It’s no secret that putting on extra pounds has more profound consequences than not fitting into your favorite jeans or looking fit in a bikini. As we covered last month, over two-thirds of the nation is overweight, and over one-third of children and adolescents are overweight or obese. Though it’s not clear exactly how added weight contributes to the development of various diseases, it’s clear that it accompanies some uncomfortable, some serious, and even some fatal signs and symptoms.

Obesity is associated with a 2-fold increased risk of cancer, a 4-fold increased risk of cardiovascular events, and a 6 to 12-fold increased risk of all-cause mortality. When broken down into body systems, extra weight can be related to, and exacerbate other issues. In the respiratory system, it can lead to sleep apnea, predispose one to respiratory infections, and be associated with the onset of asthma. In the cardiovascular system, it is associated with high blood pressure, hardening of the arteries, and increased cardiovascular events such as a heart attack or stroke. Comorbidities (conditions present at the same time) of obesity related to digestion include gallbladder disease, liver disease, and gastroesophageal reflux disorder. It is associated with metabolic and immunological disorders such as diabetes, skin infections, and complications to surgeries such as infections or clotting. One of the major symptoms we see of overweight and obese people is musculoskeletal pain and osteoarthritis, especially related to low back, hip, and knee pain. In women, it can also be related to infertility, anovulation, and polycystic ovaries. In men, it is associated with hypogonadism (reduction of testes function). Often, obesity is present alongside many cancers including breast, prostate, colon, and bladder cancer, to name a few. But worse of all, and the most difficult aspect to treat is the psychological impact often resulting in depression and decreased energy.

How is it that such a common change in the body can be the accomplice to such life changing conditions? Weight and body composition is just another gauge in the body. Like body temperature, heart rate, and blood pressure, they are dynamic measures that give us insight to the internal state of the body. But unlike our vital signs, these measures generally fluctuate over longer periods of time, have many factors that contribute to them, and they have an insidious and wide range of effects on body systems. In this way, weight is more similar to poor energy and poor sleep, although these are more difficult to measure. The trouble with these general symptoms is that often, we find ways around addressing them in order to get on with our lives. If you have poor energy, you can just drink another cup of coffee or add an energy drink to the mixture. If you have poor sleep, you can try taking a benadryl, a glass of wine, or maybe get some prescription sleep aids. These ways of addressing poor energy and poor sleep don’t really address it. It just covers up their effect on getting through the day in the moment, but the next day presents with the same problems. And the longer these problems remain, the worse they get. Weight gain is like this. You start to gain weight a little at a time, and one must be attune to its subtle effects and take action quickly to keep it in check.

Factors that contribute to being overweight and obese include genetics, demographics such as background, age, and sex, socioeconomic status, cultural factors, hormones, dietary habits, activity habits, smoking cessation, psychological factors, and medications. Other than known ethnic groups that tend towards obesity such as groups of Pacific Islanders, the Pima Indians of Arizona and some Hispanic populations, genetic profile is not a sole contributor to obesity. This may be inferred by the increasing weight we see among immigrants of developed countries, when compared to their native counterparts. A prime example is Ghanaians and Nigerians who become overweight or obese after immigrating to the US. Some studies confer that a cultural or socioeconomic factor is more dominant than even dietary habits or activity level, though socioeconomic status and education can substantially influence lifestyle factors. One of these studies looked at type 2 diabetes risk in people who worked more than 55 hours per week comparing only socioeconomic status. The risk of developing Type 2 diabetes only increased in those in the low-status category, and the increased risk was nearly 30%. A couple of large studies of kindergartners have shown that the 20% increase in obesity rates of children between 1998 and 2010 were concentrated in those from families of lower socioeconomic status.

