• Obesity is a disorder linked to excessive amount of body fat.
  • Obesity is the leading cause to  many chronic diseases.
  • There is hope for obese people who don’t find bariatric surgery. as the best solution for their disorder

Introduction – Obesity is a medical condition which involves an excessive amount of fat stored in the body due to imbalances between energy intake and consumption regulated by neuroendocrine system[1].  There are several factors that contribute to obesity; heredity, combination of high fat diets with diets rich in easily absorbed carbohydrates, lack of physical activity as well as  sleep deprivation[3],[5]. In addition to this, hypothyroidism, Cushing’s syndrome and Prader-Willi syndrome  and drugs such as tricyclic antidepressants, corticosteroids, estrogen-containing contraceptive pills are known to cause weight gain too[4],[7]. In order to maintain a healthy weight, a man needs approximately 2.500 calories  a day, whereas an  active woman needs 2000 calories [3]. Obesity is measured by BMI( Body Mass Index), a value derived from the height and the mass of a person[6]. BMI of 18.5 to 24.9 kg/m2 is considered normal, whereas BMI > 30 kg/m2 defines obesity[6].

Statistics – Latest data show that obesity (BMI >30 kg/m2)  affects every segment of the world population [8]. Approximately  2,1 billion people are obese, which means obesity affects 30% of world population[8]. According to the World Population Review, Nauru, an island country in Micronesia is listed as the first one in the world, 61% of its population is reported to have a BMI higher than 30 followed by Tonga and Samoa. America is ranked 12th and London 36th [8]. Future predictions about obesity seem to be not very optimistic; by 2020 41% of men and 36% of women will be obese, giving a rise in the prevalence of obesity-related high blood pressure, obesity-related stroke as well as obesity-related diabetes [9].

Diagnosing,  Medication and Complications – Quantifying obesity using BMI is the first step in order to asses a great plan for its treatment. Waist circumference measurement  is one of the most accurate and simplest way to measure abdominal fat [7]. Waist circumference greater than 102 cm  in men or greater than 88 cm in women is a sign of high risk of metabolic and cardiovascular complications of obesity[7].  The excess amount of adipose tissue distributed due to obesity seems to be very harmful for the liver[7].  Many factors that are released from adipose tissue such as: adipokines, adiponectin and resistin may be higher in the liver, this induces high insulin resistance which develops type 2 diabetes [7]. In addition to this, cirrhosis and non-alcoholic steatohepatitis are listed as complications due to liver fat accumulation[7]. Obese people suffer from sleep apnea, respiratory failure due to restricted ventilation caused by mechanical effects of weight[8]. This may cause urinary incontinence and varicose veins too [8].

Management of Obesity – There are several options for treating obesity[7]. Eating healthy and increasing physical activity are highly recommended[7],[10]. Patients who tend to lose weight rapidly are required to follow a supervised low-calorie diet, which sometimes may be followed by headache, nausea, diarrhea and orthostatic hypotension[7]. These days, a huge investment has been made by pharmaceutical industry in order to fight obesity[7]. Orlistat{ pancreatic lipase inhibitor} and Sibutramine { Serotonergic in CNS) are currently recommended[7]. Bariatric surgery is the final step that obese people can take in case options above are inadequately effective[7]. This surgery is performed laparoscopically and tends to be the most effective way to treat obesity[7],[10]. The mechanism is based on disruption of peptides like ghrelin from stomach or oxyntomoduline or glucagon-like-peptide from small bowel, by this it enhances satiety signals in the hypothalamus, reduces weight, and improves body mechanisms to use sugar after eating.[7],[10],[11].

Fig 1. Bariatric surgery procedures. A Vertical banded gastroplasty. B Laparaoscopic banding C Roux-en-Y gastric bypass. Image adopted from [7].

Latest research – Knowing that bariatric surgery may be followed by: chronic nausea, abdominal pain, vomiting,  many people are against it, a group of researchers at Imperial College London leaded by Professor Tricia Tan wanted to know if a subcutaneous injection of combination of three hormones (GOP Mixture) could reduce high glucose levels and help weight loss [11] This trial included patients  on GOP treatment, patients who received bariatric surgery, with prediabetes, diabetes, and patients who received saline placebo[11].Studies have shown that  after four weeks patients on the GOP treatment had lost approximately 4.5 kg. This shows that there is a chance to gain a weight loss and improve blood glucose without need to undergo bariatric and experience its side effects[11].

Conclusion – This research brings new hope for people with diabetes and obesity people since the GOP injection led to great improvements to blood glucose and weight loss.

COPYRIGHT: This article is the property of We Speak Science, a non-profit institution co-founded by Dr. Detina Zalli and Dr. Argita Zalli. The article is written by Rexhep Sahatçiu, University of Prishtina, Kosovo.

References:

[1] https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742

[2] https://www.who.int/topics/obesity/en/

[3] https://www.nhs.uk/conditions/obesity/causes/    

   
[4] https://www.healthdirect.gov.au/what-causes-obesity

[5] Harrison’s Principles of Internal Medicine 

[6] https://en.wikipedia.org/wiki/Body_mass_index

[7] Davidson Principles and Practice of Medicine 21st edition

[8] http://worldpopulationreview.com/countries/most-obese-countries/


[9] https://www.theguardian.com/society/2010/feb/16/adult-obesity-rises

[10] Kumar& Clarks Clinical Medicine- Eight edition.


[11]. https://www.sciencedaily.com/releases/2019/08/190806101531.htm