1.DIABETES MELLITUS TYPE 2 (DM 2)

TYPE 2 DIABETES IS A STATE WHERE THERE IS  INSULIN RESISTANCE  IN THE BODY LEADING TO HIGH INSULIN AND HIGH GLUGOSE LEVELS IN THE BLOOD  ,DUE TO OBESITY PROBLEMS .IT IS ESTIMATED THAT AT PRESENT 90 % OF DIABETIC CASES ARE OBESE .IN A NORMAL STATE THE PANCREAS RELEASE INSULIN TO CONTROL THE SUGAR LEVELS IN THE BODY ,BUT AS WE BECOME OVERWEIGHT THE DEMAND FOR INSULIN INCREASES AND ULTIMATELY THE PANCREATIC CELLS BURN OUT AND CANNOT KEEP UP THE DEMAND ,IN WHICH CASE THE SUGARS BECOME RESISITANT TO THE INSULIN AND THEREFORE THERE IS A DIABETIC LIKE STATE TERMED AS TYPE 2 DIABETES .IT IS SAID THAST WITH JUST 15 % WEIGHT LOSS THIS DIABETES CAN BE ELIMINATED ALLTOGETHER.

MEDICATIONS USED TO CONTROL DIABETES OFTEN CAUSE WEIGHT GAIN ,ESPECIALLY INSULIN ,THE SULFONYLUREA DRUGS & THE THIAZOLIDINEDIONES .

2.CARDIOVASCULAR DISEASE .

OBESITY IS DEFINED AS AN INDEPENDENT RISK FACTOR OF CARDIOVASCULAR DISEASE (CVD) ,DEFINED AS CORONARY HEART DISEASE ( CHD ) ,MYOCARDIAL INFARCTION( MI ),CONGESTIVE HEART FAILURE( CHF ),HYPERTENSION,ATRIAL FIBRILLATION  AND  STROKE.THE FRAMINGHAM HEART STUDY SHOWED OBESITY TO INCREASE CVD  BY 1.46 TIMES IN MALES AND 1.64 TIMES IN FEMALES.,AND THE RISK OF HYPERTENSION WAS 2.21 TIMES IN MALE AND 2.75 TIMES IN FEMALES.A WEIGHT INCREASE OF JUST 14 KGS DOUBLES THE LOAD ON THE HEART .

CARDIOVASCULAR SYSTEM MANIFESTATIONS ASSOCIATED WITH  OBESTIY

• INCREASED BLOOD VOLUME
• INCREASED CARDIAC OUTPUT
• INCREASED STROKE VOLUME
• INCREASED HEART RATE
• INCREASED LEFT VENTRICULAR FILLING AND PRESSURE ( ESPECIALLY EXERCISE )
• INCREASED LEFT ATRIAL HYPERTROPHY
• INCREASED LEFT VENTRICULAR HYPERTROPHY
• FATTY HEART
• ECG CHANGES

3.HYPERTENSION ( BLOOD PRESSURE )

THE PREVELAnce  OF HYPERTENSION IS ABOUT 6 TIMES MORE FREQUENT IN THE OBESE AND A MAJORITY OF PEOPLE WITH HYPERTENSION ARE OVERWEIGHT .A 10 KG HIGHER WEIGHT IS ASSOCIATED WITH A 3 mm HIGHER SYSTOLIC AND A 2.3 mm HIGHER DIASTOLIC BLOOD PRESSURE .

AN INCREASE IN BMI < 25 TO > 30 KG/M2  IS ASSOCIATED WITH AN INCREASED PREVELANCE OF HYPERTENSION FROM 15% TO 40 % .INCREASE IN BMI IS ASSOCIATED WITH A 1.4 TIMES HIGHER RISK IN BLOOD PRESSURE.  WEIGHT LOSS IS ASSOCIATED WITH A REDUCTION IN BLOOD PRESSURE .IN MORE THAN 50 % OF INDIVIDUALS ,BLOOD PRESSURE DECREASES AN AVERAGE OF 1-4 mm HG SYSTOLIC AND 1-2 mm DIASTOLIC PER KG OF WEIGHT REDUCTION .

4.METABOLIC SYNDROME( METS)

METABOLIC SYNDROME WAS FIRST DESCRIBED BY REAVEN AND IS ASSOCIATED WITH AN INCREASED OF MORTALITY  FROM CVD .

DIAGNOSTIC CRITERIA FOR METABOLIC SYNDROME 3 OUT 5 OF THE FOLLOWING )

• ABDOMINAL OBESITY ( WAIST CIRCUMFERENCE )———— >= 40 INCHES IN MEN & >=35 INCHES IN WOMEN
• TRIGLYCERIDES >= 150mg/dl
• HDL <=40mg/dl in males and <= 50 mg/dl in females
• BLOOD PRESSURE >=130/80mmHg
• FASTING GLUCOSE >=100mg/Dl

WEIGHT REDUCTION EVEN AS LITTLE AS 8 KGS HAS BEEN SHOWN TO LOWER THE PREVELANCE OF METS SIGNIFICANTLY .

