Obesity: the challenge of the 21st century

Why is there a World Day for Obesity?

There are currently 1.9 billion people who are overweight and 800 million who suffer from obesity. Those who live with this health problem are twice as likely to suffer complications that require hospitalization if they are infected with COVID-19. People who suffer from obesity have a triple risk of suffering from metabolic syndrome, and this risk is multiplied up to 8 times if they have been obese since childhood.

It is essential to raise awareness of this problem regarding obesity, especially because 54% of the world population under the age of 16 is overweight.

Is obesity a disease?

Obesity is a physiopathology consisting of an excess of adipose tissue that accumulates in a way that is hazardous to health.

Obesity is diagnosed by measuring certain parameters:

BMI (body mass index): This measurement is calculated by dividing the weight in kilograms by the height in meters squared.

It’s estimated that a BMI between 19 and 24 is “normal weight”, between 25 and 35 means overweight, and greater than 35 means obesity.

This parameter is only valid for middle-aged adults, as it has been used since the beginning of the 19^th century as a statistical measure but not as an indicator of the adipose tissue of a person. In fact, it was not until 1985 that it was established as a diagnostic factor, when obesity became a public health problem worldwide, even more so than malnutrition in poor countries.

Due to the limitations of this value in identifying obesity, the waist-hip ratio (WHR) and the percentage of fatty tissue are also currently measured through techniques like axial tomography or bioimpedance.

For men, a waist circumference of 102 cm and 30% fat in relation to body weight is considered overweight, and for women, a waist circumference of 88 cm and 40% fat mass.

Obesity is not an esthetic problem, since 80% of people suffering from it have a relevant predisposition to suffer from these disorders: cardiovascular diseases such as hypertension or dyslipidemia, resistance to insulin and type 2 diabetes, cognitive impairment, sleep disorders (including sleep apnea), urinary incontinence, sexual dysfunction, osteoarthritis, cancer and a higher prevalence of falls after the age of 65.

The risk of comorbidity for these people is even greater when they have been overweight since childhood.

For all these reasons, obesity is a problem and a challenge for health that involves changing dietary habits but also must be dealt with in a multifactorial way by understanding that it is a determining cause of a significant number of pathologies.

New challenges

In 1996, the term “sarcopenic obesity” was coined, designating a disease in which a person has a reduced amount of lean mass (i.e., muscle quality) in relation to the amount of fatty tissue. This means that there are people who, due to a sedentary lifestyle and poor diet, although they have a suitable or even low BMI, have a high percentage of fat due to an excessive deterioration of the muscle mass.

This disease is increasingly affecting young people but is especially typical in people over 65 years of age.

Sarcopenic obesity entails the same problems as excessive fat accumulation, but its diagnosis is more difficult, and its relevance as a health problem is socially underestimated.

This is a new challenge to tackle since there are already more than 700 million inhabitants older than 65 in the world.

How can we avoid this?

Obesity is a multifactorial problem, and therefore the way we deal with it should also be multifactorial.

1. Physical activity is the main way to prevent overweight. It is crucial to avoid a sedentary lifestyle by walking, doing housework, climbing upstairs, and maintaining an active lifestyle in general. It is also relevant to do more intense sports. Although much importance is given to lifting weights, going to the gym or practicing more demanding sports, in reality, the greatest benefit is not the caloric expenditure but that it reduces stress, increases metabolism and muscle quality, improves agility, and therefore reduces the risk of falls.
2. Secondly, the dietary pattern is basic in the prevention of overweight and obesity. In the last 25 years, hypocaloric diets have become a popular strategy to tackle overweight, but prevention is more about behavioral habits than about caloric restriction. Some ideas to include both in personal and familiar habits are avoiding ultra-processed products high in sugars and unsaturated fats, cooking your own food, eating high-fiber vegetables, eating satiating foods, etc.
3. Public health measures must include the balance between work and family lives, measures in schools and school canteens, the management of vending machines, the involvement of the food industry, the enhancement of the distribution of sports and green areas when generating urban planning, and greater investment in public health to deal with other pathologies that predispose to obesity such as depression, autoimmune diseases and traumatological problems that limit the mobility of patients.
4. Finally, we must bear in mind that mental health is as important as physical health and that obesity is a disease, so we can all help avoid stigmatizing people who suffer from it.