- Author: Milorad Radusin MD
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Obesity - the paramount, oversimplistic explanation
People like simplifications. Simple things are clear and don’t impact our time or cause frustration. For example, marriage is often perceived as a straightforward association between a husband and wife, while in war, one side is always the aggressor and morally wrong. In movies, characters are simply good or bad. It is in our nature to oversimplify, to ignore nuances that complicate our understanding. Similarly, the causes of obesity are often viewed as clear-cut: a person with excessive weight consumes too many calories and is physically inactive. And that’s it.
However, science and oversimplifications rarely align. Science delves into every detail relevant to a subject. Weight gain involves a confluence of psychological issues, environmental influences, genetic predispositions, molecular mechanisms, and pathological states. It is not merely a result of overeating and a sedentary lifestyle. To achieve meaningful progress in addressing obesity, it is essential to move beyond basic knowledge and embrace its complexities. The deeper our understanding, the more effective our interventions will be.
The Consequences of Obesity
Obesity is a gateway to numerous challenges, not just health-related ones. Finding well-fitting clothes can be a struggle. Obese children often face bullying, while obese adults encounter various social stigmas. The health implications, however, are particularly alarming. Obesity is closely associated with type 2 diabetes, dyslipidemia, low back pain, arthritis, urinary incontinence, and erectile dysfunction. Studies estimate that obesity contributes to 35% of ischemic heart disease, 55% of hypertension, and 80% of type 2 diabetes cases among European adults. These statistics underscore the urgency of addressing obesity as a major public health concern.
The Global Scope of Obesity
Obesity is a global epidemic that is steadily worsening. In 2016, 11% of the global population was classified as obese, while 39% were overweight. Despite the complexity of its causes, fewer than 1% of obese individuals have an identifiable genetic disorder or pathological condition directly responsible for their weight. Instead, the primary driver of obesity is a combination of excessive calorie intake and insufficient energy expenditure. This condition is aptly termed “exogenous obesity” to distinguish it from obesity caused by medical conditions.
Measuring Obesity
Body mass index (BMI) is a widely used, though imperfect, measure of obesity. BMI is calculated using body weight and height, and healthy values range from 18.5 to 25 kg/m². Individuals with a BMI over 40 kg/m² are considered severely obese, often leading to consideration of bariatric surgery. Waist circumference is another useful metric; measurements exceeding 94 cm in men and 80 cm in women are indicative of increased health risks.
The distribution of body fat also matters. The “apple” type of obesity, characterized by fat accumulation in the upper body, poses greater health risks than the “pear” type, where fat is concentrated in the thighs and buttocks. Excess fat is not inert; it is metabolically active and can disrupt normal bodily functions when it accumulates beyond healthy limits.
Addressing Obesity: Beyond Simplifications
While it is an oversimplification to attribute obesity solely to a long-term surplus of calories, this explanation holds a kernel of truth. Modern life is designed to minimize physical exertion, from cars and elevators to remote work. Small changes, such as walking instead of driving short distances or taking the stairs instead of the elevator, can make a meaningful difference. Similarly, fast food—a well-known contributor to obesity—can be mitigated through conscious dietary choices. Changing eating habits and incorporating physical activity are significant steps toward combating obesity.
For individuals not affected by serious medical conditions, the journey to better health often begins with simple changes, like a short, regular walk. Tackling obesity requires both an acknowledgment of its complexity and a commitment to actionable solutions.
References
Murtagh J, Rosenblatt J, Coleman J, Murtagh C, eds. Murtagh’s General Practice, 7th ed. McGraw-Hill Australia Pty Ltd; 2018.
