Morbid Obesity
Disease Details
Family Health Simplified
- Description
- Morbid obesity is a condition characterized by an excessive accumulation of body fat, typically defined by a body mass index (BMI) of 40 or higher, which significantly increases the risk of various health complications.
- Type
- Morbid obesity typically does not follow a single type of genetic transmission but is rather influenced by a complex interplay of multiple genetic and environmental factors. It is considered a polygenic trait, meaning that variations in many different genes can contribute to the risk, often in combination with lifestyle factors such as diet and physical activity. Some rare forms of severe obesity can be linked to specific genetic mutations and may follow Mendelian inheritance patterns, such as in cases of monogenic obesity involving genes like the leptin gene (LEP) or the melanocortin 4 receptor gene (MC4R).
- Signs And Symptoms
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Morbid obesity, also known as severe obesity, is characterized by excessive body fat that poses a high risk to health. Signs and symptoms may include:
1. A Body Mass Index (BMI) of 40 or higher.
2. Difficulty performing physical activities due to excess weight.
3. Shortness of breath.
4. Joint and back pain.
5. Increased sweating.
6. Frequent fatigue.
7. Sleep apnea.
8. Skin problems, such as rashes or infections in skin folds.
9. Health conditions like type 2 diabetes, hypertension, and heart disease.
Addressing morbid obesity often requires a comprehensive approach including lifestyle changes, medical interventions, and sometimes surgical procedures. - Prognosis
- Morbid obesity significantly increases the risk of developing various serious health conditions, including type 2 diabetes, cardiovascular diseases, certain types of cancer, sleep apnea, and osteoarthritis. The prognosis for individuals with morbid obesity varies depending on the presence of comorbid conditions, effectiveness of weight management strategies, and overall health. Successful long-term weight loss through lifestyle changes, medical interventions, or surgical procedures can improve the prognosis and reduce associated health risks.
- Onset
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Onset: Morbid obesity typically develops over time due to a combination of factors including genetics, environmental influences, poor diet, physical inactivity, and certain medical conditions or medications. It generally manifests in adulthood but can also develop during childhood or adolescence.
Nan: Not applicable/available. - Prevalence
- The prevalence of morbid obesity varies significantly by region and population. In the United States, it is estimated that around 9% of the adult population is affected by morbid obesity. Rates can be higher in certain demographic groups and regions. Globally, prevalence rates differ, with some countries experiencing higher rates due to lifestyle, dietary habits, and genetic factors.
- Epidemiology
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In earlier historical periods obesity was rare and achievable only by a small elite, although already recognised as a problem for health. But as prosperity increased in the Early Modern period, it affected increasingly larger groups of the population. Prior to the 1970s, obesity was a relatively rare condition even in the wealthiest of nations, and when it did exist it tended to occur among the wealthy. Then, a confluence of events started to change the human condition. The average BMI of populations in first-world countries started to increase, and consequently there was a rapid increase in the proportion of people overweight and obese.In 1997, the WHO formally recognized obesity as a global epidemic. As of 2008, the WHO estimates that at least 500 million adults (greater than 10%) are obese, with higher rates among women than men. The global prevalence of obesity more than doubled between 1980 and 2014. In 2014, more than 600 million adults were obese, equal to about 13 percent of the world's adult population. The percentage of adults affected in the United States as of 2015–2016 is about 39.6% overall (37.9% of males and 41.1% of females). In 2000, the World Health Organization (WHO) stated that overweight and obesity were replacing more traditional public health concerns such as undernutrition and infectious diseases as one of the most significant cause of poor health.The rate of obesity also increases with age at least up to 50 or 60 years old: 5 and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity. The OECD has projected an increase in obesity rates until at least 2030, especially in the United States, Mexico and England with rates reaching 47%, 39% and 35%, respectively.Once considered a problem only of high-income countries, obesity rates are rising worldwide and affecting both the developed and developing world. These increases have been felt most dramatically in urban settings.Sex- and gender-based differences also influence the prevalence of obesity. Globally there are more obese women than men, but the numbers differ depending on how obesity is measured. - Intractability
- Morbid obesity is not inherently intractable, but it can be challenging to manage. Effective treatments often require a combination of lifestyle changes, medical interventions, and sometimes surgical options. Individual response to treatment can vary, making it essential to tailor approaches to each person's specific needs.
