Problems Caused By
Being Overweight

Problems Caused By Being Overweight: Overview

There are various reasons why people are overweight.  These include genetics (suggested by studies of twins), overeating, stopping smoking, alcohol consumption, lack of exercise, a change in life-style, more energy intake than energy expenditure (taking into account resting metabolic expenditure), environmental factors, salt/potassium retention, hidden food allergies, major depression/anxiety/other psychological, medical illness, medications, during and after pregnancy, cultural (perceptions on obesity), and socioeconomic factors. Obesity, as defined by the Institute of Medicine, is "an important chronic degenerative disease that debilitates individuals and kills prematurely." It continues to contribute to hundreds of thousands of deaths in the U.S.  every year.

Causes and Development

Set Point Theory. Obesity is not strictly the product of sloth and gluttony.  Everybody has a weight that their body can defend and most people know what that weight is.  You lose a little weight, but tend to bounce back to your original weight again and again.  That weight is called the "set point".  Although weight is influenced by what and how much one eats, and by such things as exercise, ordinarily it will revert to its most comfortable level.

One thing that is not well-recognized is the fact that weight loss itself is not a particularly difficult problem.  If a human being is put on an 800 or 1000 calorie diet, they lose weight.  There do not appear to be a large number of people who have undesirable responses to a 1000 calorie diet that prevents them from losing weight: the few claims that have been investigated have not held up to scrutiny.  In other words, there are no people who are totally resistant to weight loss.  However, the vast majority of humans are very resistant to the maintenance of a body weight below whatever their set point is.

A person's set point is the approximate weight and fat percentage that their body settles into during adulthood.  Body fat is actually regulated by the brain's weight regulating mechanism in the hypothalamus.  This mechanism chooses the amount of body fat it considers ideal for the body's needs and then works tirelessly to maintain that level.

The regulating mechanism controls body weight in two critically important ways.  First, it has a profound effect of the amount of food you eat.  It is responsible for dramatically increasing or decreasing appetite to maintain the set point weight.  As you lose weight, it signals hunger; as you gain weight, it reduces appetite.  Second, the regulating mechanism can trigger the body's systems to waste excess energy if you overeat or conserve energy if you don't eat enough.  Energy conservation may lead to muscle loss and a slow down of the endocrine system due to the body's attempts to protect its fat stores for use in the future.  In addition, less muscle mass means the body requires still fewer calories.

An individual's set point is genetically determined.  There are those who are able to eat anything and everything they desire and still maintain a low body fat percentage, but others who continually struggle with their genetic set point and constantly diet and exercise to lose weight.  Often this weight loss is a loss of both muscle and fat tissue.  Once they stop dieting, those who have battled fat loss incorrectly or are simply unable to maintain the proper lifestyle will inevitably return to their original body composition or gain additional body fat.  The subsequent weight gain consists primarily of fat tissue.

If you go to a doctor and say that you need to lose weight, the doctor is not likely to tell you that are at your set point, so there is not need to treat you.  That thought usually has nothing to do with how people are treated.  The diet industry also is not based primarily on medical complications, but cosmetics and profit.

Leptin
Molecular biologists first identified leptin in 1994.  Since then, the fat hormone has been the subject of intense speculation among scientists.  Leptin has prompted research into eating disorders, obesity and diabetes.  The obesity hormone leptin appears to reduce cravings for sweet foods by targeting taste receptors on the tongue.  Therefore, it is possible that a lack of leptin, or the body's failure to respond to the hormone due to defects in leptin receptors (leptin resistance), may contribute to the so-called sweet tooth that affects so many.

Leptin, a hormone produced by fat cells, is involved in weight regulation.  It is thought that the hormone signals the brain when fat cells are full, but exactly how the hormone controls weight is not entirely clear.  Animals and humans without leptin, or with defective leptin receptors, become obese.  As one becomes fatter, the body makes more leptin and the likelihood of leptin resistance increases [NEJM, February 1, 1996;334: pp.292-5].  Men whose bodies produce more insulin also tend to have increased leptin levels.

Exercise decreases the amount of leptin in the blood of both overweight and normal weight individuals.  Recent research shows that only 3 hours of exercise per week lowers leptin levels by about 10%.  Exercise can lower the levels of leptin no matter how fat a person is.  Lowering leptin levels reduces the risk of leptin resistance seen in obesity; raising leptin levels does not appear to be an effective weight loss mechanism in humans.  However, trials have shown that large supplemental doses of leptin can result in some weight loss in obese individuals.

