Health Journal Online

Tag: Obesitys

  • Obesity’s Impacts on Our Immune System and Kidney and Liver Diseases 

    Obesity’s Impacts on Our Immune System and Kidney and Liver Diseases 

    What are the effects of weight loss on natural killer cell function, our first line of immune defense against cancer, kidney function, and fatty liver disease?

    In the ABCs of the health consequences of obesity, I is for Immunity.

    The SOS trial followed the fates of thousands of bariatric surgery patients for a decade or two, compared to a control group who maintained their weight. Those who surgically lost about 20 percent of their body weight not only lived longer, thanks in part to less diabetes and less cardiovascular disease, but they also got less cancer. This may be because anti-tumor immunity appears to be affected by weight.

    Natural killer cells are our immune system’s first line of defense against cancer cells and many viral infections, “and their function is severely impaired in individuals with obesity.” When individuals who were obese were randomized to a weight-loss program, researchers found a significant reactivation of the participants’ natural killer cell function within just three months. The program involved an exercise component, though, so it’s hard to tease out the impact of the weight loss itself since physical activity on its own can boost natural killer cell activity.

    On the other end of the immune spectrum, obesity is suspected to be a causal risk factor for the development of the autoimmune disease multiple sclerosis. This suggests obesity is associated with the worst of both worlds when it comes to immune function: underactivity when it comes to protecting against cancer and infection, and overactivity when it comes to certain inflammatory autoimmune conditions.

    J is for Jaundice. Thanks to the obesity epidemic, nonalcoholic fatty liver disease is now the most common liver disorder in the industrialized world. Fat doesn’t just end up in our belly and thighs but inside some of our internal organs. More than 80 percent of individuals with abdominal obesity may have fatty infiltration into their liver, and in those with severe obesity, the prevalence can exceed 90 percent. This can lead to inflammation, scarring, and, ultimately, cirrhosis and liver cancer, as you can see below and a 2:10 in my video The Effects of Obesity on the Immune System and Kidney and Liver Diseases. Currently, this nonalcoholic fatty hepatitis is the leading cause of liver transplants in American women. 

    K is for Kidneys. Obesity is also “one of the strongest risk factors for new-onset chronic kidney disease.” Our kidneys compensate for the metabolic demands of excess weight by red-lining into what’s called “hyperfiltration” to deal with the extra workload. This resulting increased pressure within our kidneys can damage the sensitive structures and increase the risk of kidney failure over the long term.

    What about L, M, N, O, P through Z? If you want to continue through the alphabet, L could be for diminished lung function, M could be for metabolic syndrome, and so on. There is even an X—for xiphodynia—pain at the tip of the bottom of the breastbone from being bent forward by an expanding abdomen.

    Given the myriad health conditions associated with excess weight, “annual medical spending attributable to an obese individual” is nearly $2,000 per year and workers who are obese with multiple conditions can cost companies up to $10,000 more in healthcare coverage compared to “their lean counterpart.” This may account for some of the wage gap that employees who are obese may experience, as companies try to pass along these costs of “their higher health insurance premiums,” beyond just brazen discrimination. Between healthcare costs and diminished productivity in terms of lost workdays, the total lifetime costs of obesity for children and teens have been estimated to exceed $150,000.

    Some estimates peg the annual “medical care costs of obesity in the United States” at about $150 billion, with another $50 billion per year added by 2030 as our increasingly heavy Baby Boomers continue to age. Others diametrically disagree, based on the morbid fact that individuals who are obese may not live as long. Just as “the high medical costs of smoking-related diseases are more than offset by lower survival of smokers,” the lifetime healthcare costs of individuals who are obese may turn out to be lower because they are expected to die so much sooner. So, the true cost may be more in lives, rather than dollars. How much does being overweight cut your life short? I’ll explore just that question next.

    If you missed the previous blog posts in my series on the ABCs of obesity, see related posts below.

    I continue the topic of obesity and weight with these videos: Is the Obesity Paradox Real or a Myth? and Friday Favorites: What’s the Ideal BMI and Waist Size?.

    For more on the health conditions discussed in this video, see the immune function, kidney disease, and liver health topic pages. 



