Chapter 1: Introduction, Context, Research Objectives

In the past, obesity has been described as a lifestyle condition but not one that warranted medical attention. From a point of awareness and availability of information as well as from a scientific view, it gained the title a medical condition. Due to its negative effects on health, a lot of research has been done to understand why and how the excess body fat that accumulates in the body, leading to negative health effects, reduced life expectancy and increased health problems.

With a global population of over 6 billion persons, more than 50% of the population suffers from eating disorders. Sadly, only about 10% of the said population receive treatment for the conditions. 10% suffer from bulimia and anoxia disorders each and most of the 10% are athletes. Moreover, bulimia and anorexia claim 4% each of lives while other eating disorders claim 5.2% lives annually (Ofei, 2005).

To be able to understand obesity as a medical condition, it’s important to understand how one gets diagnosed with it. One is diagnosed to be obese when his or her body mass index (BMI), which is a measurement derived by dividing a one’s weight by the square of his or her height, exceeds 30kg/m². The increase of body fat increases the chances of one getting ill from diseases such as type 2 diabetes, heart diseases, sleep apnea, osteoarthritis and certain types of cancers amongst others.  Many have long believed that obesity is caused by eating excess food and while that statement holds certain truths, it’s not entirely the case. Obesity is a medical condition that one is diagnosed with when he or she consumes excessive food energy, lacks physical activity and although not as common as the previous two, it can be caused through gene susceptibility. Similarly, it may be caused by medications, psychiatric conditions and also endocrine disorders amongst others (Wyatt, 2013).

In the past, there were claims that slow metabolism was the causative action to excessive weight gain, to which science has proven otherwise through research. It was discovered that obese people have a high energy expenditure to the energy required to maintain increased body mass. Obesity causes and can lead to endocrine disorders, weight loss, adolescence obesity, morbid obesity, obesity diabetes and metabolic syndrome amongst others.

The research will be more facts based than myths. It will concentrate on proved theories and scientific facts from conception, cure, prevention and management. Obesity is a broad subject topic being that there are a lot of contributing reasons as to what leads to it, public perception and also how it is managed. Dwelling much on discussions will take away from the fact based truths and therefore, it’s important to consider biological and other scientific considerations taken while analysis obesity. This research will therefore dwell into obesity from an investigative point of view. It will look into how one’s lifestyle or genetic makeup amongst other biological factors can lead to excessive weight gain.

• The research main objective is to understand obesity from its conception, symptoms, treatment, prevention, and management phases.

• To understand how obesity affects different age groups and genders.
• To understand the public perception of the illness.
• To understand preventative and management measures adopted over time, and their effectiveness in curbing the illness and lastly,
• To analyze the different ways of managing obesity and risk factors involved.

Obesity is often than not caused by lack of proper dietary behavior. Proper monitoring of one’s diet and exercise routines goes a long way in determining ones chances of developing diseases amongst other conditions. Consumption of excess calories other than the required ones often than not lead to calorie intake and outtake imbalance, lack of sleep, lipid metabolism issues, medication intake and sedentary life amongst others. Obesity is one of the many resultant conditions caused by eating disorders amongst them binge eating and bulimia. These result from psychological, physical or social negative effects (Omics International, 2015).

Chapter 2: Literature Review

As discussed earlier, obesity is caused by inactiveness, overeating, lack of activeness of an individual like walking and more to that, living a sedentary lifestyle. Similarly, other causes include hereditary and hormonal related problems amongst them being hypothyroidism. In small children, obesity can lead to serious health issues. This is due to the fact that a child is still in development stages and thus their hormones are a bit unstable and thus poor eating habits without consideration of the required portions can lead to malnutrition and other digestive related illnesses.  

Most teenagers, who are children who are in their early thirteens to 18 years, suffer from either bulimia or anorexia in that they can either eat too much or too less.  Most of these conditions tend to be peer influenced from wrong social ideologies in a bid to keep up with the social lifestyle of upper grade school and high school too. Similarly kids struggling to fit in with the rest for reasons such as family related problems, educational reasons or physical disability are highly prone to eating disorders due to their psychological imbalance. Most of the indicative symptoms of obesity or likelihood to get diagnosed with eating disorders include, distress, disappearance of meals, dieting, alcohol abuse and performance of excessive exercise.

Being that monitoring of diets and lack of it is a lead fact in influencing factor in obesity analysis, it’s important to understand what is termed as healthy or not and at the same time, what are the right amount of food quantities that one is expected to take in a day. In order to achieve a healthy ailment free life, one needs to be precise with their food proportions. The body has nutrients that it can synthesize on its own and those that it in dire need of on a daily. This means that all food proportion from vitamins, minerals, proteins and carbohydrates are important in one’s meal. However, they need to be taken in moderation so as to benefit one’s general health and avoid dietary related illnesses. This means that one needs to drink and eat less, avoid fast food, sugary drinks like sodas, processed food and lastly, one needs to choose the healthier foods. It’s important that one considers the required amount of calorie intake in each food portions from greens, proteins and carbohydrates (Apovian, 2016).