In Chinese medicine, extra weight is a combination of stagnant energy and dampness. Here, you can think of stagnant energy as heaviness, lethargy, aches and pains in the muscles and joints, weakness in the muscles and joints, and lack of motivation. Dampness can be viewed as an explanation of the physical characteristics of weight gain such as heaviness, ability to permeate all tissues, ability to give rise to accumulation and transformation into heat (i.e. inflammation). Factors that contribute to stagnant energy and dampness include diet choices, irregular eating, overwork, overworry, anger, inactivity, and irregular sleep. Foods that produce the most damp are sugar, dairy, and cold foods. Why is this? These foods interfere with optimal metabolism and contribute to inflammation. Cold foods require the body to take extra energy to warm it up while processing it, leading it to absorb and metabolize less effectively. Fresh, unprocessed, whole foods will provide the body with optimal nutrition, and require less energy to break it down. Irregular eating damages the rhythms of the digestive tract. The digestive tract has its own complex nervous system that relies on time triggers. The parasympathetic nervous system in the digestive tract is activates proper digestion. Rest and relaxation promote the parasympathetic nervous system, which is why overwork and overexertion can interfere with proper digestion. Other emotions can get in the way as well. And of course, good energy depends on regular activity and good quality sleep.

The rise of obesity has its effects on society as well. The cost of managing obesity in the US amounts to 20.6% of national expenditures on health. On average, an obese person spends nearly $3000 more annually than a nonobese person on medical bills. And Americans spend about $134 billion every year on weight loss products and services. Besides fiscal consequences, it alters society’s expectations. There’s a note of exasperation and hopelessness when it comes to addressing weight loss. It becomes more convenient to blame weight gain on genes. What’s worse is that many companies benefit from this perception–their survival relies on society’s surrender to obesity. What’s the point of trying to lose weight if we don’t have any control over it? It feels like it doesn’t matter whether to indulge in processed convenience food or not. It certainly makes life easier sometimes. We can take control over weight gain and the foods that contribute to weight gain by glorifying foods, using them to celebrate events, creating the most exaggerated versions of unhealthy foods. We see this at places that call themselves “The Heart Attack Grill,” or when a favorite TV character advocates eating a hot dog wrapped in pizza, covered in cheese. This becomes normal. It becomes fun. It becomes not fun to stray away from this norm–even self-depriving. Against all of these pressures, what’s the point of trying to lose weight?

The effects of obesity on society produces a vicious cycle of creating an increased susceptibility to obesity in the US. Many capitalize on the psychological effects of obesity by creating a market for addressing obesity and for creating a steady increasing supply of consumers. Economically speaking, this sector in health care has grown substantially over the last 50 years and continues to grow. We hear a lot of muddled information in the media about weight loss and how to attain a healthy weight. We clearly understand that increased convenience foods, increased fast food establishments, lack of access to fresh whole foods, and increased sedentary lifestyle all contribute to our nation’s epidemic. But we still lack the cultural infrastructure that encourages everyone to be conscious of healthy lifestyle habits, which promote healthy weight at an early age. The increase in childhood and adult obesity starts to be misinterpreted as character attributes such as apathy, laziness, and destructive behavior. We don’t see it for what it partly is, which is society’s shortcoming to support the individual in their pursuit of well being. One message we’re constantly exposed to is how skinny is attractive, and dieting and losing weight should just be normal status. Interestingly, recent studies from the US and UK have shown that people who think of themselves as overweight are more likely to gain weight. On the other hand, another message we’re receiving is that any weight, whether, overweight or obese, is acceptable, and even encouraged. This perception is a healthier one to take up to a limit. It doesn’t negate that obesity is still a medical problem. Overall, being aware that society plays a role in difficulty losing weight can be helpful when identifying obstacles to weight loss.

We’ve seen some examples of how extra weight can exacerbate multi-system conditions. Another aspect to consider is how these multi-system conditions exacerbate obesity. Short sleep duration increases the risk of obesity in children and adults. There is also evidence that functional gastrointestinal disorders such as irritable bowel syndrome either share a similar etiology or may even exacerbate weight gain. Weight gain can throw off hormonal regulation, but it can also be a sign of an endocrine cause. Weight gain is a common effect of long standing hypothyroidism. Lastly, depression is associated with an increased risk of becoming obese especially in adolescent females. Any discomfort that compromises one’s energy level will contribute to the inability to take care of oneself. It’s important to address the health and wellbeing of an individual before weight gain and obesity becomes a concern.

In the next article, we will try to gain an understanding of the physiology of obesity.

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