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Overweight and mortality
Complications
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Complications

Obesity is not just a mere disgrace. Disgrace is an issue of modesty. Certain civilisations or parts of the world have even likened obesity to wealth. Rather, the seriousness of obesity is related to the medical complications, disabilities, decrease in life-expectancy which it creates, and hence the major cost for the society.



>> General complications
>> Cardio-vascular complications
>> Pulmonary complications
>> Endocrine and metabolic complications
>> Osteo-articular complications
>> Complications related to anaesthesia
>> Other complications related to obesity

General complications
As we shall see it in details below, obesity provokes many medical complications. These complications can be very specific, such as sleep apnoea, or non-specific, such as heart angina or hypertension, albeit more pronounced than in normal individuals. We can therefore state that obesity is responsible for an increased risk in mortality and morbidity in each category of age, sometimes up to ten times more.

Meanwhile, obesity accounts for numerous disabilities, which interfere with daily life : rejection from others and feeling of loneliness, emotional problems, difficulties in getting a job, a reduced quality of life, decreased physical and sport abilities.


Cardio-vascular complications
Obese people are obviously prone to cardiac and vascular complications:

- Blood pressure increases with weight, and hypertension as an illness is three times more frequent in obese people than in the normal population.
- The risk for thromboembolism is also increased : atheroma (i.e. cluster of fat tissue inside the artery lumen) of cardiac vessels, which causes angina or even myocardial infarction, or of other vessels such as the lower limbs. The occurrence of ischemia, i.e. reduction of blood supply, is more likely to occur in various organs, with the risk of a complete interruption of blood-flow and necrosis.
- Other cardiac diseases can occur : heart failure, rhythm pathologies, and sudden death.
- There is an increased risk for the venous system : lower limb venous insufficiency (varicose veins, heavy legs), a greater risk for phlebitis, the most serious consequence of which is pulmonary embolism. The risk for the latter is doubled in obese patients above 100 kilos.
- Higher frequency of diabetes and hypercholesterolemia in obese patients contributes to the above risks, since these two illnesses entail vascular pathologies.

Pulmonary complications
- Obese people are very often breathless under effort, whatever the activity. This hampers practicing sport, or even the simple gestures of daily life such as dressing or climbing the stairs. Respiratory tests and exams show almost constant significant impairments of the respiratory function in morbid obese patients.
- Sleep apnoea is a specific complication of obesity, and concerns one third of morbid obese people and 10% of the rest of the obese population.
It can be matched with the so-called Pickwick syndrome (described by Burwell in 1956). The patient affected by this syndrome falls asleep at all times during the day, generally while seated and inactive, typically after dinner. It has been described in a startling way by Dickens, whose character, the fat mister Pickwick, actually gave his name to this illness. Sleep apnoea itself may cause other complications (cardiac or neurological for example).

- Thrombosis is more likely to occur in obese people. For example, the frequency of postoperative (or even spontaneous) phlebitis and pulmonary embolism is much greater in obese people.




Osteo-articular complications
They are numerous.

>> The most frequent is diabetes mellitus:
There is a vast record of medical publications on the subject. More often it is the fat-related type of diabetes, which is the non insulin-dependant type, at least in the early stages of obesity. Thus in the beginning, this type of diabetes can be treated by diet and weight-loss, possibly combined with oral medication. Later on, the disease can turn into insulin-dependant diabetes, therefore requiring daily injections of insulin.
Diabetes is a severe illness that causes many secondary complications: cardiac and vascular complications (atheroma, heart angina and infarction, diseases of the retina that can lead to blindness, etc.).There is a three-folf risk increase for diabetes in obese patients compared with the normal population.
The role of insulin in obese people is complex. Insulin is normally secreted by the pancreas, and acts as a regulator of the sugar level in blood, usually keeping it sufficiently low. Without going into details, an increased level of insulin is observed in the blood flow of obese people. But this increase is not correlated with a drop of the sugar level (glycaemia). The opposite is true, however, for certain rare tumours of the pancreas which secrete an excessive amount of insulin. The mechanism here consists in the occurrence of a multiplication of fat cells, which results in a resistance of the tissues against insulin. This is called the insulin-resistance phenomenon.

>> Blood lipid problems:
Circulating fat increases, which enhances the vascular and cardiac risk. This risk is estimated five times more frequent than in the normal population. The most common trouble is a raised level in blood triglycerides. An increase in blood cholesterol is also observed, specifically the " bad cholesterol " that is LDL-Cholesterol, opposed to the "good cholesterol" (HDL-Cholesterol).

>> Other metabolic and endocrine consequences:

- Fertility troubles, leading to sterility.
- Anomalies of ovulation, the multicyst ovarian syndrome being frequent (resulting in abdominal pain in the middle of the cycle).




Osteo-articular complications
Obesity makes articulations generally painful and ill. Some are specifically affected: knees, hips and back bone. Arthritis is more frequent and accelerated, where articulations age faster, until a state of major disability. Slipped disc, lumbago and sciatic are common as well.

Whatever the degree of obesity, specialists in rheumatology and orthopaedics often ask their patients to loose a significant amount of weight in order to relieve their articulations and to prevent osteoarthritis and aging of the articulations.

Loosing weight is likely to improve the outcome of some operations as well, e.g. the placement of a knee or hip prosthesis, which could otherwise grow fragile much faster.

Symptoms of gout are observed more frequently than in the normal population, and are combined with a higher blood level of uric acid (uricemia).

Other complications are tendinitis and osteoporosis (loss of bone substance occurring in older women after the menopause), which increases the risk for bone-injury.




Complications related to anaesthesia
Any anaesthesic procedure puts the obese patient at risk, because of their deteriorated cardiac and pulmonary functions, and because of the greater risk of thromboembolism.
Some casual difficulties may also occur in the technical procedure : placement of an intraveinous catheter for perfusions, intubation, ventilation , controlling of respiratory parameters and volume of injected



Other complications related to obesity
- Cutaneous complications: mycosis and maceration of the folds, hypersudation, lower limbs ulcers.
- Higher frequency of certain cancers: endometrium, breast, colon and rectum, prostate.
- Digestive complications: cholelithiasis (gallstones), liver steatosis, gastro-oesophageal reflux.


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