Medical Co- Morbidities associated with Obesity

• Cardiovascular & Vascular
• Genitourinary
• Metabolic
• Respiratory
• Locomotor
• Neuropsychiatric
• Gastro-intestinal
• Cranial Effects
• Other

Obesity affects virtually every organ system of the body and is linked to the following medical complications:

• Cardiovascular and Vascular - High blood pressure, stroke, coronary heart disease, deep venous thrombosis, varicose veins, oedema and heart failure in advanced cases.

The following guidance can be accessed if appropriate:

• Hypertension
• Strokes
• Ischaemic Heart Disease
• Peripheral Vascular Disease
• Venous Disorders
  • Respiratory - Breathlessness at rest and on exertion, due to the altered mechanics in an obese person (pressure on the lungs from below the diaphragm and a narrowed airway due to excess fat); and obstructive sleep apnoea (a condition where the person snores heavily and in which breathing may stop for up to a minute at a time. During this time, heart arrhythmias may occur, which could be fatal. With many episodes occurring every night, the person feels tired the next day and concentration at work and while driving, for instance, may be significantly affected). Obstructive sleep apnoea is a vastly under-diagnosed condition and if the condition is diagnosed in a person, they should not drive because of the adverse effects the following day. A man who has a collar size of more than 17” will have an increased likelihood of suffering from obstructive sleep apnoea. Another name for obstructive sleep apnoea is “Pickwickian Syndrome”.

The following guidance can be accessed if appropriate:

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
  • Gastro-intestinal - Gastro-intestinal complications include gallstones, (more frequent in women), hiatus hernia, reflux oesophagitis (due to a weak or overloaded valve at the top of the stomach causing reflux of acid from the stomach into the oesophagus) and increased incidence of cancer of the colon, rectum and pancreas. Non-alcoholic steatohepatitis (NASH) or fatty liver is becoming increasingly prevalent and around 20% of persons with this condition will go on to develop cirrhosis or liver cancer.

The following guidance can be accessed if appropriate:

• Gallstones
• Dyspeptic Disorders
  • Genitourinary - There is an increased risk of cancer in both women and men (cancer of the breast, uterus, ovaries and prostate). Menstrual disorders and polycystic ovary syndrome are associated with obesity in women. Protein in the urine is a recognised complication of obesity, the mechanism being unclear and there is a link between obesity and kidney (renal) disease, with and Type 2 diabetes being common consequences of obesity. Stress incontinence occurs in obese women because there is extra pressure on the bladder due to fatty tissue; however it depends on the age of the person as well.
  • Locomotor - The risk of osteoarthritis is increased in overweight and obese people because the extra weight puts pressure on the lower back, hips, knees and ankles. There is an increased association between obesity and gout (the deposit of uric acid crystals into joints and tissue). It is thought that obesity is associated with increased production and reduced elimination of uric acid from the body. Walking is also impaired and the gait changes, becoming more wide-based to accommodate weight.

The following guidance can be accessed if appropriate:

• Generalised Osteoarthritis
• Back Pain.
  • Cranial Effects - Headaches and dizziness and benign intracranial hypertension are common in people who are obese.
  • Metabolic - Type 2 Diabetes Mellitus. Obesity has been found to be one of the strongest - influencing factors in the prevalence of diabetes in a population and up to 90% of people with type 2 diabetes are reported to be overweight or obese. A person who is overweight is 10 times as likely to develop Type 2 Diabetes.

The following guidance can be accessed if appropriate:

• Diabetes
  • Dyslipidaemia. This is a term used to encompass an abnormal blood lipid picture, namely high total cholesterol, high triglyceride and high low - density (LDL) cholesterol.
  • Metabolic Syndrome / Insulin Resistance. Insulin resistance is a term used to describe an inability of the body to use insulin to metabolize blood sugar. This is characterised by a high blood insulin level (as a result of unresponsiveness to insulin in the fat, muscle and liver cells of the body) and a high fasting blood glucose concentration.
  • If a person has insulin resistance, there is a high risk of diabetes and other symptoms should be looked for.
  • Neuropsychiatric - Depression, Alzheimer’s disease and Macular Degeneration are found in obese people. Several studies have shown that there is an increased risk of depression, psychological and emotional distress, poor coping abilities and low self-esteem. Women are particularly affected. Obese adolescents who binge-eat are more likely to have high levels of psychological distress.

The following guidance can be accessed if appropriate:

• Depressive Illness,
• Organic Brain Disorders
• Vision
  • Other - there is more likelihood of fungal skin infections, panniculitis (inflammation of the hair follicles), oedema (fluid retention) due to impaired efficiency of circulation in the lower limbs, especially and cellulitis (infection of the tissues). Pigmentation in skin folds (acanthosis nigricans) can also occur and is often associated with insulin resistance.

Amended April 2008