMI) is the most widely used measure to diagnose obesity. While the accuracy of BMI in diagnosing obesity is limited, it provides a general guideline. At our Abingdon chiropractic clinic, we understand that those with a higher BMI have a higher prevalence of comorbidities.
Studies suggest that obese adults (BMI over 30) are more likely to experience pain compared to their normal-weight and underweight counterparts. For example, individuals classified as Class I obesity (BMI of 30 to 34.9) are 1.762 times as likely as underweight and normal-weight participants to report severe pain.
Those in Class II obesity (BMI of 35 to 39.9) are 1.888 times more likely to experience severe pain, while those categorised as Class III obesity are 2.297 times more likely.
•BMI (Underweight) < 18 kg
•BMI (Healthy): 19 to 24.9 kg
•BMI (Overweight): 25 to 29.9
•BMI (Class I obesity): 30 to 34.9 kg
•BMI (Class II obesity) 35 to 39.9 kg
•BMI (Class III obesity) 40 kg and above
Body Mass Index is a simple calculation using a person's height and weight. The formula is BMI = kg/m2 where kg is a person's weight in kilograms and m2 is their height in metres squared.
Obesity and Pain: How Chiropractic Care in Abingdon Can Help
Recent reports suggest that almost half of the UK population is expected to be obese by 2030. With this rise, the presentation of obese patients with chronic pain will likely increase.
At our Abingdon chiropractic centre, we have observed that several studies positively correlate the experience of pain with an increase in BMI.
However, it remains unclear whether obesity causes chronic pain, chronic pain causes obesity, or another factor causes both concurrently. Chronic pain may result in obesity due to physical inactivity and the use of eating as a form of pain relief, both physically and emotionally.
Increased mechanical stresses on the body due to obesity are believed to contribute to an increased risk of musculoskeletal and joint pain.
Our chiropractic treatments in Abingdon often address these issues, particularly focusing on lower back pain and lower limb pain, such as knee pain.
Additionally, the proinflammatory state associated with obesity can exacerbate pain and is linked to conditions like type 2 diabetes mellitus.
Interestingly, inflammatory markers like interleukin 6 (IL-6) contribute to the systemic manifestations of rheumatoid arthritis (RA), which is another area where Abingdon chiropractic care can be beneficial.
Obesity and Health Outcomes
Depression
Previous research suggests a relationship between excess body weight and depression. Those with extreme obesity are almost five times more likely to have experienced an episode of major depression in the past year as compared with those of average weight. This relationship between obesity and depression seems to be stronger for women than men, perhaps because of society’s emphasis on thinness as a characteristic of female beauty.
Eating Disorders
Disordered eating is common among those with obesity. Many individuals report that they engage in eating for emotional reasons; others report having difficulty controlling the frequency of their eating, portion sizes, or eating behaviour in response to the bombardment of food cues from modern society. Somewhat surprising to some, only a small minority have formally recognized eating disorders. The most common eating disorder among those with obesity is binge-eating disorder. Binge-eating disorder is characterized by the consumption of a large amount of food in a brief period (less than 2 hours), during which the individual experiences a loss of control. As a result, the individual eats much faster than normal, until uncontrollably full, in the absence of hunger, and often eats alone. After eating, the individual often reports disgust.
Anxiety
Anxiety disorders are common among those with obesity. The most common anxiety disorder in candidates for bariatric surgery is social anxiety disorder, found in 9% of patients. Considering Western society’s emphasis on thinness as a marker of physical beauty, it is not surprising that people with extreme obesity report increased anxiety in social situations. Nevertheless, social anxiety, unless of crippling intensity, is not believed to contraindicate weight loss treatment.
Substance Abuse
A small minority of individuals with obesity present for weight loss treatment actively abusing substances. Active use or abuse is considered a contraindication to weight loss treatment. Approximately 10% of candidates for bariatric surgery report a history of illicit drug use or alcoholism, a percentage higher than seen in the general population.
Mental Health Treatment
Many individuals with obesity have turned to mental health treatment to modify their eating habits or address the emotional consequences of the disease. The use of psychiatric medications, particularly antipsychotics and some classes of antidepressants, can contribute to weight gain and/or negatively impact weight loss efforts.
Self-Esteem
Obesity can impact an individual’s self-esteem. For some individuals, it may be difficult to recognize and appreciate talents and abilities because of their struggles with their weight. For others, obesity has relatively little impact. These individuals may be comfortable with their work and home life, but their weight has been the one area where they have not been successful.
Quality of Life and Body Image
Obesity also negatively impacts health-related quality of life. Numerous studies have shown a relationship between excess body weight and decreases in quality of life. Individuals often report significant difficulties with physical and occupational functioning. These impairments likely motivate many individuals to seek weight loss treatment. Body image is an important aspect of quality of life for many individuals as body image dissatisfaction is common for individuals who are overweight, as it is for women and girls of average weight. The degree of dissatisfaction seems to be directly related to the amount of excess weight a person has, although persons can report dissatisfaction with their entire bodies or with specific features. Even in the presence of significant weight-related health problems, body image dissatisfaction is believed to play an influential role in the decision to seek weight loss treatment.