Often than not, obesity isn’t considered as a form of malnutrition.  However, it is. Malnutrition is a condition in which an individual may lack nutrients or have an excess of them. Nutrients can be vitamins, proteins or carbohydrates. During early childhood development, such a condition may have condemning effects physically and mentally as well. Persons suffering of obesity can also be diagnosed with malnutrition due to lack of or excess of nutrients in their body system.  

It’s alarming that the rate of overweight and obesity has risen so fast over shorts periods of time, earning both illnesses as the second most chronic preventable causes of death globally. Though they aren’t the same, the difference is set by the ranges in weight gain. Obesity is now treated as an epidemic. According to the National Health and Nutrition Examination survey (NHNE), one out of every five children in the U.S.A. from the age of six to nineteen are either overweight or obese. It still fascinates the scientists and researchers on just how the body regulates the body fat. This is due to the fact that a person can consume much more calories and yet the body have no way of dispensing the extra energy. From genetics, socioeconomic factors, metabolic factors as well as lifestyle choices, there are many influencers on an individual’s weight. The treatment on adolescents requires a multidisciplinary, multiphase approach which involves proper diet management, enhancement of physical activities, and restriction of sedentary behaviors, pharmaceutical therapy and surgery in the worst case scenarios.

Chapter 3: Research Methodology

Moreover, there needs to be an involvement of use of policies and legislative measures in mobilization of communities, restructuring of organizations, network establishment and empowerment using skills and knowledge. The situation in low and middle income counties has captured the attention of most health practioners as well as policy makers. This is due to the fact that obesity and overweight in children is causing cardiovascular diseases (CVDs) and diabetes at very early ages. This has increased the treatment costs to high amounts with many children’s BMI registering at above 85% and below 95%, causing morbidity scares (Sahoo, 2015).

In genetic mutations, single and polygenic mutations commonly in rats and mice, is also documented in human obesity. Leptin, causes a protein deficiency in animals and thus influencing obesity, body fat distribution and high levels of plasma cholesterol. This causes diseases like Prader-Willi syndrome and Bardet-Biedl syndrome amongst others which are common syndromes seen in adolescents. Thus, if both or either one of the parents was obese, the odds of the child becoming obese in his or her adolescents age are also quite high. Intrauterine growth patterns usually play a significant role in modification of body fat and lean body mass causing increase in appetite as well as pancreatic functional activities. weight gain in later courses of life for a child increases his or her risks of becoming obese due to adiposity and insulin resistance in their early onsets of life. This can cause serious CVDs later in life. Breastfeeding a child for a period of time after childbirth has been shown to have consistent protective effects against obesity in children (Sahoo, 2015).

In low and middle income countries, there is less accessible food variety choices for most families.  This largely contributes in causing adolescent obesity as vegetables and fruits tend to be quite high in pricing. Similarly, the lack of sleep for most children who are either working or studying and working to make due, reduces metabolic activities that cause burning of fats and thus increase the odds of the adolescents becoming obese. Urbanization behaviors have largely shown to contribute in adolescent obesity. This is due to consumption of fast foods at fast food outlets. Similarly, consumptions of high calorie foods in oversized portions at home and restaurants have significantly increased increase in obese people (Apovian, 2016).

 There is less consumption of healthy foods and more consumption of low-fiber, high fat foods and also sweetened beverages among them sodas. This is made so by the affordability, abundance, ease of consumption and availability of high calorie foods. At the same time, marketing strategies of high calorie food influence the child’s feeding behavior from a young age. Metabolic syndrome in adolescents also cause risks of obesity among other diseases. Most adolescents in are in a period where they are experiencing hormonal shifts which may cause psychological anomalies among them depression. Females tend to be quite stronger emotionally than males in such ages and require much more than depression to risk obesity. Obesity for females is usually a combined emotional trauma situation, which is inclusive of depression and anxiety.  Both genders experience such emotional trauma from experiences like bullying and teasing in schools. It causes seclusion, lineless, low self-esteem, and lack of interest in physical activities and leads to binge eating causing rapid increase in weight. In worst case scenarios, it may lead to suicidal tendencies (Ofei, 2005).

