The lesser-known effects of being overweight
This is a personal topic for me. I’m not overweight and never have been. But my wife and I have family members who are. Outside of being physical therapists, my wife and I are also what many would call “health nuts”. Naturally, we’ve tried to promote this lifestyle to the people we love. I’ve said it countless times…I could care less about how they look…selfishly, I want them to live as long as possible because I love these people and they’re important in my life.
This is especially true now that we have two children. For their sake, I want my family to stick around so they can spoil them, play with them, and teach them the important lessons of life. Unfortunately, they lost their grandmother (my mother-in-law) at the young age of 62, mostly due to a poor lifestyle and partly due to an unhealthy weight. It deeply saddens me that she's no longer here to show my children how to be kind even when people don't deserve kindness. This was my mother-in-law's finest quality and something I truly admire and aspire to achieve.
I love and miss you, Mrs. Donna! This is dedicated to you!
To my overweight readers, this isn’t meant to make you feel bad about yourself. It’s to encourage you to lead a better, healthier life.
Body Mass Index (BMI)
According to the World Health Organization (WHO), body mass index (BMI) is classified as follows:
Severely underweight: Less than 16 kg/m2
Underweight: 16.0 to 18.4 kg/m2
Normal weight: 18.5 to 24.9 kg/m2
Overweight: 25.0 to 29.9 kg/m2
Moderately obese: 30.0 to 34.9 kg/m2
Severely obese: 35.0 to 39.9 kg/m2
Morbidly obese: 40.0 kg/m2 or more
If you’re interested in determining your BMI, click this link.
Now, BMI isn’t a perfect representation of your health. BMI can be misleading, but these situations usually apply to muscular, lean individuals. A better indicator is body fat percentage, particularly in the superficial tissues and viscera (organs). Unfortunately, methods for determining body fat percentage aren’t perfect either and they’re much less accessible and affordable. This is why BMI is used in many cases.
As you may, or may not know, being overweight or obese puts you at risk for many health conditions. The CDC, among many other resources, lists some health issues that you may be at increased risk for:
All causes of death (mortality)…yes, that says ALL
High blood pressure (Hypertension)
High LDL cholesterol, low HDL cholesterol, and/or high levels of triglycerides
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis (a breakdown of cartilage and bone within a joint)
Sleep apnea and breathing problems
Many types of cancer
Clinical depression, anxiety, and other mental disorders
Body pain and difficulty with physical functioning
How much risk, you ask?
Harvard did a review of multiple clinical research papers and found the following:
Type 2 Diabetes
7x more likely for men with a BMI >30
12x more likely for women with a BMI >30 2
Coronary Artery Disease (CAD) – the condition that can lead to heart attacks
32% of overweight individuals
81% of obese individuals
Ischemic Stroke (due to a lack of oxygen to the brain)
22% of overweight individuals
64% of obese individuals
Depression = 55% increased risk
Asthma = 50% increased risk in obese men and women
Alzheimer’s Disease = as much as a 42% increased risk if you’re obese
Excess weight causes chronic, systemic inflammation…
Now, inflammation isn’t as bad as it’s made out to be. Inflammation is necessary in many scenarios. Acute inflammation is essential in the presence of an injury, wound, infection, cold, after exercise, etc. to promote healing and restore homeostasis. There are times when acute inflammation can be harmful, but in many instances, it’s our body's best way of dealing with problems. Chronic, systemic inflammation, in the simplest explanation, is inflammation throughout the entire body that develops over time. Research shows that being overweight or obese (among other things) causes this chronic, low-grade systemic inflammation, also known as “metabolic inflammation”, which is likely the primary cause of increased disease and mortality risk in overweight people.
How does it happen?
In response to certain stimuli, adipose tissue (fat) releases excess pro-inflammatory cells (cytokines). To my knowledge, the mechanism behind this excess cytokine release isn’t completely understood. However, we do know most of the cytokines responsible for this inflammatory state, including, but not limited to, the following:
Remember, the above proteins mentioned aren’t harmful in acute situations. On the contrary, proteins like TNF-alpha can aid in the destruction of cancer cells. However, when these proteins are in excess for long periods, they become problematic. Surprisingly, adipose tissue in leaner or normal-weight people produces and secretes anti-inflammatory cells and has beneficial effects. So, being overweight causes the inflammatory process to initiate and stay active.
There are other biological impacts due to this inflammatory state.
Insulin Resistance – Insulin is the compound your body uses to regulate glucose (sugar). Insulin resistance commonly leads to the development of Type 2 Diabetes, which has many negative health effects.
Increased C-Reactive Protein (CRP) – CRP is the most important marker associated with an increased risk of cardiovascular disease and a predictor of future cardiac events like a heart attack.
Leptin Resistance – part of leptin’s purpose is to influence the brain to decrease food intake and increase metabolism. Therefore, leptin resistance may be the primary reason why it’s difficult for overweight people to lose weight.
Soft-tissue health, surgical outcomes, injury risk, & recovery are impacted too!
Unfortunately, being overweight or obese doesn’t just put you at risk for developing severe diseases and disorders. It also increases your risk for injury, surgical complications, and recovery from said injury/surgery.