Sexual Abuse, Physical Abuse, and Emotional Neglect
There seems to be a modest association between sexual abuse and obesity. Physical abuse is similarly common among persons with obesity. Approximately 50% of persons with extreme obesity report some form of emotional neglect during their childhood, ranging from verbal abuse, emotional neglect, or other family dysfunction associated with separation, divorce, substance abuse, or incarceration of a member of the nuclear family.
Stigma and Discrimination
Obesity can contribute to the experience of discrimination. Individuals with obesity are less likely to complete high school, are less likely to marry, and typically earn less money compared with persons of average body weight. Persons who are obese are frequently subjected to discrimination in several settings, including educational, employment, and even health care settings. These experiences may be even more common among those suffering from severe obesity.
Depression and Suicide
Several studies have identified a relationship between depression, suicidality, and obesity. For example, women with obesity are significantly more likely to experience suicidal ideation and to make suicide attempts than their normal-weight counterparts. Persons with extreme obesity have been found to be more likely to attempt suicide than persons in the general population. In general, weight loss is associated with improvements in depressive symptoms.
Thyroid function and obesity
The thyroid is a small butterfly-shaped gland located in the front of the neck just above the windpipe (trachea). The thyroid produces and releases hormones such as thyroxine (T4) and triiodothyronine (T3), which influence basal metabolic processes and/or enhance oxygen consumption in nearly all body tissues. Thyroid hormones also influence linear growth, brain function including intelligence and memory, neural development, dentition, and bone development. All forms of thyroid diseases are much more frequently observed in women than men, with the prevalence about 2% in women and 0.2% in men. The most common cause of primary hypothyroidism is chronic autoimmune thyroiditis (Hashimoto's disease), in which the thyroid is destroyed by antibodies (proteins that protect you when an unwanted substance enters your body) or lymphocytes (white blood cell in the immune system) that attack the gland. Other causes are radioactive iodine and surgical therapy for hyperthyroidism or thyroid cancer, thyroid inflammatory disease, iodine deficiency, and several drugs that interfere with the synthesis or availability of thyroid hormone. Stress can be one of the environmental factors for thyroid autoimmunity. For example, posttraumatic stress disorder has been associated with higher risk of hypothyroidism, especially in women with PTSD.
An important interaction exists between thyroid function, weight control, and obesity as it is known that little variations in thyroid function are closely related to weight changes and adipose tissue that can affect the thyroid function.
An underactive thyroid gland (hypothyroidism) is where your thyroid gland does not produce enough hormones and results in a deficiency in T4 (thyroxine) and T3 (triiodothyronine), that can result in symptoms such as fatigue, tiredness, depression, lethargy, cold intolerance, slowed speech and intellectual function, slowed reflexes, hair loss, dry skin, weight gain, constipation, muscle cramps, carpal tunnel syndrome.
An overactive thyroid (hyperthyroidism) is where the thyroid gland produces too much of the thyroid hormones and can result in nervousness, anxiety, heart palpitations, rapid pulse, tiredness, fatigability, tremor, muscle weakness, weight loss with increased appetite, heat intolerance, frequent bowel movements, increased perspiration, and often thyroid gland enlargement. Preventive nutrition enriching the daily diet in products with a high antioxidant value to support the internal antioxidant defence systems may constitute a promising approach to preventing the development of many chronic thyroid diseases as well as other oxidative diseases.
An alternative approach to losing weight with health benefits
Promoting weight loss through dietary and lifestyle intervention such as exercise is necessary in the prevention of obesity which is crucial for thyroid disorders. Studies have shown strong beneficial associations of intermittent fasting, especially modified alternate-day fasting for 1 - 2 months as a weight loss approach for adults with overweight or obesity. The main forms of fasting, activating the metabolic switch from glucose to fat and ketones, starting 12–16 h after cessation or strong reduction of food intake. Clinical and animal studies have clearly indicated that modulating diet and meal frequency, as well as application of fasting patterns, e.g. intermittent fasting, periodic fasting, or long-term fasting are part of a new lifestyle approach leading to increased life and health span, enhanced intrinsic defences against oxidative and metabolic stresses, improved cognition, as well as a decrease in cardiovascular risk in both obese and non-obese subjects.
KEY MESSAGES
Biochemical changes during fasting are characterised by a glucose to ketone switch, leading to a rise of ketones, advantageously used for brain energy, with consequent improved cognition.
Ketones reduce appetite and help maintain effective fasting and weight loss.
Application of fasting patterns increases healthy life span and defences against oxidative and metabolic stresses.
Long-term fasting, with durations between 5 and 21 days can be successfully repeated in the course of a year.