Penn Herb Wellness Guide

Obesity

About one-third of the U.S. population is overweight. Excess body weight—and, in particular, male pattern obesity characterized by excess abdominal fat as opposed to fat accumulation in the thighs and buttocks— is implicated as a risk factor for many different diseases. Therefore, maintaining a healthy body weight is prudent. Unfortunately, keeping lost weight off is very difficult for most people.

Health Problems Associated with Obesity

(The following list is comprehensive, although not necessarily exhaustive. Contact your health care professional for more information.)

Benign Prostatic Hyperplasia (BPH)

The prostate is a small gland that surrounds the neck of the bladder and urethra in men. Its major function is to contribute to seminal fluid. If the prostate enlarges, pressure can be put on the urethra, acting like a partial clamp and causing related symptoms. This condition is known as benign prostatic hyperplasia (BPH). Obesity has been linked to an increased risk of developing BPH.1

Cancer

Cancer is a general term for more than 100 diseases that are characterized by uncontrolled, abnormal growth of cells. Cancer is the second leading cause of death in Americans. Obesity has been linked to cancers of the endometrium, colon, kidney, and breast (in postmenopausal women only) and possibly to cancers of the ovary and prostate.2

Cardiovascular Disease

Cardiovascular disease is the number one cause of death in the United States. Obesity increases the risk of cardiovascular disease.3 Obesity is associated with increased risk for heart attack, particularly among younger people.4 One study found this relationship increased in women who also had a history of diabetes or high cholesterol.5 Nutritionally oriented doctors encourage people who are at risk for heart attack and are overweight to lose the extra weight and keep it off.

Cholesterol (High)

Although it is by no means the only major risk factor, elevated serum cholesterol is clearly associated with a high risk of heart disease. Obesity increases the risk of heart disease,6 in part because weight gain lowers HDL cholesterol (the "good" cholesterol).7 Weight loss increases HDL,8 thereby reducing (improving) the ratio between total cholesterol and HDL, a change linked to lowered risk of heart disease.

Diabetes

People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose to rise. At the same time, however, the cells of the body can be starved for glucose. Diabetes can lead to poor wound healing, higher risk of infections, and many other problems involving the eyes, kidneys, nerves, and heart. Most people with type 2, or non-insulin dependent diabetes mellitus, are obese.9 Excess abdominal weight does not stop insulin formation,10 but it does make the body insensitive to insulin.11 Excess weight even makes healthy people pre-diabetic.12 Weight loss reverses this problem.13 Type 2 improves with weight loss in most studies.14,15,16 Being overweight does not cause type 1, or insulin dependent diabetes mellitus, but it does increase the need for more insulin. Therefore, people with type 1 should achieve and maintain appropriate body weight.

Gallstones

Gallstones are formed in the gallbladder and primarily consist of cholesterol. They are commonly associated with bile that contains excessive cholesterol, a deficiency of other substances in bile (bile acids and lecithin), or a combination of these factors. Some,17 but not all studies have found apparent links between obesity and increased risk of gallstone formation.18

Hypertension

Hypertension is the medical term for high blood pressure. The cause of most hypertension remains unknown. Many people with high blood pressure are overweight. Weight loss can lower blood pressure significantly in those who are both overweight and hypertensive.19 People with hypertension who are overweight should talk with a nutritionally oriented doctor about a weight loss program.

Immune Function

Both excessive thinness and severe obesity are associated with impaired immune responses,20 and obesity has increased the risk of infection in hospitalized patients according to preliminary research.21 However, these effects may not occur with mild to moderate obesity in otherwise healthy people, and attempts to lose weight through dietary restriction may actually be harmful to the immune system.22 The detrimental effects of both excess weight and weight-loss diets appear to be offset when people regularly perform aerobic exercise.23,24

Infertility (Female)

Excessive weight can be a cause of female infertility.25 Infertile women who are overweight should consult a nutritionally oriented physician to develop a weight loss plan.

Mortality

A clear association between obesity and increased mortality (higher death rate) has been reported.26

Osteoarthritis

Osteoarthritis is a common disease that develops when linings of joints fail to maintain normal structure, leading to pain and decreased mobility. Obesity increases the symptoms suffered by people with osteoarthritis of weight-bearing joints. Weight loss is thought by arthritis experts to be of potential benefit, at least in reducing pain in weight-bearing joints.27

Stroke

Strokes are caused either by a lack of blood supply to the brain or by hemorrhage in the brain. Depending on the area of the brain that is damaged, a stroke can cause coma, reversible or irreversible paralysis, speech problems, and dementia. Abdominal obesity has been associated with an increased risk of stroke.28 Smoking (which lower weight but increases the risk of stroke) and other factors sometimes lower the strength of the association between obesity and stroke risk. Nonetheless, scientists believe that being overweight significantly increases the risk of suffering a stroke.29

Triglycerides (High)

Most studies indicate that people with elevated triglycerides (a type of fat in the blood) are at higher risk of heart disease. Obesity increases triglyceride levels.30 Maintaining ideal body weight helps protect against elevated triglyceride levels. Many nutritionally oriented doctors encourage overweight people who have elevated triglycerides to lose the extra weight.