In short, leptin levels should be kept within the normal range: low levels can result in food cravings and higher levels tend to suppress appetite but are also associated with tissues becoming less sensitive to the hormone and contributing to craving and more weight gain.  Exercise can lower leptin levels, but caution must be taken in some individuals that levels do not go too low.  Researchers have long been busy searching for the key to safely control a person's weight.  It remains to be seen if they will ever be successful.

Signs and Symptoms

Fatigue (especially after exertion), shortness of breath, decreased energy, palpitations, irregular heart beat, edema (especially swelling of the feet and legs), sleep apnea (Pickwickian syndrome) and respiratory obstruction (for obesity to cause sleep apnea and respiratory obstruction it must be severe).

Physical signs and risks of being overweight
Hypertension, coronary heart disease, predisposition to diabetes, hyperlipidemia (increased cholesterol level), metabolic abnormalities, increased risk for gallbladder disease, gout, some types of cancer, and development of osteoarthritis of the weight-bearing joints.

Treatment and Prevention

One way to rationalize the treatment of obesity is to treat only individuals who have medical causes and complications.  Treat the individual who has hypothyroidism, hyperlipidemia, gall bladder disease, or type II diabetes, to the point where the cause and risks are reduced.  Don't treat the obesity itself – treat the cause or the body fat content until you relieve the metabolic consequences.  It turns out that just a 10% body fat reduction can produce increases in insulin sensitivity and blood pressure reduction.

Complications

The relationship of weight to blood pressure. Being overweight is a significant risk factor for the development of hypertension.  The prevalence of hypertension in the U.S.  is greatly increased by the fact that one quarter to one half of all adults (results differ by study) are overweight.  Although the association between higher body fat and blood pressure has been recognized for years, recent studies have discovered a 50-300% higher incidence of hypertension among adults who consider themselves overweight compared to those classified as normal weight.  Similar findings are revealed from studies involving children and young adults, in which the connection between weight and blood pressure has been observed to be very strong.

Two proposed mechanisms underlying this correlation are the stimulation of sodium retention and increased catecholamine release, which are results of increased sodium sensitivity and hyperinsulinemia.  Age, gender, and race are also part of the equation and so should be considered when studying preventive interventions.  Hypertension and obesity treatment are necessary to avoid potential morbidity and mortality from coronary heart disease or stroke.

References and Further Information

[Institute of Medicine, Weighing the Options.  National Academy Press, 1995]
[American Heart Journal 147 (2004): p.841]
[New England Journal of MedicineVolume 338 (1998): p.1]
[Annals of Internal Medicine 138 (2003): p.24]
[Journal of the American Medical Association 289 (2003): p.187]

Signs, symptoms & indicators of Problems Caused By Being Overweight:

Symptoms - Abdomen

Constant slight bloating may be a sign or symptom of Problems Caused By Being Overweight Constant significant/constant slight bloating

The classic 'beer belly' is usually caused by high levels of visceral fat.  This is not the same as subcutaneous fat, which lies immediately under the skin.  Visceral fat or "gut fat" surrounds the internal organs and causes central obesity.

Symptoms - Metabolic

Symptoms - Muscular

Counter-indicators

Conditions that suggest Problems Caused By Being Overweight:

Circulation

Coronary Disease / Heart Attack may suggest Problems Caused By Being Overweight Coronary Disease / Heart Attack

Even if you never become diabetic, high levels of insulin contribute to cardiovascular risk by increasing the process of atherosclerosis.  Insulin increases the rate at which cholesterol-laden plaque builds up on arterial walls.  The abnormally high levels of insulin produced by all overweight individuals, diabetic or not, is an independent risk factor for early cardiac death.

Digestion

Hormones

Low Sex Hormone Binding Globulin often suggests Problems Caused By Being Overweight Low Sex Hormone Binding Globulin

Obesity tends to increase the levels of sex hormone (estrogen, testosterone) activity, and decrease levels of sex hormone binding globulin.

Lab Values

Mental

Depression may suggest Problems Caused By Being Overweight Depression

Obese and underweight persons are more often depressive than people in the normal body weight range.