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  • Obesity’s Impacts on Gallstones, Acid Reflux, and Heart Disease 

    Obesity’s Impacts on Gallstones, Acid Reflux, and Heart Disease 

    Sufficient, sustained weight loss may cut the risk of fatal heart attacks and strokes in half.

    In the ABCs of health consequences of obesity, G is for Gallstones.

    The top digestive reason people are hospitalized is a gallbladder attack. Every year, more than a million Americans are diagnosed with gallstones, and about 700,000 must have their gallbladders surgically removed. It is a relatively safe procedure, with complication rates tending to be under 5 percent and a mortality rate of only about 1 in 1,000. However one in ten may develop a post-cholecystectomy syndrome of persistent gastrointestinal symptoms long after their gallbladder is removed.

    What are gallstones made of? In 80 to 90 percent of cases, gallstones are mostly crystalized cholesterol, forming like rock candy in our gallbladder when cholesterol gets too concentrated. This was used to explain why some small, early studies found that non-vegetarians had a higher incidence of gallstones. However, results from more recent, larger studies are more equivocal; one study suggests that a “vegetarian diet may therefore protect” against gallbladder disease, for instance, while another shows higher rates among vegetarians, independent of weight.

    As I discuss in my video The Effects of Obesity on Gallstones, Acid Reflux, and Cardiovascular Disease, the biggest purported cause-and-effect risk factor may be obesity, increasing risk as much as sevenfold, as you can see below and at 1:32 in my video, with a doubling of risk even at the heavier side of “the normal BMI range.” 

    Ironically, rapid weight loss may also be a trigger. Half a pound (1.5 kg) a day has been deemed the upper limit for medically safe weight loss, based on gallstone formation. Ultrasound studies found that, above that, the chance of new gallstones can go from less than 1 in 200 a week to closer to 1 in 40, as shown below and at 1:59.

    To help prevent a gallstone attack, we can increase our fiber intake. Not only is dietary fiber intake associated with less gallbladder disease in the first place, but those placed on high-fiber foods during a weight-loss regimen suffered significantly less gallbladder sludging than those losing the same amount of weight without getting the extra fiber.

    G is also for gastroesophageal reflux disease, or GERD. Fiber-rich food consumption decreases the risk of acid reflux, too. I previously explored how chronically straining at stool may push part of the stomach up into the chest cavity. Well, excess abdominal pressure due to obesity may have the same effect, pushing acid up into the throat and causing heartburn and inflammation. The increased pressure on the abdominal organs associated with obesity may also explain why overweight women suffer from more vaginal prolapse, where organs such as the rectum push out and into the vaginal cavity. 

    The deadliest letter in the alphabet of obesity consequences is H, which is for Heart Disease. Of the four million deaths attributed to excess body weight every year around the world, nearly 70 percent are due to cardiovascular disease. Is it just because of eating poorly? Mendelian randomization studies suggest that people randomized from conception to be heavier—based only on genetics—do indeed have higher rates of heart disease and stroke regardless of what they eat. The question is: If you lose weight, does your risk drop?

    Enter the Swedish Obese Subjects (SOS) trial, the first long-term controlled trial to compare the outcomes of thousands of bariatric surgery patients to matched control subjects who started out at the same weight but went the nonsurgical route. Individuals in the control group maintained their weight, whereas those in the surgical group maintained about a 20 percent weight loss over the next 10 to 20 years. In that period, those in the weight-loss group not only developed 80 percent less diabetes, but they suffered significantly fewer heart attacks and strokes. So, unsurprisingly, they significantly reduced their total mortality overall. Ten years out, the weight-loss group appeared to cut their risk of fatal heart attacks and strokes in half, as shown below and at 4:23 in my video. 

    If you missed the previous videos in my series on the ABCs of obesity, see:

    I continue the topic of obesity and weight with videos in the related posts below.

    For more on the health conditions discussed in this video, see the gallstones, GERD, and heart disease topic pages.

    The GERD-related video I mentioned is Diet and Hiatal Hernia. 