- Disease Severity
- For morbid obesity, the severity of the disease can vary but is typically considered severe due to its serious health implications. Morbid obesity, often defined as having a Body Mass Index (BMI) of 40 or higher, significantly increases the risk of developing numerous comorbid conditions such as diabetes, heart disease, hypertension, and obstructive sleep apnea. The severity also encompasses challenges related to mobility, mental health, and quality of life. Effective management often requires a multidisciplinary approach, including medical treatment, lifestyle changes, and sometimes surgical interventions.
- Healthcare Professionals
- Disease Ontology ID - DOID:11981
- Pathophysiology
- Two distinct but related processes are considered to be involved in the development of obesity: sustained positive energy balance (energy intake exceeding energy expenditure) and the resetting of the body weight "set point" at an increased value. The second process explains why finding effective obesity treatments has been difficult. While the underlying biology of this process still remains uncertain, research is beginning to clarify the mechanisms.At a biological level, there are many possible pathophysiological mechanisms involved in the development and maintenance of obesity. This field of research had been almost unapproached until the leptin gene was discovered in 1994 by J. M. Friedman's laboratory. While leptin and ghrelin are produced peripherally, they control appetite through their actions on the central nervous system. In particular, they and other appetite-related hormones act on the hypothalamus, a region of the brain central to the regulation of food intake and energy expenditure. There are several circuits within the hypothalamus that contribute to its role in integrating appetite, the melanocortin pathway being the most well understood. The circuit begins with an area of the hypothalamus, the arcuate nucleus, that has outputs to the lateral hypothalamus (LH) and ventromedial hypothalamus (VMH), the brain's feeding and satiety centers, respectively.The arcuate nucleus contains two distinct groups of neurons. The first group coexpresses neuropeptide Y (NPY) and agouti-related peptide (AgRP) and has stimulatory inputs to the LH and inhibitory inputs to the VMH. The second group coexpresses pro-opiomelanocortin (POMC) and cocaine- and amphetamine-regulated transcript (CART) and has stimulatory inputs to the VMH and inhibitory inputs to the LH. Consequently, NPY/AgRP neurons stimulate feeding and inhibit satiety, while POMC/CART neurons stimulate satiety and inhibit feeding. Both groups of arcuate nucleus neurons are regulated in part by leptin. Leptin inhibits the NPY/AgRP group while stimulating the POMC/CART group. Thus a deficiency in leptin signaling, either via leptin deficiency or leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity.
- Carrier Status
- Morbid obesity is not a condition associated with carrier status. It is generally due to a combination of genetic, environmental, psychological, and metabolic factors rather than being a single-gene inherited condition.
- Mechanism
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Morbid obesity is an extreme form of obesity characterized by an excessive accumulation of body fat that significantly increases the risk of various health problems. At both the physiological and molecular levels, several mechanisms contribute to its development:
### Mechanism
1. **Energy Imbalance**: Consuming more calories than the body expends leads to energy storage in the form of fat, resulting in obesity.
2. **Genetics**: Genetic factors can influence susceptibility to weight gain, affecting processes such as appetite regulation, metabolism, and fat storage.
3. **Environmental Factors**: Poor diet, physical inactivity, and socio-economic factors play significant roles.
4. **Behavioral Factors**: Psychological factors and eating behaviors, such as emotional eating and binge eating, contribute to excessive calorie intake.
### Molecular Mechanisms
1. **Leptin and Leptin Resistance**:
- **Leptin**: A hormone produced by adipose tissue that helps regulate energy balance by inhibiting hunger.
- **Leptin Resistance**: In obese individuals, despite high levels of leptin, the body becomes resistant to its effects, leading to persistent hunger and overeating.
2. **Insulin and Insulin Resistance**:
- **Insulin**: A hormone that regulates glucose uptake. In obesity, the body often develops insulin resistance.
- **Insulin Resistance**: Reduced sensitivity to insulin leads to increased blood glucose levels and can contribute to fat storage and further weight gain.
3. **Adiponectin**:
- A hormone involved in regulating glucose levels and fatty acid breakdown. Lower levels of adiponectin are often found in obese individuals, contributing to insulin resistance and inflammation.
4. **Inflammatory Cytokines**:
- Obesity is associated with chronic low-grade inflammation. Adipose tissue secretes pro-inflammatory cytokines such as TNF-α and IL-6, which can impair insulin signaling and promote metabolic dysfunction.
5. **Gut Microbiota**:
- Imbalances in gut bacteria can influence energy extraction from food, inflammation, and overall metabolism, contributing to obesity.
6. **Genetic and Epigenetic Factors**:
- Specific gene mutations and variations, such as those in the FTO gene, have been linked to obesity risk.