Chapter 4: Findings, Analysis and Evaluation

The treatments taken in drastic measures involving all stakeholders from pediatric physicians, nurse practioners, physical instructors, behavioral therapists and social workers together with a team of motivated parents , caretakers, teachers and policy makers. A minimum weight loss of 0.5kgs per month with intake of supplementary adequate calorie intake is allowed for overweight adolescents. However, for obese adolescents, there is need for them to lose not more than 1kg per week. This is achieved through diet management, enhancement of physical activities, and restriction of sedentary behaviors, pharmacotherapy and bariatric surgery when necessary. These phases are achieved in ascending order by practicing the prevention oriented approach. More to that there is implementation of structured weight management, comprehensive multidisciplinary interventions and tertiary care interventions. It’s important for obese adolescents to eat right, practice walking and running, avoid lazy behaviors like long hours of watching TV, playing games over computers and phones (Sahoo, 2015).

Being that the obesity is a rather uncomfortable condition, its reduction or management is quite important. At instances when a person’s BMI is above 30, considerations are made to put him or her under weight loss medication such as orlistat, saxenda, belviq and contractive in order to curb their appetite. This doesn’t reduce their weight immediately but through regulation of food intake, a person loses weight gradually from lack of excess food consumption.

Similarly, one can undergo weight loss through professional help. This is achieved through positive and healthy lifestyle changes among them being dieting, taking weight loss mediation if deemed necessary by medical practioners and more to that, adapting to daily exercise routines. Needless to say, regardless of the condition and its control measures, it’s important for nutrition to be observed especially during childhood development ages like adolescents.

During adolescence, teenagers tend to have a tendency to take up debilitating social behaviors among them being dieting and skipping meals in order to fit in social groups. This can lead to psychological imbalance that results in binge eating and extreme dieting in worst case scenarios. In the long run, obesity may lead to many health problems from heart diseases, angina pectoris, high blood pressure, type 22 diabetes, stroke, osteoarthritis, sleep apnea, increased blood vessel thinning and even heart failure. More to these, obesity can also cause digestive disease which often have symptoms like abdominal pain, weight loss, blood stool and heart burns amongst many others. It’s therefore important to constantly check up on teenagers and engage them in conversations that bring about awareness of health, and healthy lifestyles in order for them to adapt healthier ways of thinking and more so eating.

According to Sahoo 2015, developing countries have registered epidemic levels for obesity at an early age for children. This is due to the fact that there are more unhealthy junk foods available for them to eat and there is little monitoring placed on the health benefits of the foods being consumed. This may lead to serious health effects, some of which can be quite severe like long term conditions from bone and joint problems and different cancers in various body parts. This may be due to factors like lifestyle, cultural, and environmental causes.  In cases where obesity is passed down genetically, it’s important to understand the genes responsible for the obesity. Often, bardet-biedl and prader-will syndrome have been considered as the main obesity genes. There are a type of protein hormone that causes excessive eating when in high levels.

Due to this, it’s therefore important to observe healthy diets. Among these include the approved proportions of food. This means one has to be cautious of their vitamins, nutrients, carbohydrates, proteins and roughages. This means balancing the fat intake and incorporating more fiber rich food, low fat products, vegetables, healthy fats and low protein foods. A diet plan often than not helps ne in keeping up the required food intake levels. At the same time, exercise is an important daily routine that helps in body metabolism. Doing house chores, jogging, running, lifting weights amongst other forms of fitness routines, help in burning body fat and improving one’s health and general well-being. Ensuring a minimum of 30 mins daily routine exercise routines can lead to a long term healthy lifestyle for an individual (Omics International, 2015).

In cases where lifestyle changes cannot manage extreme obesity conditions, bariatric surgery is considered.  It’s taken as a last case measure in the onset of diet balancing medication failing. It is also referred to as gastric banding or bariatric surgery where the stomach size is shrunken so as to slow digestion processes. Similarly, surgery can be done to remove parts of digestive tracts in which case it is referred to as malabosorptive surgery. Moreover, electric devices can be implanted between the stomach and brain so as to act as blocking signals to control excessive eating and induce weight loss. Many at times, obesity can become quite addictive and thus it’s important for one to take one’s wellbeing and health importantly. Neglecting ones stability psychologically, mentally and physically from factors and influences such as physical and environmental factors, wealth, education amongst others, can cause adverse effects to the quality of life. 

 From scientific research, surveys, observations and medical reports that have been analyzed, a lot of information has been documented on obesity from its symptoms, causes, management as well as prevention. However there is still contrast on the major causes of obesity.

According to Ofei, 2005 obesity is a common and preventable ailment with a public and clinic importance. This is due to the fact of risks development of other serious ailments which can lead to disability and premature deaths. It is treated as a global epidemic that affects all age groups from both developed and undeveloped countries causing a huge burden on health and cost. Therefore, its management and prevention are considered as health improvement leading to economic development. 

