Weight Matters - Part 2
In this post, we are going to look into some of the common and serious medical conditions that are associated with increased weight/obesity; this post focuses on co-morbidities  resulting from fat distribution and function, and the resultant impact on our body.
Type 2 Diabetes Mellitus (T2DM)
“Diabesity” is the latest epidemic on the block. According to the International Diabetes Federation, the current prevalence of diabetes in India is 8.8%, roughly nine out of every 100 Indians have diabetes (approximately 117 million Indians). India also harbors the second highest number of people with diabetes, second only to China and followed by the USA.
Diabetes is also responsible for 3% of deaths in India. Complications of diabetes include blindness, lower limb amputation, kidney failure, heart attacks, and stroke.
These figures are alarming, for a chronic disease that not only leads to a painful, debilitated, shortened life, but is also largely preventable if proper lifestyle measures are adopted at the right time.
Large-scale population studies have shown that obesity is the most important independent risk factor for insulin resistance and T2DM.
Depending on ethnicity, age, and gender, 50-90% of T2DM patients have a BMI >25 kg/m2. Patients with BMI >35 kg/m2 are almost 20 times more likely to develop T2DM compared to those with a normal BMI.
In addition to generalized obesity, a strong independent association exists between central obesity (beer belly) and T2DM. This makes us Indians more vulnerable, since we are more susceptible to central obesity.
LSM can help control obesity and reduce the single biggest avoidable risk for T2DM.
Hypertension and cardiovascular disease (coronary artery disease and stroke)
Cardiovascular disease is the biggest killer worldwide, and in India. Heart disease and stroke account for 28% of all deaths in India each year.
Weight gain progressively promotes sub-clinical inflammation (inflammation that does not produce symptoms until it is too late), with harmful effects on various organs, including blood vessels. This increases the risk of hypertension, atherosclerosis, blood clots and coronary artery disease (angina, myocardial infarction, stroke).
What’s more, the effect gets compounded: the patient develops multiple co-morbidities (associated diseases) à obesity leading to hypertension and diabetes, and now both hypertension and DM become individual risk factors for cardiovascular disease.
The good news is, LSM targets all, the risk factors as well as the diseases, at the same time.
Obesity and Cancer Risk
Cancer is the second most common cause of death in India, after cardiovascular disease.
There is convincing evidence to indicate that obesity can increase the risk of certain cancers:
· esophagus, stomach, colon and rectum
· uterus (endometrium), ovary
· kidney (renal-cell)
· multiple myeloma
Obesity and physical inactivity are currently recognized as the most important modifiable risk factors for primary cancer prevention, along with tobacco use.
Again, as with the majority of obesity-related co-morbidities, central obesity is identified as an independent predictor of increased risk, primarily for cancer of the endometrium, breast, colon, pancreas and liver. This is crucial for Indians, since central obesity is the commonest pattern of body fat distribution amongst us.
Overall, the risk of cancer in adults appears to increase when BMI exceeds 22 kg/m2. And this value of BMI still falls within normal range!
Also, not only does obesity increase the risk of cancer, it’s also associated with poorer outcomes, and is associated with increased recurrence. It’s a deadly triad: obesity can cause cancer, reduce the chances of curing cancer, and increase the chances of the cancer coming back.
Insulin resistance and the resultant increased insulin levels appear to be the primary mechanisms for obesity-related cancers. Increased level of certain hormones, as well the chronic low-grade inflammatory state in obesity, are other proposed mechanisms by which increased weight can increase the risk of cancer.
Obesity, Stress and Psychiatric Co-Morbidities
Obesity has a complicated relationship with psychological well-being, especially with chronic stress and mood disorders.
Stress and anxiety are omnipresent nowadays, and depression is a very common psychiatric disorder. In India, the National Mental Health Survey 2015-16 revealed that nearly 15% Indian adults need active treatment for mental health issues, and one in 20 Indians suffers from depression.
Chronic stress, manifested with depressive and/or anxiety symptoms, can lead to prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis which, along with other health risk behaviors, can increase the risk of visceral obesity.
And turning the wheel of this vicious cycle, central obesity again plays the villain, leading to a low-grade inflammatory state that acts as a persistent stress stimulus.
In addition, the psychological impact, low confidence levels and constant feeling of being inadequate, not being good enough, adds to the chronic stress. Overweight and obese people are more prone to depression, which can lead to overeating…and so the cycle goes.
Non-Alcoholic Fatty Liver Disease
Nonalcoholic fatty liver disease (NAFLD) affects 25% of the global adult population.
Prevalence of the disease is estimated to be around 9-32% in the Indian population, with a higher incidence rate amongst obese and diabetic patients. 
NAFLD is one of the most common causes of chronic liver disease, with a worldwide distribution that matches closely the prevalence of obesity and T2DM.
Obesity may cause hyperinsulinemia and hyperglycemia, as well as fat accumulation and insulin resistance in the liver. In turn, this leads to NAFLD. Chronic fatty liver can eventually lead to reduced liver function, resulting in abnormalities ranging from steatosis, hepatitis, cirrhosis, liver failure and even liver cancer.
Gallbladder Disease (gallstones)
In India, the prevalence of gallstones ranges from 6% to 9% in the adult population. Overall, gallstone formation is strongly associated with being overweight and obese; a mnemonic for gallstone risk factors taught in medical colleges is known as the "4 Fs" (“fat, female, fertile, and forty”).
Women with BMI >30 kg/m2 have twice the risk of gallstones compared to non-obese women, while a 7 times higher risk was noted in women with BMI >45 kg/m2 (Nurses’ health study).
Obesity is characterized by a high daily cholesterol turnover, resulting in increased secretion of cholesterol, which eventually leads to the formation of gallstones and the need for a potentially avoidable surgery.
Obesity and Reproductive system
Obesity can cause dysfunction of the hypothalamic-pituitary-gonadal (HPG) axis in both genders.
Reproductive disorders are more frequent in obese women, presenting with a wide range of manifestations, from menstrual abnormalities to infertility.
Obese men can present with decreased libido, erectile dysfunction and sub-fertility.
That, in a nutshell is how severely and universally obesity impacts our body. There is more to be discussed about this, of course, and the final concluding part of this series will be coming soon.
 Conditions existing simultaneously with and usually independently of another medical condition  https://www.ncbi.nlm.nih.gov/books/NBK278973/  Obesity associated with diabetes  Prognostic factors include characteristics that define the natural history of the disease, and are associated with disease-free or overall survival  http://www.searo.who.int/india/topics/depression/about_depression/en/  Transplantation. 2019 Jan;103(1):22-27. Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis: Implications for Liver Transplantation. Younossi ZM, Marchesini G, Pinto-Cortez H, Petta S.  Study of prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT). Kalra S, Vithalani M, Gulati G, Kulkarni CM, Kadam Y, Pallivathukkal J, Das B, Sahay R, Modi KD.