- Epigenetic modifications, such as DNA methylation and histone acetylation, can influence gene expression related to metabolism and fat storage.
Understanding these mechanisms provides insight into the complexity of morbid obesity and underscores the multifaceted approach needed for its effective management and treatment. - Treatment
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Treatment for morbid obesity typically includes a multifaceted approach:
1. **Lifestyle Modifications**:
- Diet: Calorie-restricted, balanced diet.
- Physical Activity: Regular exercise to increase energy expenditure.
2. **Behavioral Therapy**:
- Counseling and support groups to address eating behaviors and lifestyle changes.
3. **Pharmacotherapy**:
- Medications prescribed to aid weight loss by reducing appetite or increasing feelings of fullness.
4. **Surgery**:
- Bariatric Surgery: Procedures such as gastric bypass, sleeve gastrectomy, and adjustable gastric banding.
5. **Medical Monitoring**:
- Regular monitoring by healthcare professionals to manage and adjust treatment plans as needed.
Working with specialized healthcare providers, such as dietitians, endocrinologists, and bariatric surgeons, is crucial for effective management and treatment of morbid obesity. - Compassionate Use Treatment
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For morbid obesity, compassionate use treatments and off-label or experimental treatments include:
1. **Medications**:
- **GLP-1 Agonists** (e.g., Liraglutide at doses higher than those approved for diabetes, or Semaglutide for weight management).
- **Metformin**: Sometimes used off-label for weight management, though it is primarily a diabetes medication.
- **Bupropion/Naltrexone Combination**: Used for weight management but monitored for its behavioral risks.
2. **Bariatric Surgery**:
- Procedures generally accepted but applied in compassionate use cases for severely obese patients who may not strictly meet standard criteria.
- Types include Gastric Bypass, Sleeve Gastrectomy, and Adjustable Gastric Banding among others.
3. **Endoscopic Procedures**:
- **Endoscopic Sleeve Gastroplasty (ESG)**: A newer, less invasive procedure using an endoscope to reduce stomach size.
- Intragastric Balloons: Devices temporarily placed in the stomach to reduce food intake.
4. **Experimental Therapies**:
- **Gene Therapy**: Studies investigating genetic interventions for weight management.
- **Microbiome Transplantation**: Experimental approaches involving modifications to gut bacteria.
5. **Devices**:
- FDA-approved but used in off-label capacities includes vagal nerve blocking devices.
Each treatment involves specific eligibility criteria, potential risks, and benefits, and should only be considered in consultation with healthcare providers specialized in obesity management. - Lifestyle Recommendations
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### Lifestyle Recommendations for Morbid Obesity:
1. **Dietary Changes:**
- **Balanced Diet:** Incorporate a variety of fruits, vegetables, lean proteins, and whole grains.
- **Portion Control:** Use smaller plates and avoid second helpings.
- **Limit Sugars and Fats:** Reduce intake of sugary drinks, snacks, and high-fat foods.
- **Meal Planning:** Prepare meals in advance to avoid unhealthy choices.
2. **Physical Activity:**
- **Regular Exercise:** Aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity per week.
- **Strength Training:** Include exercises that work all major muscle groups twice a week.
- **Daily Movement:** Increase daily physical activities like walking, taking stairs, or gardening.
3. **Behavioral Interventions:**
- **Set Realistic Goals:** Establish achievable milestones and track progress.
- **Professional Guidance:** Work with dietitians, therapists, or weight-management programs.
- **Support Groups:** Join groups or forums for encouragement and shared experiences.
- **Mindful Eating:** Focus on eating without distractions like TV or smartphones.
4. **Sleep and Stress Management:**
- **Adequate Sleep:** Aim for 7-9 hours of sleep per night to support overall health.
- **Stress Reduction:** Practice stress-relief techniques such as meditation, yoga, or deep-breathing exercises.
5. **Medical Interventions:**
- **Regular Check-ups:** Keep ongoing appointments with a healthcare provider to monitor health.
- **Medications:** Consider medication under medical supervision if lifestyle changes are insufficient.
- **Surgical Options:** In some cases, procedures such as bariatric surgery may be recommended.