Uterine Fibroids

Obese women are more likely to develop uterine fibroids (benign tumors in the uterus that may cause irregular menses) than non-obese women.31

Work Disability

Obese individuals have a higher risk of having disabilities severe enough to interfere with the ability to work.32

References

1. Soygur T, Kupeli B, Aydos K, et al. Effect of obesity on prostatic hyperplasia: its relation to sex steroid levels. Int Urol Nephrol 1996;28:559.

2. Carroll KK. Obesity as a risk factor for certain types of cancer. Lipids 1998;33:10559.

3. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:96877.

4. Schargrodsky H, Rozlosnik J, Ciruzzi M, et al. Body weight and nonfatal myocardial infarction in a case-control study from Argentina. Soz Praventivmed 1994;39:12633.

5. Tavani A, Negri E, D’Avanzo B, La Vecchia C. Body weight and risk of nonfatal acute myocardial infarction among women: a case-control study from northern Italy. Prev Med 1997;26:5505.

6. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:96877.

7. Glueck CJ, Taylor HL, Jacobs D, et al. Plasma high-density lipoprotein cholesterol: association with measurements of body mass: the Lipid Research Clinics Program Prevalence Study. Circulation 1980;62 (Suppl IV):IV-629.

8. Wood PD, Stefanick ML, Dreon DM, et al. Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med 1988;319:11739.

9. Isida K, Mizuno A, Murakami T, Shima K. Obesity is necessary but not sufficient for the development of diabetes mellitus. Metabolism 1996;45:128895.

10. Casassus P, Fontbonne A, Thibult N, et al. Upper-body fat distribution: a hyperinsulinemia-independent predictor of coronary heart disease mortality. Arterioscler Thromb 1992;138792.

11. Karter AJ, Mayer-Davis EJ, Selby JV, et al. Insulin sensitivity and abdominal obesity in African-American, Hispanic, and non-Hispanic white men and women. Diabetes 1996;45:154755.

12. Park KS, Hree BD, Lee K-U, et al. Intra-abdominal fat is associated with decreased insulin sensitivity in healthy young men. Metabolism 1991;40:6003.

13. Long SD, Swanson MS, O’Brien K, et al. Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. Diabetes Care 1994;17:372.

14. Pi-Sunyer FX. Weight and non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1996;63(suppl):426S9S.

15. Wing RR, Marcuse MD, Blair EH, et al. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care 1994;17:30.

16. Henry RR, Gumbiner B. Benefits and limitations of very-low-calorie diet therapy in obese NIDDM. Diabetes Care 1991;14:80223.

17. Shiffman ML, Sugermann HG, Kellum JH, et al. Gallstones in patients with morbid obesity. Relationship to body weight, weight loss and gallbladder bile cholesterol solubility. Int J Obes Relat Metab Disord 1993;17:1538.

18. Fraire AE, Johnson EH, Kim HS, Titus JL. Gallstones and obesity: observations from 352 autopsied patients. Tex Med 1990;86:268.

19. Alderman MH. Nonpharmacologic approaches to the treatment of hypertension. Lancet 1994;334:30711 [review].

20. Chandra RK. Nutrition and the immune system: an introduction. Am J Clin Nutr 1997;66:4603S [review].

21. Stallone DD. The influence of obesity and its treatment on the immune system. Nutr Rev 1994;52:3750.

22. Nieman DC, Nehlsen-Cannarella SI, Henson DA, et al. Immune response to obesity and moderate weight loss. Int J Obes Relat Metab Disord 1996;20:35360.

23. Nieman DC, Henson DA, Nehlsen-Cannarella SL. Influence of obesity on immune function. J Am Diet Assoc 1999;99:2949.

24. Scanga CB, Verde TJ, Paolone AM, et al. Effects of weight loss and exercise training on natural killer cell activity in obese women. Med Sci Sports Exerc 1998;30:166671.

25. Green BB, et al. Risk of ovulatory infertility in relation to body weight. Fertil Steril 1988;50:6216.

26. Solomon CG, Manson JE. Obesity and mortality: a review of epidemiologic data. Am J Clin Nutr 1997;66:1044S-50S.

27. Altman RD, Lozada CJ. Practice guidelines in the management of osteoarthritis. Osteoarthritis Cartilage 1998;6(Suppl A):224 [review].

28. Walker SP, Rimm EB, Ascherio A, et al. Body size and fat distribution as predictors of stroke among US men. Am J Epidemiol 1996;144:114350.

29. Shinton R, Sagar G, Beevers G. Body fat and stroke: unmasking the hazards of overweight and obesity. J Epidemiol Comunity Health 1995;49:25964.

30. Despres J-P, Tremblay A, Leblanc C, Bouchard C. Effect of the amount of body fat on the age-associated increase in serum cholesterol. Prev Med 1988;17:42331.

31. Sato F, Nishi M, Kudo R, Miyake H. Body fat distribution and uterine leiomyomas. J Epidemiol 1998;8:17680.

32. Rissanen A, Heliovaara M, Knekt P, et al. Risk of disability and mortality due to overweight in a Finnish population. BMJ 1990;301:83537.

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