Metabolic

Syndrome X / Metabolic Syndrome often suggests Problems Caused By Being Overweight Syndrome X / Metabolic Syndrome

The International Diabetes Federation consensus worldwide definition of Metabolic Syndrome (Syndrome X) is as follows:

Central obesity (or a BMI index of over 30) AND any two of the following:

  • Raised triglycerides: > 150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality.
  • Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality
  • Raised blood pressure: systolic BP > 130 or diastolic BP > 85, or treatment of previously diagnosed hypertension
  • Raised Fasting Plasma Glucose (FPG): previously diagnosed Type 2 Diabetes, or FPG > 100 mg/dL (5.6 mmol/L).  If FPG is above this value, an OGTT Glucose tolerance test is strongly recommended but is not necessary to define presence of the syndrome.

Musculo-Skeletal

Gout / Hyperuricemia may suggest Problems Caused By Being Overweight Gout / Hyperuricemia

Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

Osteoarthritis may suggest Problems Caused By Being Overweight Osteoarthritis

Forcing joints to carry more weight than they were designed for often results in premature failure.

Organ Health

Diabetes Type II may suggest Problems Caused By Being Overweight Diabetes Type II

Scientists have discovered a hormone that may explain the link between diabetes and obesity – a tantalizing finding that could someday lead to new treatments for the disease.  The hormone, dubbed resistin, is produced by fat cells and prompts tissues to resist insulin, the substance the body needs to process blood sugar, researchers reported in the scientific journal NatureDiabetics produce too little insulin or cannot use it efficiently.  This will probably result in new drug treatments, but emphasizes the need for weight reduction.

Gallbladder Disease may suggest Problems Caused By Being Overweight Gallbladder Disease

Obesity in both men and women increases the risk for gallstones.  This may be a result of lower levels of bile salts relative to cholesterol in the bile causing a higher risk for cholesterol supersaturation and the formation of stones.

Reproductive

Menorrhagia (Heavy Periods) may suggest Problems Caused By Being Overweight Menorrhagia (Heavy Periods)

Chronic menorrhagia and PMS is usually the result of deficient progesterone secretion or constant adipose-released estradiol from obesity or recent substantial weight loss.

Amenorrhea may suggest Problems Caused By Being Overweight Amenorrhea

Women who are obese often experience amenorrhea as a result of excess fat cells interfering with the process of ovulation.

Respiratory

Asthma may suggest Problems Caused By Being Overweight Asthma

Being overweight increases the risk of asthma.  [Arch Intern Med 1999;159: pp.2582-8] Obese people with asthma may improve their lung-function symptoms and overall health status by engaging in a weight-loss program.  A controlled study found that weight loss resulted in significant decreases in episodes of shortness of breath, increases in overall breathing capacity, and decreases in the need for medication to control symptoms.  [BMJ 2000;320: pp.827-32]

Risk factors for Problems Caused By Being Overweight:

Diet

Habits

Hormones

Lab Values - Chemistries

Counter-indicators

Lifestyle

Counter-indicators
(Very) good anaerobic exercise level may decrease risk of Problems Caused By Being Overweight (Very) good anaerobic exercise level

Our indication of whether a person is overweight is based on the BMI (Body Mass Index) calculation.  If you perform a lot of non-aerobic exercise then much of your 'excess' weight is likely to be muscle mass rather than fat.  In this case, a BMI-based assertion that you are overweight may be untrue.

Mental

Stress may increase risk of Problems Caused By Being Overweight Stress

Some people respond to stress by eating.  "Stress Eaters" use food as a drug to deal with external stressors such as work, deadlines or finances.  Carbohydrates are often the craved foods because they increase levels of serotonin in the brain, which has a calming effect and helps induce sleep.  Stress Eaters often use candy, cookies, pretzels, etc.  on the job to relieve stress and are unaware of the reason behind it.  A habit of eating in response to stress may lead to obesity.

Reproductive

Symptoms - Metabolic

Counter-indicators
Counter-indicators

Symptoms - Reproductive - General

Counter-indicators
Being in early pregnancy often decreases risk of Problems Caused By Being Overweight Being in late/being in mid-/being in early pregnancy

Women generally gain 15-40 pounds (7-18kg) during pregnancy, depending on their weight before pregnancy and how many babies they are carrying.  Obviously this needs to be taken into account when deciding if weight is a problem for you.

