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Running head: OBESITY: A CHRONIC DISEASE
Obesity: A Chronic Disease
Britney M. Bernard
Frostburg State University
An Introduction to Obesity as a Chronic Disease
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Obesity is a wide spread healthcare issue that is currently affecting millions of people
worldwide. In 2008 the World Health Organization reports, “an estimated 205 million men and
297 million women over the age of 20 suffer from obesity – a total of more than half a billion
adults worldwide” ("Obesity," 2014). A staggering number, five hundred million adults are at risk
for associated health issues related to obesity. “It is more than simply a thermodynamic, genetic,
or a metabolic problem of handling calories; it is a behavioral disorder and an inflammatory
disease leading to dysregulation of metabolism and energy balance, and impairment of the
neurohormonal systems, leading to accumulation of intra-abdominal fat leading to serious
complications”(Wimalawansa,2013).
Obesity carries a heavy concern among the population due to the increase in a multitude
of health disparities including but not limited to: coronary heart disease, type 2 diabetes, cancer,
hypertension, respiratory problems, and gynecological problems ("The pathophysiology of,"
2012). The associated cost of health care is also an issue. “In 2008, US obesity-related medical
care costs were estimated to be as high as $147 billion, and are projected to increase by $28
billion by 2020 and $66 billion by 2030” ("The pathophysiology of," 2012).
The importance of educating the population to better understand the cause and effect of
obesity is an important first step to reducing this multifaceted issue. “The increase in obesity over
the past 30 years has been fueled by a complex interplay of environmental, social, economic, and
behavioral factors, acting on a background of genetic susceptibility” ("About nih obesity," 2012).
The goal is to educate the population on the complexity of obesity while providing tools for
weight loss or maintenance. It is not a simple approach but an involved tactic that will help
reduce the number of people affected by obesity. “While recognizing the multifaceted nature of
obesity is the first step in any attempt to contain the growing epidemic of the disease,
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understanding the underlying pathophysiology of obesity is essential to developing successful
treatment strategies” ("The pathophysiology of," 2012).
Pathophysiology
Research by Dr. Sunil Wimalawansa (2013) illustrated that the causes of obesity fall into
two general categories including genetic and environmental, the current situation is a
combination of the two. It is important that both aspects are evaluated when treating a patient. It
is imperative for the care provider to explain how obesity is reached for a patient to fully
understand the pathophysiology. Professionals state, “The development of obesity occurs when
the caloric intake is disproportionate to the energy expended” (Pi-Sunyer, 2002). “Obesity, which
is characterized primarily by the disruption of the balance between energy intake and energy
expenditure is a chronic disease state with multiple etiologies” ("The pathophysiology of," 2012)
Wimalawansa (2013) proclaims that the excess consumption of refined sugar and carbohydrates
are of the main contributors. It is also stated that, “Three metabolic factors have been reported to
be predictive of weight gain: a low adjusted sedentary energy expenditure, a high respiratory
quotient (RQ; carbohydrate-to-fat oxidation ratio), and a low level of spontaneous physical
activity” (Pi-Sunyer, 2002). Once a strong perspective is gained about the factors contributing to
weight gain, a look even further into energy homeostasis is helpful. “Physiologically, energy
homeostasis involves the interplay of various secreted signals from the periphery, as well as
homeostatic and hedonic neural networks in the brain, engaged in bidirectional communication
to regulate appetite and satiety” ("The pathophysiology of," 2012).
“Obesity results in excessive adiposity which, over time, leads to an imbalance in
adiposity signals to the brain and adiposopathy. The imbalance in the levels of secreted peptide
hormones from adipose tissue seen in obese individuals may contribute to pathways involved in
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the development of associated comorbidities” ("The pathophysiology of," 2012). It is also
helpful to understand, utilizing body mass index and abdominal girth as a measurement tool; we
are able to identify proof that obesity is a rising epidemic in the United States and most
industrialized countries (Wimalawansa, 2013). It is also identified that,“At the current rates, it is
predicted that obesity-associated deaths are going to surpass cardiovascular deaths within the
next two decades” (Wimalawansa,2013).