Slower recovery time (delayed healing?)
A study of 500 people, 31% of whom were classified as obese, showed that 6 months after an ankle sprain obese people hadn’t recovered to the same extent as their normal-weight counterparts.¹
Increased injury risk
A Canadian study of 7,678 working adults showed that obese workers were 40–49% more likely to suffer a work-related injury compared to their normal-weight counterparts.²
Increased post-surgical complications
6,928 patients received surgery to their distal humerus (the end of their large arm bone). The obese subjects in this study were at significantly higher risk of post-operative complications like infections and venous thromboembolism (a clot that could kill you). In terms of post-operative infections, obese people were anywhere from 3 – 4 times more likely to develop an infection.³
A study of 84 patients receiving spinal surgery showed that as BMI increased the rate of significant post-surgical complications like infections, deep vein thrombosis, cerebrospinal fluid leakage, cardiac events, and more, also increased:
14% for patients with a BMI of 25⁴
20% for patients with a BMI of 30⁴
36% for patients with a BMI of 40⁴
521 people had a total knee replacement. 318 of these patients were classified as obese or morbidly obese. Post-surgical complications in the first 12 months were 35.1% for morbidly obese patients, 22.1% for obese patients, and 14.2% for non-obese patients.⁵
Also, the authors of this study pointed out that for every 1 unit increase in BMI, there was an 8% increase in the risk of post-surgical complications, regardless of age or gender. Finally, the two obese groups showed poorer pain and functional outcomes compared to the non-obese group at 12 months post-surgery.⁵
Economically speaking…
Obesity has become such a problem that in 2006 it was estimated to contribute anywhere from $86 – $147 BILLION in medical costs in the USA alone (🤯🤯🤯).⁶ On a per-person basis, obese people spent $1,429/YEAR MORE (42%) than their normal-weight counterparts.⁶
Disturbingly, prescription drug costs were approximately $568 MORE/YEAR for obese people, which is an 80% increase from 1998 to 2006.⁶ Unfortunately, obesity has only increased in the USA, and around the world, so it’s safe to assume that the medical costs attributable to obesity have increased as well.
Here are a few tips to help manage your weight…
A balanced, healthy diet.
Limit refined or highly processed foods and focus on whole foods such as fruits, vegetables, whole grains, fungi (mushrooms), lean meats, and seafood.
Most importantly though is burning more calories than you consume (calories out > calories in).
Allow 10 - 20% of your daily calories to be discretionary (calories from foods you enjoy).
A nutrition expert I admire and respect, Alan Aragon, makes this recommendation.
This is a good way to help you stay on track since being strict with eating patterns is difficult.
Exercise should be consistent and intense
At least 150 minutes/week of moderate-intensity exercise or 75 minutes/week of high-intensity exercise.
At least 1 hour/week should be dedicated to weight-lifting.
Weight-lifting and high-impact exercises (running, jumping, power movements, etc.) are especially important for women due to bone health concerns.
Prioritize sleep.
Between 7-9 hours of undisturbed, high-quality sleep.
Manage distress.
Meditate, take a walk outside, socialize, or do anything that helps you mitigate distress and add more eustress.
Patience and a positive attitude.
Please don’t focus on the scale because it may discourage you from maintaining consistency.
You’ll have plateaus, and, you might even gain weight at times. But your efforts will pay off if you stay consistent, are patient, and maintain a positive attitude.
I’ve showcased why it’s important to maintain a healthy weight. I’m not saying it’s easy. Most things in life are hard and weight loss can certainly be difficult. However, if you’re committed and you make consistently good choices, you can make a positive change in your life.
“If you want the rainbow, you’ve got to put up with the rain.”
To break up the seriousness and share a laugh, here’s a clip from Austin Powers…
References:
Bielska IA, Brison R, Brouwer B, et al. Is recovery from ankle sprains negatively affected by obesity?. Ann Phys Rehabil Med. 2019;62(1):8-13. doi:10.1016/j.rehab.2018.08.006
Janssen I, Bacon E, Pickett W. Obesity and its relationship with occupational injury in the Canadian workforce. J Obes. 2011;2011:531403. doi:10.1155/2011/531403
Werner BC, Rawles RB, Jobe JT, Chhabra AB, Freilich AM. Obesity is associated with increased postoperative complications after operative management of distal humerus fractures. J Shoulder Elbow Surg. 2015;24(10):1602-1606. doi:10.1016/j.jse.2015.04.019
Patel N, Bagan B, Vadera S, et al. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine. 2007;6(4):291-297. doi:10.3171/spi.2007.6.4.1
Dowsey MM, Liew D, Stoney JD, Choong PF. The impact of pre-operative obesity on weight change and outcome in total knee replacement: a prospective study of 529 consecutive patients [published correction appears in J Bone Joint Surg Br.2010 Jun;92(6):902]. J Bone Joint Surg Br. 2010;92(4):513-520. doi:10.1302/0301-620X.92B4.23174
Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822-w831. doi:10.1377/hlthaff.28.5.w822