Problems Caused By Being Overweight suggests the following may be present:

Diet

Hormones

Problems Caused By Being Overweight suggests Low HGH (Human Growth Hormone) Low HGH (Human Growth Hormone)

Dr. Brett Jancques, ND reports that all of the obese individuals tested thus far by AAL Reference Laboratories were found to have low growth hormone levels.  Testing was accomplished through 24-hour urinary growth hormone measurements.  [Townsend Letter, Feb/March 2002, Vol 223/224; pp.74-78]

Counter-indicators

Mental

Problems Caused By Being Overweight often suggests Stress Stress

Some people respond to stress by eating.  "Stress Eaters" use food as a drug to deal with external stressors such as work, deadlines or finances.  Carbohydrates are often the craved foods because they increase levels of serotonin in the brain, which has a calming effect and helps induce sleep.  Stress Eaters often use candy, cookies, pretzels, etc.  on the job to relieve stress and are unaware of the reason behind it.  A habit of eating in response to stress may lead to obesity.

Metabolic

Counter-indicators

Reproductive

Problems Caused By Being Overweight can lead to:

Circulation

Problems Caused By Being Overweight often leads to Coronary Disease / Heart Attack Coronary Disease / Heart Attack

Even if you never become diabetic, high levels of insulin contribute to cardiovascular risk by increasing the process of atherosclerosis.  Insulin increases the rate at which cholesterol-laden plaque builds up on arterial walls.  The abnormally high levels of insulin produced by all overweight individuals, diabetic or not, is an independent risk factor for early cardiac death.

Digestion

Environment / Toxicity

Lab Values

Musculo-Skeletal

Problems Caused By Being Overweight often leads to Osteoarthritis Osteoarthritis

Forcing joints to carry more weight than they were designed for often results in premature failure.

Organ Health

Problems Caused By Being Overweight often leads to Diabetes Type II Diabetes Type II

Scientists have discovered a hormone that may explain the link between diabetes and obesity – a tantalizing finding that could someday lead to new treatments for the disease.  The hormone, dubbed resistin, is produced by fat cells and prompts tissues to resist insulin, the substance the body needs to process blood sugar, researchers reported in the scientific journal NatureDiabetics produce too little insulin or cannot use it efficiently.  This will probably result in new drug treatments, but emphasizes the need for weight reduction.

Problems Caused By Being Overweight often leads to Gallbladder Disease Gallbladder Disease

Obesity in both men and women increases the risk for gallstones.  This may be a result of lower levels of bile salts relative to cholesterol in the bile causing a higher risk for cholesterol supersaturation and the formation of stones.

Reproductive

Problems Caused By Being Overweight often leads to Amenorrhea Amenorrhea

Women who are obese often experience amenorrhea as a result of excess fat cells interfering with the process of ovulation.

Problems Caused By Being Overweight often leads to Menorrhagia (Heavy Periods) Menorrhagia (Heavy Periods)

Chronic menorrhagia and PMS is usually the result of deficient progesterone secretion or constant adipose-released estradiol from obesity or recent substantial weight loss.

Respiratory

Tumors, Malignant

Problems Caused By Being Overweight sometimes leads to Breast Cancer Breast Cancer

Women with 'apple-shaped' bodies may be more likely to develop breast cancer than their 'pear-shaped' counterparts.  Harvard researchers studied breast cancer risk among postmenopausal women who had never used hormone replacement therapy (HRT) and found even greater risks, with larger-waisted women appearing to be 88% more likely to develop breast cancer than smaller-waisted women.  HRT use can increase the risk of breast cancer, regardless of waist size.  Exactly why fat distribution affects breast cancer risk is not fully understood but perhaps, the researchers speculate, upper or central body fat is deeper and may be closer to the important organs and glands that regulate hormone balance than fat in the other areas of the body.  These hormonal changes may be responsible for the increased risk of the cancer. 
[American Journal of Epidemiology December 1999;150: pp.1316-1324]

Problems Caused By Being Overweight sometimes leads to Cancer, General Cancer, General

Apart from excess stimulation by estrogen in breast and ovarian cancer, obese people are more prone to cancer, although it is still uncertain why.