Effects of Overweight/Obesity on the Cardiovascular System
Obesity is characterized by excessive adiposity in the body and plays a major role in the
development of conditions such as insulin resistance, hypertension, dyslipidemia,
atherosclerosis, and diabetes mellitus. This is expected when excessive adipokines are secreted
into the blood stream. On a wider scale, obesity influences the dysfunction of organs such as the
liver, intestines, heart, pulmonary glands, and reproductive organs. The relationship between
obesity and cardiovascular disease is a complex issue. It is undisputed that obesity, or excess
body weight, plays a significant role in regards to causing cardiovascular disease. As observed by
Lawler et al (2010), the increase in adipose tissue detected in obese and overweight individuals
increases the chances of cardiovascular complications occurring and these could result in death.
Some of the cardiovascular complications that can be traced to obesity include increased
pressure on the walls of the heart and blood vessels, eccentric left ventricular hypertrophy,
hardening of blood vessels, and blockage of blood vessels around the heart.
Obesity results in an increase of the overall volume of blood and the increase of cardiac
output due to the increase in metabolic demand that results from excessive body weight. This
implies that the cardiac workload in obese and overweight individuals is considerably greater
than lean individuals. Moreover, in obese and overweight individuals, the Frank-Starling curve
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inclined to the left due to the increase filling volume and pressure in the left ventricle (Poirier et
al 2005). This increase with time may lead to dilation in the ventricular chamber which may then
result in increased wall stress which may augment myocardial mass and eventually result in left
ventricular hypertrophy. Obese or overweight individuals have additional fat tissue in their body
systems, just like the other tissue, require oxygen and nutrients to live. In order to supply blood
to the additional blood vessels that serve the additional fat tissues, the heart has to pump harder
and this increases the blood pressure. If left uncontrolled, the increased pressure may damage the
muscles of the heart and eventually result in a heart attack.
In obese and overweight individuals, the additional fat could easily begin building up
within the walls of vessels that supply blood to the heart (Lacobelllis, 2009). The buildup of fat
reduces the cross section of the blood vessels therefore limits the amount of blood that flows into
and out of the heart. This situation also results in the heart having to pump harder so it can
circulate blood around the body. The increased rate of pumping places additional stress on the
walls of the blood vessels around the heart and, over time, the added pressure could damage
these blood vessels. The damaged arteries will not be able deliver sufficient oxygen to the heart
and other organs and this could trigger multiple organ failure. The deposit of fat within the
cardiac vessels could also lead to hardening of these arteries or atherosclerosis, making it easy
for blood clots to form within the artery. Blood clots and other fragments of the plaque could
block the flow of blood vessels in the smaller vessels that supply the heart with blood therefore
causing cells in the affected area to die and trigger a heart attack.
As mentioned previously, eccentric left ventricular hypertrophy is another condition that
can result from excessive adipose tissues in the body. This condition is commonly found in obese
individuals whose BMI is equal or more than 40 Kg/m2 and has been connected with diastolic
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dysfunction of the left ventricle (Poirier et al. 2005). If the individuals remain obese for a long
time, the ventricular systolic function and the left ventricular diastolic function may also be
impaired. Obesity can also result in cardiomyopathy when tiny irregular bands and aggregates of
adipose tissue cause a separation of myocardial cells and this can potentially result in pressureinduced atrophy.
Effects of Overweight/Obesity on the Endocrine System
Being overweight and/or obese plays a major role in the functioning of the endocrine
system. One disease related to this system, that is increasing and closely relates to obesity, is
diabetes. “Of the people diagnosed with type II diabetes, about 80 to 90 percent are also
diagnosed as obese” (Healthy living). This fact in itself is very substantial in the risk factors for
diabetes. The fact that 80-90 percent of diabetics are also obese is such a high statistic. There
have been many studies done to correlate these two diseases together and the facts make sense
when they are broken down.
Often times, people think being overweight is just an issue in itself. Obesity leads to a
variety of other diseases, and increases your rate of developing them. “Being overweight places
extra stress on your body in a variety of ways, including your body’s ability to maintain proper
blood glucose levels. This can then cause your body to become resistant to insulin” (Healthy
living).The endocrine system is the body system that regulates insulin production and obesity can
contribute to its decreased functioning leading to diabetes mellitus.
