Obesity is a disease that, once established, is the trigger for multiple disorders that occur in most organs and systems of the body. Thus, the first metabolic changes occur, which are the basis of the appearance of type 2 diabetes, cardiovascular, respiratory, hepatic, hormonal, etc. disorders appear, all of which are triggered by the disorders that occur in the body with excess weight.
The risk of complications secondary to obesity is closely related to a series of factors such as: the degree of obesity, the preferred location of excess weight (considerably higher risk in the case of abdominal obesity), the age of the patient, his pathological history, lifestyle (sedentarism is often indicted as an important factor in the progression of obesity) and, last but not least, the diet of the obese, quantitatively and qualitatively different from that of a normal weight person.
Among the formidable complications of obesity, insulin resistance and hyperinsulinism seem to occupy one of the first places. The main role of insulin would be to control blood sugar and regulate the metabolism and growth of carbohydrates. From the studies conducted to date, adult obesity with normal insulin sensitivity does not seem possible. All these disorders that gradually manifest themselves in the body of the obese patient are at the basis of the appearance of one of the most devastating metabolic diseases: type 2 diabetes. However, the sum of these disorders would not be sufficient for the onset of diabetes, as the involvement of the genetic factor is also necessary, through a predisposition to exhaustion of the pancreas after intense demand and an impossibility of hypersecretion.
Among the important metabolic changes that occur in the obese patient, there are also those of lipid metabolism, which occur at a relatively early stage in the evolution of the disease. Therefore, there was an increase in the level of fasting and postprandial triglycerides, a decrease in the plasma level of HDL cholesterol (good cholesterol) and an increase in the values of total cholesterol and LDL cholesterol (bad cholesterol).
Of all the complications that an obese patient can develop, cardiovascular ones are the most common and the most significant. In association with a number of factors such as: poor physical activity, psychological and social problems, diabetes, dyslipidemia, hypertension, sleep apnea, the obese patient can easily develop cardiovascular disease. Coronary heart disease is a slowly evolving condition over several decades. The main cause is atherosclerosis. The process begins in childhood and continues throughout life, regardless of whether the person is of normal weight or not. However, this process is accentuated in obese patients as lipid metabolism disorders are more important, but not limited to. Therefore, the risk and incidence of angina pectoris, sudden death and myocardial infarction are significantly increased, the risks being related to the age, sex and distribution of the patient’s adipose tissue. The risk of arrhythmias and sudden death in the obese is much higher than in a person of normal weight, even in the absence of pre-existing heart disease. The most common rhythm disturbance seen in obese people is an increase in normal heart rate of 2-5 beats / minute. Obesity, especially abdominal obesity, is an independent risk factor for stroke. It is known that one of the important factors for the development of this pathology is the presence of high blood pressure. The combination of these risk factors (obesity and high blood pressure) will significantly increase the risk.
A major increase in cancer was found in the evolution of obesity, relative to its frequency in people of normal weight. Lifestyle and diet are indicted in the development of this pathology. Breast cancer, cervical cancer and ovarian cancer occur very frequently in women. All obese patients are at risk of developing colon cancer, kidney cancer, esophageal cancer (especially through gastroesophageal reflux involvement), pancreatic cancer. In men, the frequency of prostate cancer is increasing.
In conclusion, obesity has been recognized by a large number of countries as a disease that poses numerous problems, not negligible, the population with varying degrees of overweight is increasing year by year all over the globe. It affects the patient’s quality of life, freedom of movement, family budget, professional and social integration and, through the resulting comorbidities, can create a significant disability.
Dr. Claudiu COBUZ
General Practitioner for Diabetes, Nutrition and Metabolic Diseases, Doctor of Medical Sciences, University Lecturer
