Obesity and Diabetes Diabetes Now
What is Obesity in relation to Diabetes
Excess weight and obesity can affect a person’s health in many ways. Many methods of measurement can be used to evaluate how much excess weight a person has. One of these methods is calculating body mass index (BMI). BMI is a number calculated by dividing weight in kilograms by height in meters squared. There are four weight status categories (underweight, normal weight, overweight, and obesity).
Obesity increases a person’s risk of developing:
- Hypertension (high blood sugar)
- Type 2 diabetes
- Certain types of cancer
- Osteoarthritis (the breaking down of cartilage and bone)
- Dyslipidemia (this consists of high blood cholesterol and triglycerides, a type of fat)
Obesity and Related Medical Risks?
The issue medically with obesity is, of course, the medical complications.
And as one becomes more and more obese you’re increasing your risk of cardiovascular disease, heart attacks, strokes, peripheral vascular disease, damage to the circulation to your lower limbs, an increased risk of cancer of reproductive organs, colon cancer, amongst others, an increased risk of mortality.
As you gain weight, your life expectancy decreases. And there are also other issues, such as effects on fertility; obesity decreases your fertility, and also effects on joints, particularly lower limbs, knees, hips, lower spine. A weight increase causes degenerative changes to be accelerated in individuals who are overweight.
If you have any questions about obesity, the measurement, or treatment of it, please do discuss it with your primary care practitioner.
Local Practitioners: Endocrinologist
Understanding Why Obesity is a Chronic Disease
Obesity is a chronic disease. 2015 was the year where the Canadian Medical Association recognized obesity as a chronic disease. For decades, obesity was recognized as a risk factor to develop other complications such as diabetes and hypertension.
It is an entity on its own, and it’s a chronic disease, because we all know—and everybody that’s tried dieting or losing weight does know that the battle is lifelong. Once we suffer from obesity, we have dis-regulation of several hormones, or even the neurobiology is modified.
For a long time obesity was regarded as being a lack of motivation. We now know that there are genetic factors involved, there is neurobiology involved, and there are hormonal factors that are implicated in weight management. Let me explain. Our adipose tissue actually secretes a hormone called lectin. Lectin goes to our brain to tell our brain we have enough storage.
Well, when we suffer from obesity, and we live with obesity, that signaling is lost. There’s a hormone secreted by our gut called the GLP-1, secreted after we eat, to tell our brain we just ate, we just had a caloric intake, so you can stop eating. It’s called satiety, satiety signaling. Well when we suffer from obesity, that signaling is also dampened. So now imagine: you’re trying to lose weight. You’re trying to control your caloric intake. And the two main signaling are dampened in your brain.
This being said, there is a concept of setpoint that I wanted to bring up. The concept of setpoint is important because it finally explains the weight rebound. Everybody that loses weight on a diet re-gains their weight. Sometimes very quickly, sometimes over years. But the reason is the setpoint theory.
Let me explain. When we lose weight, we also lose muscle mass. And muscle mass is very important for our basal metabolic rate. If we lose muscle mass, we lose basal metabolic rate, which kind of limits our calorie burn at rest. So we tend to re-gain weight.
Not only that, there’s also hormonal adaptation. I told you about a hormone secreted by the gut that is used for signaling in our brain to tell us we just had a caloric intake. Well, when we lose our weight, we lose that signaling. Imagine that? Even less. We’re already resistant to that satiety signaling, okay, that fullness feeling. And now we have less signalization to our brain.
Not only that, there’s a hormone called ghrelin secreted at the level of the stomach, that actually increases appetite. Well, guess what? When we lose weight it increases. So we have our defense mechanism is to make sure that we don’t die from starvation. So if we lose weight, as soon as there’s going to be food around we’re going to be able to re-gain our weight.
If you’re looking for more information on obesity and how to help with weight management, ask your family doctor, ask a specialist. You need a multidisciplinary approach: dietitian, kinesiologist, personal trainer even, to make sure that there are agents, medication to help you also if you suffer and you live with obesity.
Local Practitioners: Family Doctor
An echocardiogram is an ultrasound that is performed on the heart. It is the same technology as an ultrasound that is used, for example, for pregnancy. Except instead of obviously looking at the uterus, we’re looking at the heart.
And the purpose of an ultrasound of the heart is to understand the structures, as well as the function of the heart in terms of its pumping function, its relaxation properties, as well as how well the one-way valves work. We can also get other information such as indirect assessment of pressures inside the chambers of the heart, as well as an understanding of the sac that lines the heart.
The idea of an echocardiogram is it gives us a good understanding of the net effect of all the sub-systems of the heart, on how the heart performs. Well, an echocardiogram is a fairly commonly-used test for cardiologists and for internists, and it is used when there is some question about whether or not someone has an abnormal function of either the cardiac performance, or an abnormal function in one of the valves.
Common conditions in which an echocardiogram is used to diagnose are conditions in which you’re suspicious that a patient has a weak heart, or if a patient has dysfunction of one of the valves, and you’re considering surgery or some other method to replace or repair that valve. These would be cases in which valves don’t open properly, because of end-stage changes that cause arthritic changes, or conditions which lead to incompetence of the valve, causing regurgitation.
Echocardiograms should be done in an accredited facility. Mostly they are done in hospitals, but they are private facilities. But ensure that they’re accredited, and they should be overseen by physicians who have special accreditation and/or training in echocardiography.
If you have any further questions about an echocardiogram, you should speak to your family physician, or potentially even a specialist who performs echocardiography.
Presenter: Dr. Graham Wong, Cardiologist, Vancouver, BC
Local Practitioners: Cardiologist