The endocrine system plays a vital role in health and reproduction. It is imperative to
understand how obesity can cause such negative outcomes. Being overweight causes all organs
to work harder and faster to compensate, it also struggles to keep normal glucose levels in the
body. The extra stress then causes an increased risk of developing diabetes.
OBESITY: A CHRONIC DISEASE
Diabetes can be a preventable illness; taking action against obesity can prevent one from
acquiring this disabling ailment. Patient education is lucrative; there are countless education
opportunities for the patient. The first teaching needs for prevention of diabetes should be
focused on diet. Dietary intake closely relates to obesity, and therefore negatively results in
diabetes. “A high fiber, low carbohydrate diet and 20 to 30 minutes of moderate activity per day
are recommended” (Healthy living). Patients should maintain a healthy weight and increase
physical activity. Dieticians and nurses should work together to create a diet and activity plan
that is best suited for the patient. Every patient’s needs are different; therefore an individualized
approach should be completed.
Obesity continues to be a concern, especially in the United States. “The prevalence of
obesity has risen dramatically in developed countries over the past 2 to 3 decades. Obesity has
reached epidemic proportions in the United States with more than 20% of adults defined as
clinically obese and an additional 30% defined as overweight” (Heindal,2003). Cultural
differences also play a major role in obesity, as many traditions focus around food and meals for
family gatherings. Food is often times associated with emotions and should also be considered
when educating a patient. For example, most people eat when they are happy, sad, excited,
stressed or even scared. Therefore, this leads to an increased risk of developing obesity.
Together, with an increase in education and exercise, a difference can be made in the
outcomes of diabetes, and overweight/obesity. A focus on preventative teaching should be a
common goal.
Functional Health Literacy Level
Obesity in the Unites States is widespread and a leading public health problem (Food
Research and Action Center, 2012).According to the National Center for Health
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Statistics(2009),obesity rates have more than doubled in Adults since 1970's and by 2015, it is
estimated that 75% adults will be overweight while 41% will be obese (Y.Wang and
M.Beydoun.,2007).While many factors contribute to obesity, health literacy is seen as the most
influential factor leading to high obesity rates.
The Agency for Healthcare Research and Quality (2011) defines health literacy as the
degree to which individuals can obtain, process, and understand the basic health information and
services they need to make appropriate health decisions. Findings suggest that low health literacy
has adverse effects on medical condition knowledge and the inability of patients with chronic
conditions to take responsibility of effective self-care (F.H.Wallace,1998).
Overweight/Obesity; A Study
The factsheet for Patient Education, “Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults“ provided by the National Heart,
Lung, and Blood Institute Obesity Education Initiative was evaluated. After reviewing and
completing the assessment of the factsheet, the findings are as follows:
Based on the calculation provided by SMOG readability score, the fact sheet results were
of 10th grade reading level which is above the recommended 5th grade reading level (Doak et
al.,1996). Hence, making it too difficult for the average adult reader to easily comprehend which
raises the issue of terminology and the complexity of language used.
This finding should be of immense concern to designers of printed and internet health
information sources as some of the patient education materials (PEM) available are likely to not
be readily understood by a large group of the population. Readability measures and tool for web
pages design, and patient education materials that are non-English and reflect cultural
competence are needed (M.Wilson.,2008) as this fact sheet used in the case study does not justify
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any of the aforementioned needed PEM components. As noted earlier, the result of
misunderstanding or not fully comprehending health related information has the potential to be
life threatening.
Conclusion
The preceding information is imperative to grasp due to the continual climb in health
disparities overall. Obesity impairs the ability to complete normal every day activities as well as
greatly affecting your health and increasing your risk for a multitude of diseases. Although
obesity is not limited to two systems, it is noted here that there are significant health effects on
the cardiovascular and endocrine systems. Patient education is a key element to changing the
direction of this widespread problem. As our world begins to identify the grave nature of obesity
as a true epidemic, education can begin to be infiltrated into the lives of people. Small steps
toward change can begin, with proper education, and the human population can begin to address
obesity with diligent focus and attention.
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