*Magdalena Olszewska1, Dawid Groth1, Lukasz Szczerbinski2, Elwira Siewiec2, Urszula Puchta2, Pawel Wojciak1, Patrycja Pawluszewicz1, Lukasz Szarpak3, Hady Razak Hady1
Epidemiology and pathogenesis of obesity
Epidemiologia i patogeneza otyłości
1Ist Department of General and Endocrinological Surgery, Medical University of Bialystok, Poland
2Department of Endocrinology, Diabetology and Internal Medicine, University of Bialystok, Poland
3Lazarski University, Warsaw, Poland
Otyłość jest aktualnym problemem zdrowotnym osiągającym skalę epidemii światowej. Niniejsza praca stanowi przegląd danych i piśmiennictwa na temat epidemiologii i złożonej patogenezy zagadnienia. Oprócz konsekwencji zdrowotnych i skrócenia oczekiwanej długości życia otyłość to także rosnący problem społeczno-ekonomiczny.
Obesity is a current health problem reaching the range of the world epidemic. This article reviews the data and literature on epidemiology and the complex pathogenesis of the issue. In addition to health consequences and shortening the life expectancy, obesity is also a growing socio-economic issue.
The aim of this study was to draw attention to the issue of obesity, which has been growing for over a dozen years, in particular its epidemiology and pathogenesis. Obesity is a consequence of weight gain due to a positive energy balance, i.e.: the consumption of more calories than the body demands. Excessive fat gain, exceeding human body’s physiological needs and adaptation possibilities leads to structural and functional defects of many organs and systems, biochemical and physiological disorders, and as a consequence to shortening the life expectancy. Among the many methods assessing the severity of obesity, the most common and most frequently used is the determination of the body mass index (BMI), which is the quotient of body weight (kg) and height (m) squared. Using this method, we recognize overweight in patients with a BMI between 25 and 29.9 kg/m2, and obesity with BMI above 30 kg/m2. Morbid obesity is diagnosed when the patient’s BMI is above 40 kg/m2.
Epidemiology of obesity
Until recently, obesity and overweight have been a problem of developed countries. Currently, this problem concerns developing countries as well as third world countries, and at the same time all socio-economic groups. According to the report of the World Health Organization (WHO) of January 2015, the number of obese people has tripled since 1980 and currently reaches epidemic proportions. In 2014, more than 1.9 billion of world population over 18 were overweight, which is 39%, among them, 600 million were obese (13% of the population, including 11% of men and 15% of women) (1). The highest percentage of obese people is in the United States, where, according to the World Obesity Federation report from 2015, over 60% of adults are overweight and over half of them are obese (2). In Europe, approximately 150 million adults (20% of the population) and 15 million children and adolescents (10% of the population) suffer from obesity. In Poland in 2014, 56.7% of women and 65.8% of men were overweight, and 26.7% of women and 23.5% of men were obese. The obesity problem in Poland has been analyzed within the projects of Pol-MONICA, NATPOL PLUS and the Multicultural National Population Health Survey (WOBASZ) (3-5). In the Polish population between 20 and 74 years old, the average BMI below 25 kg/m2 has been found in only 47% of respondents, 34% was overweight and 19% was obese. According to 2009 GUS data, the problem concerned over 61% of men (45% were overweight, 17% obese) and almost 45% of women (30% were overweight and 15% obese) (6). The most disturbing, however, is the fact that in 2013 42 million children under the age of 5 were found overweight or obese. Currently, in Europe, about 20% of children are overweight, and nearly 1/3 of them achieve values of BMI suggesting obesity and it is the most common health problem in children. It is estimated that by 2030 one child in 10 will be obese. Among Polish children, overweight were diagnosed in 9.7% of 13-year-old boys and 3.9% of 13-year-old girls (7, 8). What is more, those children will probably remain obese even after reaching adulthood and will have an increased risk of developing diseases leading to a decrease in the quality and length of their lives. It has been proven that along with the increase in BMI the risk of obesity complications, including early death, increases (9, 10). The World Health Organization warns that obesity is responsible for 10-13% of deaths, and the majority of the population lives in countries where overweight and obesity is the cause of death of a larger percentage of society than malnutrition. Obesity leads to a shortened life expectancy of 5-20 years depending on its severity as well as patient’s age, sex and race (11). Patients with obesity are more likely to develop diseases such as type 2 diabetes, arterial hypertension, coronary heart disease, strokes or some cancers (endometrium, ovary, breast, prostate, large intestine) (12, 13). 90% of patients with type 2 diabetes are obese or overweight (14). Long-lasting and, above all, unregulated diabetes leads to a number of changes in the body, especially those of micro- and macroangiopathy, which in turn increases the risk of death, myocardial infarction or stroke (15). Studies show that up to 60% of obese patients also develop fatty liver (16, 17), including up to 55% in the pediatric population (18, 19). Although, approximately 20% of obese patients do not find typical changes in the lipid metabolism, most of them present the symptoms of disorders of lipid metabolism, which is associated with an increased risk of developing cardiovascular disease, including myocardial infarction or ischemic stroke (20). Obesity also increases the risk of pancreatitis, gout, hyperuricemia, sleep apnea syndrome, urolithiasis, in women problems with infertilization and delivery, which is associated not only with hormonal changes (increased estradiol, estriol, testosterone, androstendione) and disorders of ovulation, but also with systemic diseases accompanying obesity. Health-related consequences are less serious but also disturbing (21). Reduced mobility, disturbed perception of one’s body may increase the risk of depression or personality disorders. In addition, the social and economic costs of obesity are extremely high. In Europe, they absorb up to 6% of health expenditure, depending on the region (22, 23). It should not be forgotten that obese people are less likely to work professionally due to co-morbidities, and children achieve worse results in learning. Unwanted weight gain is caused by a positive energy balance, i.e. more calories than those consumed by a person. The causes of the epidemic are complex. We call many of them the so-called “Environment favorable to obesity” and include such factors as the structure of society, economic policy, socio-economic development (a greater number of urban residents, driving cars, a sedentary lifestyle at home and at work, consumption of processed food, etc.).
Pathogenesis of obesity
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