Obesity is a disease of energy homeostasis with accumulation of excessive fat leading to negative health effects associated with increased morbidity and mortality. The World Health Organization (WHO) estimates approximately 700 million people worldwide in the obese category. Life expectancy due to obesity is decreased by 6–7 years. A body mass index (BMI) of 30–35 kg/m2 reduces life expectancy by 2–4 years, while BMI >40 kg/m2 reduces life expectancy by 10 years. In this manuscript, we will review the global updates on the burden of obesity, current management of obesity, evolution of bariatric endotherapy, various aspects of bariatric endotherapy, and literature review of the data supporting the bariatric endotherapy.
The scientific and economic development has led on to phenomenal changes in the environment as well as dietary patterns of the human beings. There is a phenomenal increase in the intake of refined carbohydrates, saturated fatty acids (SFAs), trans fat, and substantial decrease in the intake of omega-3 fatty acids. The increased consumption of energy dense food products along with sedentary lifestyle and increased emotional as well as mental stress is an ideal recipe for the development of various noncommunicable diseases (NCD). Increased frequency of combination of environmental, behavioral, and biological risk factors for various NCDs have led on to an epidemic of these diseases in modern times. A healthy food contains adequate amount of carbohydrates with low glycemic index (GI), low sodium content, and sufficient amount of proteins, fibers, micronutrients, and antioxidants. Healthy food and regular exercise are ideal recipes for healthy life and preventing various NCDs. This review discusses the important role of food in various NCDs.
Obesity is a raging epidemic with a significant impact on cardiovascular health profile. It harbingers the development of both structural [coronary artery disease (CAD), heart failure (HF)] and electrical (atrial fibrillation) cardiac disorders. On a background of low-grade chronic inflammation, the changes in body composition, hemodynamic alterations, and myocardial fat deposition accelerate the associated cardiovascular morbidity. Quite counterintuitively, obese patients having CAD or HF fare better than their normal-weight counterparts; a phenomenon described as the “obesity paradox”. An increase in lean mass (LM) and consequent improvement in cardiorespiratory fitness (CRF), partly explains this phenomenon. In the following review, we aim to decipher the links between obesity and cardiovascular diseases (CVDs) along with the evolving concept of “adiposopathy” and current evidence shedding light on the intriguing “obesity paradox”. The significance of estimating and improving CRF is also discussed along with current recommendations for managing obesity.
The fatty pancreas is a newly recognized entity with limited available literature on its risk factors, pathogenesis, diagnosis, and management. Obesity and metabolic syndrome both are emerging pandemic in recent times and the fatty pancreas is closely linked with both of them. Though obesity is one of the most important risk factors for the development of a fatty pancreas, it is not perquisite for the development of same. Radiological investigations are the most commonly used modality for the diagnosis of the fatty pancreas; however, criteria to define fatty pancreas are still not present. Studies have shown that fatty pancreas is associated with metabolic syndrome, acute/chronic pancreatitis, pancreatic exocrine insufficiency, and the development of pancreatic carcinoma. However, none of the associations is proved to have a cause–effect relationship and it requires further exploration in future studies. Though the pathophysiological mechanism of the fatty pancreas is unclear, one can assume that similar to the nonalcoholic fatty liver disease the pathological changes of the fatty pancreas may be reversible. However, the effect of lifestyle modification, weight reduction, and medical therapy in reversing fatty pancreas and its sequelae still requires further exploration in future studies.
The ability of the body to store energy in adipose tissue for utilization during exigency has helped us cope with periodic food shortages through much of human history. The easy availability of calorie-dense food and a sedentary lifestyle has, however, resulted in this becoming a bane with adverse health consequences. Both obesity and nonalcoholic fatty liver disease (NAFLD) are lifestyle diseases that have emerged as substantial public health problems globally and in India. Obesity is an important risk factor for NAFLD and its severe form of nonalcoholic steatohepatitis (NASH). Weight loss is the only proven beneficial intervention in NAFLD/NASH. This provides a unique opportunity for managing NASH in obese patients. Lifestyle interventions including dietary modifications and exercise should be the primary modality for weight loss and have shown to be feasible and effective in obese patients with NASH. Although not yet indicated for the management of NASH per se, anti-obesity drugs and bariatric procedures may be considered in selected patients if otherwise indicated and may lead to indirect hepatic benefits secondary to weight loss.
Obesity is a modifiable risk factor that is associated with osteoarthritis (OA). The pathogenesis is multifactorial which includes mechanical, humoral, and genetic factors. We discuss the role of obesity in this article in the early onset and progression of knee OA and whether there is a correlation with arthroplasty and the prevention of obesity with OA in the obese population.
Nonalcoholic fatty liver disease (NAFLD) has emerged as the commonest liver disease in children. The entire spectrum of NAFLD from simple steatosis to inflammation and fibrosis is seen in children. Pediatric NAFLD (pNAFLD) is most common in preadolescent and adolescent children and has the potential to cause severe liver-related as well as cardiovascular morbidity in young adulthood. The natural history of pNAFLD needs further elucidation. However, early diagnosis is imperative to prevent serious later outcomes. Lifestyle modification through diet and exercise remains the cornerstone in the management of pNAFLD. There is a great potential for the development of noninvasive biomarkers for diagnosis and novel pharmacotherapy to become available for the treatment of pNAFLD shortly.
Clinicopathological Conference Report
Prof HS Kohli,
Dr Anand Bardia,
Prof D Behera