Taking in WHO regulations and guidelines, less than 18.5kg/m² is considered as being underweight. Greater than 18.5 but less than 24.9kg/m² is considered as the ideal weight.  However greater than 25 but less than 29.9kg/m² is considered as being overweight whereas greater than 30kg/m² as obese. This comes from the consideration of weight divided by height.  More to that,  obesity is divided into various categories from class 1 to 3 where class 1 ranges from BMI 30-34, class 2 BMI 35-39, and class 3 BMI 40 and higher (Wyatt, 2013).

Similarly, fat accumulation can be calculated from the waist to hip ration (WHR) where the waist circumferences is measured. This is more effective when compared to BMI as it offers more information on risk of fatal illnesses and mortality rates. 108 cm is considered catastrophic for men and 98cm for women.  WHR > 1 for men and >0.85 for women are considered as the indicators for excessive body fat accumulation. In previous researches, most of the BMI researches were based on U.S.A. children however, being that the data was old and obsolete, there was need to acquire new data considering more countries and Ghana was one of the countries considered in the study being that obesity is a medical conditional experienced by both developed and developing countries. Leptin a protein hormone has been believed to be the major factor in reducing food intake. For children, obesity is measured using CDC growth chart where a child with weight over 85% is referred to as overweight. Above 95%, the child is referred to as obese and above 120% is recognized as extremely obese (Sahoo, 2015).

The national health and nutrition examinations conducted by national center for health statistics (NCHS) recorded extreme obesity levels in women than men. Howver, more men were overweight than women. Ethnically, the non-Hispanic black Americans had the highest obesity levels follower by the Hispanics and non-Hispanic whites respectively. This was accounted for by the fact that most women eat as they cook and eat afterwards and more to that, when stressed, more people engage in binge eating as a form of stress management. Similarly, Hispanic Americans have a diverse palates for Hispanic cuisines which are high on carbs and proteins leading to high probabilities of them becoming overweight. Other researches have accounted obesity as not only a cause of excessive eating but a result of medical conditions like crushing syndromes (Sahoo, 2015). 

The most recent data from NCHS showed the following statistics.

The above statistics show that women are more obese than men and men are more overweight than women. This means that there is a high perceptibility of both genders being diagnosed with type two diabetes if a healthier lifestyle is not adopted on time (Wyatt, 2013).

According to Wyatt 2013, dietary therapy proposes that intake levels should be as follows. Any calorie intake below and above the recommended levels should be highly discouraged.

The above dietary consideration helps in maintain the right body mass index as low and high BMI leads to health complications and as it increases beyond the acceptable range so does the risk of illnesses.

Chapter 5: Conclusion and Recommendation

5.1. Conclusion:

While different researches account obesity as a medical condition caused by different factors, they all do concur in the fact that it is a burden on both health, general wellness as well as costs. Whatsoever the reasons are, excessive eating is harmful to one’s health and it affects all ethnicities, developing and developed countries, as well as all age groups. The risk factor is high during early childhood development and the resultant illnesses can be catastrophic and somewhat of an epidemic nationally as well as globally.  If properly managed, one can realize a healthy yet sustainable lifestyle.

There is therefore need to adopt healthier lifestyles from simple and constant exercise routines on a daily basis as well as improving one’s diet to incorporate more of healthier foods and less of junk foods. Being that it’s quite hard to rid of junk food that easily, its highly recommendable that one adopts creative cooking habits that focus on healthier yet tasteful foods that are nourishing to the body so as to save one’s health and promote global economic growth. This will also see the $400 billion expenditure on obesity related issues reduce in a drastic manner.

References:

Apovian, M. C. (2016, Jan 14). The Obesity Epidemic — Understanding the Disease and the Treatment. The New England Journal of Medicine (NEJM), 1. doi:10.1056/NEJMe1514957

Ofei, F. (2005, September). Obesity – Apreventable Disease. Ghana Medical Journal, 1. Retrieved 3 27, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1790820/

Omics International. (2015). Obesity. Omics International, 1. Retrieved 3 27, 2018, from WWW.omicsinternational.org

Sahoo, K. S. (2015, April – Jun). Childhood obesity: causes and consequences. National Center for Biotechnology Information, 1. doi: 10.4103/2249-4863.154628

The conversation. (2017, Spetember 22). Obesity is about much more than an unhealthy lifestyle. The Conversation, 1.

Wyatt, R. H. (2013, April 1). Update on Treatment Strategies for Obesity. The Journal of Clinical Endocrinology & Metabolism., 98(4), 1299-1306. Retrieved from https://doi.org/10.1210/jc.2012-3115