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  • Obesity’s Impacts on Our Brain, Dementia, and Fertility 

    Obesity’s Impacts on Our Brain, Dementia, and Fertility 

    Weight loss can decrease dementia risk and improve mental performance and fertility.

    As I’ve discussed previously, in the ABCs of the health consequences of obesity, A is for Arthritis, B is for Back Pain and Blood Pressure, C is for Cancer, and D is for Diabetes. That brings us to E, which is for Encephalopathy.

    Encephalopathy means brain disease. There are consistent data linking obesity in middle age to a higher risk of dementia later in life. Researchers found that individuals who are overweight have about a one-third higher risk of dementia and those who are obese in mid-life have about 90 percent greater risk. The risk isn’t limited only to future dysfunction, though. People with excess body weight don’t appear to think as clearly at any age.

    “It was found that obese participants showed broad impairments on executive functions” of the brain, including working memory, decision-making, planning, cognitive flexibility, and verbal fluency. “From resisting temptation to keeping long-term goals in mind, executive functions play a critical role in everyday life,” noted a meta-analysis and review of 72 studies on the issue.

    According to researchers, people may think about their obesity and the resulting stigma they experience as much as five times an hour, but the cognitive deficits do not appear to arise just from distraction; there are structural brain differences between individuals who are at an ideal weight versus overweight.

    A review entitled “Does the Brain Shrink as the Waist Expands?” noted gray matter atrophy across all ages among those carrying excess body fat. It’s this reduced brain volume that has been correlated with lower executive function. As you can see below and at 1:42 in my video The Effects of Obesity on Dementia, Brain Function, and Fertility, compromised integrity of the rest of the brain—the white matter—suggests accelerated brain aging, even in young adults and children with obesity. 

    Cognitive deficits in younger populations suggest there’s something about obesity itself that is affecting brain function, rather than a later clinical consequence, such as high blood pressure. Purported mechanisms for this executive dysfunction include obesity-related inflammation and oxidative stress.

    So, does weight loss improve cognitive function? Based on a meta-analysis of 20 studies, researchers found that mental performance across a variety of domains can be significantly improved with even modest weight loss. However, no studies have yet to be done to determine if this then translates into a normalization of Alzheimer’s disease risk.

    Back to the ABCs of obesity’s health consequences, F is for Fertility—or rather failed fertility. “Overweight and obese persons seeking fertility should be educated on the detrimental effects of fatness and the benefits of weight reduction, including improvement in pregnancy rates,” one meta-analysis concluded. Men also may suffer impaired fertility. The heavier a man is, the greater his risk of having a low sperm count or being completely sterile, as you can see below and at 3:01 in my video. This may be due in part to the effects of excess body fat on testosterone levels. 

    Fat isn’t the primary site of estrogen production in only postmenopausal women, but in men, too. An enzyme in body fat converts testosterone into estrogen. Men losing weight and going from obese to overweight could potentially raise the testosterone levels in their blood by 13 percent.

    A more dramatic cause of infertility in obese men is called a “hidden penis.” The condition, which is also described in the medical literature as a “hidden, buried, concealed, trapped, and inconspicuous” penis, occurs when excess fat in the pubic area subsumes the penis (since its base is attached internally to the pubic bone). The moist enfolding skin surfaces can result in chronic inflammatory dermatitis leading to scarring and requiring a surgical intervention.

    If you missed the previous blog posts, I covered The Best Knee Replacement Alternative for Osteoarthritis Treatment and The Effects of Obesity on Back Pain, Blood Pressure, Cancer, and Diabetes.

    I continue the topic of obesity and weight with videos in the related posts below.

    I cover all of this and more at length in my book How Not to Diet, and its culinary companion, The How Not to Diet Cookbook, has more than 100 delicious, weight-conscious recipes. Request them from your local library. 

    For more on the health conditions discussed in this video, see the Alzheimer’s disease, cognition, and fertility topic pages.  



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  • Obesity’s Impact on Back Pain, Blood Pressure, Cancer, and Diabetes 

    Obesity’s Impact on Back Pain, Blood Pressure, Cancer, and Diabetes 

    Losing weight can reduce sciatica, hypertension, and cancer risk, as well as reverse type 2 diabetes.

