Why some people are predisposed to Obesity

Obesity is the new global epidemic! In the UK, 28, 25, 29 and 25 percent of adults are obese in England, Wales, Scotland and Northern Ireland respectively. The figure is 30 percent for the US. Although there is not enough data for India, one can expect similar figures.

However, obesity is not treated seriously in India and often dismissed as a result of an undisciplined lifestyle. Awareness about how the condition works, and acceptance of obesity as a genuine ailment is very low. In the process, obese or overweight people face constant judgement, criticism and prejudice all the time. They are also at risk of chronic kidney disease, type-2 diabetes, and a range of cardiovascular ailments.

The time has come to understand that Obesity is not a choice and some people are predisposed to the condition for several reasons. Understanding this will help them seek more effective treatment and cope with the condition more positively.

Genetic / Physiological Risk factors

Our body-weight depends on 3 factors: the number of calories we consume, how many of these calories are stored in the body, and finally how many of these are burned up. But each of these factors is influenced by our genes, the environment and behavior. How these factors affect us begins right from the moment we are conceived and continues all our lives.

Genes: There are over 400 genes which affect our energy balance and increase the risk of obesity. But a handful of them have a pronounced effect (source: cdc.gov):

• FTO: Fat mass- and obesity-associated gene, promotes food intake
• MC4R: Melanocortin 4 receptor, when bound by AMS hormone, stimulates appetite
• ADIPOQ: Adipocyte-, C1q-, and collagen domain-containing gene, produced by fat cells, adiponectin promotes energy expenditure
• LEP: Leptin, produced by fat cells
• LEPR: Leptin receptor, when bound by leptin, inhibits appetite
• PCSK1: Proprotein convertase subtilisin/kexin type 1, regulates insulin biosynthesis
• INSIG2: Insulin-induced gene 2, regulates cholesterol and fatty acid synthesis
• PPARG: Peroxisome proliferator-activated receptor gamma gene, stimulates lipid intake and development of fat tissue

Birth, infancy and childhood: Pregnant women who smoke increase the risk for obese children. Infants born out of C-section are at higher risk than those born naturally. Infants that are breast-fed for 3 months or more are less likely to be obese than those who are breast-fed for less than 3 months, or formula-fed.

Medications and ailments: While hypothyroidism increases weight, medicines taken for diabetes, anti-psychotics and anti-depressants all increase the risk by reducing metabolism, reduce burning of fat, increasing fat intake and increasing appetite.

Hunger hormones: Dopamine is a feel-good hormone that is secreted when one has had a good or full meal. People who enjoy junk or unhealthy food create a vicious cycle of dopamine surges which gradually leads to craving, indulgence and hence junk-food addiction.

Leptin resistance: Leptin is a hormone produced by fat cells that signal the body when to stop eating, so it regulates appetite. It also affects how much fat is stored in the body and how much is burnt, so it regulates metabolism too. People who are obese secrete more leptin so the hunger or cravings don’t subside. At the same time, they suffer from leptin resistance. The brain doesn’t receive signals from the leptin and starts storing fat as if the person were starving.

Gut-bacteria: Gut microbiota or gut bacteria regulate digestion and absorption of energy from food. Gut bacteria in obese people behave differently. They are very efficient in absorbing energy from food, so the overall calorific intake increases.

Environmental / Societal Risk Factors

1. Dietary habits: Wrong dietary habits that are picked up at any age can increase the risk of obesity. However, when picked up in childhood, it can last a lifetime, heightening the risk. Kids who tend to overeat, who eat often, who eat random times of the day, prefer unhealthy or junk food, as well as sugary sodas, are more prone to cravings and junk-food addiction, binge eating and hoarding food, all of which increase the risk of obesity.
2. Sedentary snacking: Snacking or having a meal while watching TV is an extremely common behavior influenced by peers. Such people tend to eat more than their regular fill, snack on unhealthy junk-food creating a cycle of addiction, craving and sedentary snacking.
3. Poor nutrition awareness: Parents who lack awareness of healthy diet and nutrition make poor dietary choices for themselves and their children. These habits can last a lifetime, increasing the risk of obesity.
4. Availability and lack of food: While TV ads glorify junk-food consumption, food packaging and retail outlets beautify food. Similarly, the presence of multiple eateries near the home or workplace create vicious cycles of craving, indulgence and addiction. All these add to the risk of obesity. At the other end, people who live in remote places with poor availability of food make unhealthy food choices, which leads to obesity in the long run.

Psychological / Behavioural Risk Factors

1. Stress: Stress in one’s professional and personal lives forces parents to make unhealthy food choices for themselves and their kids, in favor of quick, ready-to-eat and instant or refined foods rich in sugar, salt and unhealthy fat This increases the risk of cravings and junk-food addictions.
2. Lack of sleep: People who sleep less than 7 or 8 hours a day are at increased risk of obesity as this disrupts the hormones that regulate appetite and weight-gain.
3. Anxiety and depression: People who suffer from these tend to use food to feel good about themselves or their life. This leads to binge-eating, cravings and addictions. The excess weight also adds to anxiety and depression creating a vicious cycle that is hard to break.

Treatment options

Merely changing the diet or exercising regularly doesn’t cure the illness called obesity. Fortunately, there are other options:

1. Drugs such as Saxenda and Semaglitude that suppress appetite
2. Liposuction surgery: Here, excess fat is sucked out of the body
3. Gastric band surgery: Here, a band is placed around the stomach, making the person feel fuller, sooner
4. Gastric bypass surgery: Here, the top part of the stomach is joined to the small intestine. The person feels fuller sooner, absorbs fewer calories from food, and has improved metabolism
5. Sleeve Gastrectomy – In this surgery, a part of the stomach is removed so the person cannot eat as much as before, and feels fuller sooner. The metabolism also improves.

Outlook

As is obvious from the above, Obesity is a serious and genuine physiological condition with emotional, psychological and health consequences. The bodies of the obese are fighting the person’s urge to stay slim, eat healthy and live a disciplined lifestyle. So the next time you see a person in your friend or acquaintance circle, who is battling this disorder all the time, empathize with their situation, and do not judge them. Educate them on treatment options. And applaud them every time they make some headway in this battle. It will go a long way in creating a positive environment that will motivate them to take the right steps and win this battle.

 

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