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Obesity types

Differences in prevalence of obesity types between both sexes result from the different distribution of adipose tissue depending on hormonal and genetic factors.

• “Pear” obesity, where the fat is distributed on the hips, thighs, and bottom, is more often found in women;
• “Apple” obesity, otherwise known as abdominal obesity or visceral obesity, where the adipose tissue is located mainly inside the abdominal cavity, more often affects men.

People with apple obesity are at a greater risk of associated diseases. Metabolic disorders are more prevalent, leading to arterial hypertension, coronary disease, diabetes, and other cardiovascular disorders.
 
In post-menopausal women, the risk of abdominal obesity becomes similar to that of men due to the ovaries ceasing to produce female sex hormones.

WHR (waist to hip ratio)

In order to define the distribution of fat, you should measure your waist and hips. The waist circumference (in centimetres) is measured at the level of navel. The largest hip circumference (in cm) is measured at the broadest point of a hip. Then, the waist circumference should be divided by the hip circumference in order to get the number - waist hip ratio (WHR). Visceral obesity (apple shape) is recognised when the WHR is equal to or greater than 0.8 in women, and when it is equal to or greater than 1.0 in men. Values of this ratio below 0.8 in women and below 1.0 in men indicate pear obesity.

Causes of obesity

• Hereditary factors
   A genetic predisposition to be obese is often found in whole families. Studies have shown  that in 70% of obese people, at least one of the parents was also obese. Unfortunately, the  exact mechanism of this type of obesity is not fully understood, although we do know that  several genes affecting the intake of food and energy utilisation are involved in the  obesity-generating process.
• Physiological factors
    Physiologically, in our bodies the appetite is regulated by the size of meals, their  frequency, composition, taste, and is also under the control of the central nervous system  (mainly the hypothalamus). Appetite is influenced by neurotransmitters, generally  monoamines such as serotonin, dopamine, noradrenalin. Noradrenalin increases, for  example, an appetite for carbohydrates, while serotonin has the opposite effect. This  means that one possible treatment of obesity is to change the concentration of these  substances in the body. Any excess of dietary carbohydrates is initially deposited in the  liver in the form of glycogen. Then it is transformed into fat. An excess of amino acids,  caused by dietary proteins, is also initially transformed into glycogen; afterwards it is  transformed into fat (triglycerides) and stored in the adipose tissue. One kilogram of fat  stores approximately 7,000 kcal.
• Psychological factors
    Obesity can be treated as a form of dependence, in other words, a loss of control over  eating. Obesity negatively affects quality of life, and it is not uncommon for obese people  to avoid contact with others for fear of rejection. Paradoxically, obesity may become a  way of life, a convenient explanation for all personal failures, and eating itself then  becomes the consolation; a method of releasing anger or sadness, or a way of relieving  boredom. Typical for obese people is the illusion that they will achieve everything in life  when they lose weight. Sometimes, obesity is necessary to the patient’s family, in that a  husband or wife feels more self-confident with a less attractive partner.
• Lifestyle
  Obesity results predominantly from ingesting too large quantities of fat and taking too little physical exercise. Studies have shown that between 1960 and 1980, physical exercise in western societies reduced substantially. Currently, almost one-fourth of Americans aged over 18 do not take any physical exercise in their spare time. Women with a sedentary lifestyle are seven times more predisposed to weight gain, and sedentary men are predisposed four times more.
    Alcohol ingested in excessive quantities leads to increased energy delivery (“empty”  calories), liver disorders, and gallbladder disorders.
    Although smoking lowers appetite, it is not a method which makes it possible to maintain  normal weight and good health, because smoking and obesity are the first avoidable  causes of cardiovascular death. People who quit smoking have twice the risk of weight  gain than people who have never smoked. This is usually due to an increased appetite  following quitting.

Diseases associated with obesity

Obesity has been shown to lead to an increased incidence of the following disorders:

• Type 2 diabetes, which accounts for 90% of diabetes cases. Eighty to 90% of diabetic patients are obese. Losing as little as five to 10% of bodyweight leads to a reduction in the blood sugar level and allows the dosage of anti-diabetic medicines, including insulin, to be decreased.
• Arterial hypertension: a body weight gain of 20% causes an eightfold increase in the prevalence of hypertension.
• Hyperlipidaemia, i.e. increased levels of cholesterol and triglycerides in the blood. Apart from total cholesterol, the ratio of “good” HDL-cholesterol to “bad” LDL-cholesterol is important in the risk of cardiac disorders. This ratio is always unfavourable in obese people.
• Stroke: the risk of obese people suffering a stroke is twice as high as people of normal weight.
• Heart failure: the risk of this disease in obese people is 1.9 times higher.
• Ischaemic heart disease (coronary disease): 40% of cases are associated with a BMI above 25. The probability that an obese person will have coronary disease is 1.5 times higher than for a person with normal weight. Obesity also impairs the course of post-myocardial infarction rehabilitation.
• Gallbladder stones: in obese people, gallbladder diseases occur six times more often than in people of a normal weight.
• Degenerative joint disorders: joints under excessive loads become damaged more rapidly, in particular causing pain in the spine and knee joints.
• Cancer: obese people are more likely to develop endometrial, breast, gallbladder, colorectal, and prostate cancers.
• Sleep respiratory disturbances: manifested by such symptoms as hypoventilation syndrome or sleep apnoea syndrome.
• Varicose veins in the lower legs: in an obese person, the conditions of blood outflow from the lower extremities is impaired. This leads to an increased filling of veins with blood and, as a consequence, to the formation of varicose veins.
• Hormonal disturbances and complications in pregnancy occur more often in obese women.
• X syndrome (currently called polymetabolic syndrome): this is a syndrome of general pathologies, consisting of visceral obesity, impaired glucose tolerance, increased insulin concentration, insulin resistance, arterial hypertension, dyslipidaemia and coronary disease. To date, a number of additional elements have been added to the traditional X syndrome described by Reaven, including gout, increased cortisol level, reduced fibrinogen level, and increased albumin excretion in urine.