Problems Caused By Being Overweight sometimes leads to Pancreatic Cancer Pancreatic Cancer

At least two studies have found that obesity significantly increases one's risk of developing pancreatic cancer.  [JAMA.  2001;286: pp.921-929]

Problems Caused By Being Overweight sometimes leads to Ovarian Cancer Ovarian Cancer

Examples of cancers linked to obesity are breast and ovarian cancer – it is thought that the excess estrogen produced by obese patients increases their chance of developing hormone-sensitive versions of these cancers.

Problems Caused By Being Overweight sometimes leads to Lung Cancer Lung Cancer

Researchers used data from a study of lung cancer patients in New York from 1982 to 1985.  They focused on patients who had never smoked, or those who hadn't smoked in the last 10 years, then took into account physical data on patients' heights and weight.  Researchers found that study subjects who were at the most extreme levels of obesity had the highest risk of lung cancer.  The study is a first for linking being overweight to lung cancer; it has previously been shown to play a role in breast, uterine, and colon cancer.

Researchers are unsure why being obese plays a role in lung cancer; some researchers suggest it's related to hormones such as higher levels of estrogen and insulin.  In addition, being overweight puts an added strain on the lungs, reduces lung capacity, and increases asthma risk.  [American Journal of Epidemiology Sept.  2000]

Recommendations for Problems Caused By Being Overweight:

Amino Acid / Protein

Tryptophan / 5HTP may help with Problems Caused By Being Overweight Tryptophan / 5HTP

Although used chiefly as an antidepressant, preliminary evidence from three small double-blind placebo-controlled clinical trials suggests that 5-HTP may also help people lose weight.  It is thought to work by raising levels of serotonin, which in turn may influence eating behavior.  A typical therapeutic dosage of 5-HTP is 100 to 300mg 3 times daily.

Animal-based

CLA (Conjugated Linoleic Acid) often helps with Problems Caused By Being Overweight CLA (Conjugated Linoleic Acid)

In animals, CLA helped repartition their body weight, decreasing fat and increasing lean body mass.  One human study confirms this.

Botanical

Ephedra (Ma Huang) is highly recommended for Problems Caused By Being Overweight Ephedra (Ma Huang)

Contrary to commonly reported stories, 3 months of intermittent or continuous treatment with an ephedra-containing weight-loss product containing ephedra (but not caffeine) had no ill effect on heart rate or blood pressure and there were no cases of serious adverse effects reported in a well-controlled study of 279 healthy, overweight people.  33% of patients on intermittent treatment and 48% on continuous treatment experienced adverse effects deemed non-serious such as dry mouth, headache, insomnia, nervousness, agitation, constipation and/or diarrhea.  [Experimental Biology 2002, April 20-24, 2002, New Orleans, LA, USA.  Abstract]

Diet

Weight Loss is highly recommended for Problems Caused By Being Overweight Weight Loss

The sad thing, according to the director of nutrition for the Center for Science in the Public Interest, is that "people keep believing that the magic bullet is just around the corner... if they only eliminate food 'X' or combine foods 'A' and 'B', or twirl around three times before each meal." The reality is that most ordinary people lose weight without the gimmicks Americans spend

KEY

Weak or unproven link: may be a sign or symptom of; may suggest; may increase risk of; sometimes leads to
Weak or unproven link:
may be a sign or symptom of; may suggest; may increase risk of; sometimes leads to
Strong or generally accepted link: often suggests; often increases risk of; often leads to
Strong or generally accepted link:
often suggests; often increases risk of; often leads to
Definite or direct link: is a sign or symptom of; increases risk of; suggests
Definite or direct link:
is a sign or symptom of; increases risk of; suggests
Weakly counter-indicative: may decrease risk of
Weakly counter-indicative:
may decrease risk of
Strong counter-indication: often decreases risk of; often reduces the likelihood of
Strong counter-indication:
often decreases risk of; often reduces the likelihood of
Definitely or absolutely counter-indicates: strongly contraindicates; decreases risk of; greatly reduces the likelihood of
Definitely or absolutely counter-indicates:
strongly contraindicates; decreases risk of; greatly reduces the likelihood of
May be useful: may help with
May be useful:
may help with
Moderately useful: often helps with
Moderately useful:
often helps with
Very useful: is highly recommended for
Very useful:
is highly recommended for