    In the ABCs of the health consequences of obesity, A is for Arthritis, as I discussed in my previous blog post, and B is for Back Pain. Being overweight is not just a risk factor for low back pain, but it is also a risk factor for sciatica (a radiating nerve pain), as well as degenerating lumbar discs and disc herniation. Similar to what we learned in the arthritis story, this may also be due to a combination of the excess weight, high cholesterol, and inflammation associated with being overweight. Why cholesterol? Studies of autopsies and angiographies show that the lumbar arteries that feed our spine can get clogged with atherosclerosis and starve the disks in our lower back, as you can see below and at 0:47 in my video The Effects of Obesity on Back Pain, Blood Pressure, Cancer, and Diabetes. 

    B is also for Blood Pressure. Excess visceral fat—for example, internal abdominal fat—can physically compress our kidneys. The increased pressure can effectively squeeze sodium back into our bloodstream, increasing our blood pressure. Together, the combination of obesity and hypertension can have “disastrous health implications,” but the good news is that just a few pounds of weight loss can help take off the pressure. Losing excess weight has been described as “a vital strategy for controlling hypertension.” In fact, researchers found that losing around nine pounds (4 kg) may lower blood pressure about as much as cutting salt intake approximately in half can.

    C is for Cancer. As many as three-quarters of people surveyed “were unaware that being overweight or obese increased a person’s risk of cancer,” when, in fact, based on a comprehensive review of more than a thousand studies, excess body fat raises the risk of most cancers, including esophageal, stomach, colorectal, liver, gallbladder, pancreatic, breast, uterine, ovarian, kidney, brain, thyroid, and bone marrow (multiple myeloma) cancers, as you can see below and at 2:00 in my video.

    It could be the chronic inflammation of obesity or perhaps it is the high insulin levels due to insulin resistance. (Besides controlling blood sugars, insulin is also “a potent growth factor” that can promote tumor growth.) In women, it could also be the excess estrogen.

    After the ovaries shut down at menopause, fat takes over as the principal site of estrogen production. That’s why women who are obese have up to nearly twice the estrogen levels circulating in their bloodstream, which is associated with an increased risk of developing breast cancer and dying from it. The data on prostate cancer aren’t as strong, though obesity is associated with increased risk of invasive penis cancer. 

    One of the reasons we’re confident the link between obesity and cancer is cause-and-effect—and not just an indirect consequence of eating poorly—is that the overall risk of cancer goes down when people lose weight, even through bariatric surgery. Researchers found that those experiencing a sustained weight loss of about 40 pounds (19.9 kg) after surgery went on to develop around one-third fewer cancers over the subsequent decade, compared with matched individuals in the nonsurgical control group who continued to slowly gain weight over time. The exception, though, is colorectal cancer. 

    “Colorectal cancer is the only known malignancy where the risk of being diagnosed with disease seems to increase after obesity surgery.” Indeed, after bariatric surgery, the rate of rectal cancer death may triple. The rearrangement of anatomy involved in one of the most common surgeries—Roux-en-Y gastric bypass—is thought to increase bile acid exposure along the intestinal lining. This causes sustained pro-inflammatory changes even years after the procedure, which is thought responsible for the increased cancer risk. In contrast, losing weight by dietary means has the potential to decrease obesity-related cancer risk across the board.

    D is for Diabetes. As presented in a consensus statement from the International Diabetes Federation, obesity is considered the single most important risk factor for the development of type 2 diabetes, which is the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness. Ironically, many of the leading drugs used to treat diabetes (including insulin itself) cause further weight gain, creating a vicious cycle. 

    So, again, using lifestyle medicine to treat the underlying cause is not only safer, simpler, and cheaper, but can also be most effective.

    If you missed my previous video, check out The Best Knee Replacement Alternative for Osteoarthritis Treatment.

    Coming up next? See related posts below.

    I continue the topic of weight control with these videos that may be of interest to you: Is the Obesity Paradox Real or a Myth? and Friday Favorites: What’s the Ideal BMI and Waist Size?.

    For more on back pain, blood pressure, cancer, and diabetes, check out their topic pages. 



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