These strategies can help manage and potentially reduce morbid obesity, improving overall health and well-being. - Medication
- Since the introduction of medicines for the management of obesity in the 1930s, many compounds have been tried. Most of them reduce body weight by small amounts, and several of them are no longer marketed for obesity because of their side effects. Out of 25 anti-obesity medications withdrawn from the market between 1964 and 2009, 23 acted by altering the functions of chemical neurotransmitters in the brain. The most common side effects of these drugs that led to withdrawals were mental disturbances, cardiac side effects, and drug abuse or drug dependence. Deaths were reportedly associated with seven products.Five medications beneficial for long-term use are: orlistat, lorcaserin, liraglutide, phentermine–topiramate, and naltrexone–bupropion. They result in weight loss after one year ranged from 3.0 to 6.7 kg (6.6-14.8 lbs) over placebo. Orlistat, liraglutide, and naltrexone–bupropion are available in both the United States and Europe, phentermine–topiramate is available only in the United States. European regulatory authorities rejected lorcaserin and phentermine-topiramate, in part because of associations of heart valve problems with lorcaserin and more general heart and blood vessel problems with phentermine–topiramate. Lorcaserin was available in the United States and then removed from the market in 2020 due to its association with cancer. Orlistat use is associated with high rates of gastrointestinal side effects and concerns have been raised about negative effects on the kidneys. There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death; however, liraglutide, when used for type 2 diabetes, does reduce cardiovascular events.In 2019 a systematic review compared the effects on weight of various doses of fluoxetine (60 mg/d, 40 mg/d, 20 mg/d, 10 mg/d) in obese adults. When compared to placebo, all dosages of fluoxetine appeared to contribute to weight loss but lead to increased risk of experiencing side effects such as dizziness, drowsiness, fatigue, insomnia and nausea during period of treatment. However, these conclusions were from low certainty evidence. When comparing, in the same review, the effects of fluoxetine on weight of obese adults, to other anti-obesity agents, omega-3 gel and not receiving a treatment, the authors could not reach conclusive results due to poor quality of evidence.Among antipsychotic drugs for treating schizophrenia clozapine is the most effective, but it also has the highest risk of causing the metabolic syndrome, of which obesity is the main feature. For people who gain weight because of clozapine, taking metformin may reportedly improve three of the five components of the metabolic syndrome: waist circumference, fasting glucose, and fasting triglycerides.
- Repurposable Drugs
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Repurposable drugs for morbid obesity are medications initially developed for other conditions but found to aid in weight loss. These include:
1. **Metformin**: Originally for type 2 diabetes, it may help with weight loss.
2. **Topiramate**: An anticonvulsant, often combined with phentermine for obesity.
3. **Bupropion**: An antidepressant, sometimes used with naltrexone.
4. **Liraglutide**: Developed for diabetes, now also approved for obesity.
5. **Orlistat**: Initially for weight loss, it inhibits fat absorption.
Always consult healthcare providers for personalized advice. - Metabolites
- Morbid obesity is associated with various metabolic changes. Key metabolites affected include glucose, insulin, free fatty acids, adipokines (such as leptin and adiponectin), and inflammatory cytokines like TNF-alpha and IL-6. These metabolic alterations contribute to insulin resistance, inflammation, and the dysregulation of lipid and carbohydrate metabolism.
- Nutraceuticals
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Nutraceuticals are products derived from food sources with extra health benefits in addition to the basic nutritional value found in foods. For morbid obesity, certain nutraceuticals may aid in weight management by enhancing metabolism, reducing appetite, or increasing fat oxidation. Common examples include:
1. **Green Tea Extract**: Contains catechins and caffeine, which may boost metabolism and increase fat burning.
2. **Conjugated Linoleic Acid (CLA)**: May help decrease body fat mass.
3. **Garcinia Cambogia**: Contains hydroxycitric acid (HCA), which is believed to suppress appetite and inhibit fat production.
4. **Omega-3 Fatty Acids**: Found in fish oil, may help reduce inflammation and improve overall metabolic health.
It is important to consult healthcare professionals before using nutraceuticals, especially for those with morbid obesity, as they may interact with other medications or conditions. - Peptides
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In the context of morbid obesity, peptides are often explored for their potential therapeutic roles. Certain peptides, such as glucagon-like peptide-1 (GLP-1) agonists, have shown promise in promoting weight loss and improving metabolic health. GLP-1 agonists work by increasing insulin secretion, reducing appetite, and slowing gastric emptying.
Nanotechnology (nan) is also being researched for its potential applications in treating morbid obesity. Nanoparticles can be designed to deliver drugs more effectively to targeted tissues, improve bioavailability, and minimize side effects. For example, nanoparticles can be used to deliver weight-loss medications more precisely to fat cells, enhancing the treatment's efficacy.