5.CANCER

NUMEROUS STUDIES HAVE SHOWN A CORRELATION BETWEEN OBESITY AND THE RISK OF DEVELOPING OR DYING FROM CANCER .THE MILLION WOMEN STUDY SHOWED A SIGNIFICANT INCREASE IN THE INCIDENCE OF CANCER AND OF CANCER MORTALITY.CANCERS ASSOCIATED WITH OBESITY ARE

• LEUKEMIA
• MULTIPLE MYELOMA
• NON-HODGKIN’S LYMPHOMA
• CANCER OF ENDOMETRIUM
• OESOPHAGUS
• KIDNEY CANCER
• BREAST CANCER ( POST MENOPAUSAL WOMEN )
• COLON /RECTUM CANCER ( IN PREMENOPAUSAL WOMEN )
• PROSTRATE CANCER

A PROSPECTIVE STUDY IN THE USA INVOLVING 900,000 SUBJECTS  FOR MORE THAN 15 YEARS ,SHOWED THOSE WITH A BMI >39.9 HAD A 50%-60% INCREASE IN OVERALL CANCER MORTALITY AND MORE SPECIFICALLY WITH HIGHER DEATH RATES FROM CANCER OF THE COLON AND RECTUM .

6.OSTEOARTHRITIS (OA)

OSTEOARTHRITIS IS A COMMON PROBLEM WHICH LEADS TO DECREASED MOBILITY,LOST PRODUCTIVITY,CHRONIC PAINAND DISABILITY .OBESITY HAS BEEN SHOWN TO INCREASE THE RISK OF OSTEOARTHRITIS ESPECIALLY IN  THE KNEE AND HIP JOINTS .IN ROTTERDAM STUDY OVER 61/2 YEARS IT WAS FOUND THAT THE RISK OF OA WAS 3 TIMES MORE WITH PEOPLE OF BMI > 27KG/M2 .WEIGHT LOSS HAS BEEN SHOWN TO SIGNIFICANTLY REDUCE THE SIGNS AND SYMPTOMS OF OA AND IMPROVE FUNCTIONAL CAPACITY AND QUALITY OF LIFE  IN AFFLICTED OBESE PATIENTS .

7.NONALCOHOLIC FATTY LIVER DISEASE ( NAFLD )

NONALCOHOLIC FATTY LIVER DISEASE AFFECTS 15-30 % OF GENERAL POPULATION AND UPTO 70 % OF PATIENTS WITH DM2 .NAFLD IS ASSOCIATED WITH OBESITY HYPERTENSION AND DYSLIPIDEMIA .

IN ONE MULTIVARATE STUDY AND INCREASED BMI ( > 26.9 ) WAS SHOWN TO BE THE MAIN VARIABLE ASSOCIATED WITH NAFLD .A BMI > 30 AND THE LACK OF PHYSICAL FITNESS WERE SHOWN TO BE SIGNIFICANTLY AND INDEPENDENTLY ASSOCIATED WITH NAFLD IN A GROUP OF NONSMOKING HEALTHY MEN .

8.OBSTRUCTIVE SLEEP APNOEA( OSA )

OSA IS 30 % MORE IN OBESE PATIENTS AND AROUND 50-98% MORE IN SEVERELY OBESE PATIENTS .OBESITY IS THE MOST IMPORTANT  RISK FACTOR FOR THE DEVELOPMENT OF OSA AND THE RELATIVE RISK IS HIGH .COMPLICATIONS INCLUDE PULMONARY HYPERTENSION,RIGHT HEART FAILURE ,STROKE,HYPERTENSION AND CARDIAC ARRYTHMIAS .

9.GALL BLADDER DISEASE .

AN ALLITERATIVE CHARACTERISATION OF THOSE AT HIGHER RISK FOR GALLBLADDER DISEASE IS THAT THEY ARE FAT,FORTY,FEMALE,FERTILE AND FLATUENT .A STUDY OF 1 MILLION SCOTTISH AND ENGLISH WOMEN SHOWED A STRONG ASSOCIATION BETWEEN GALLBLADDER DISEASE AND OBESITY .MEN WHO HAVE A BMI > 28.5 WERE AT 2.5 TIMES GREATER RISK OF HAVING GALLSTONES .

10.MENTAL HEATH ISSUES

STUDIES HAVE SHOWN THAT BMI WAS SIGNIFICANTLY ASSOCIATED WITH ANXIETY ,MOOD AND PERSONALITY DISORDERS.MAJOR DEPRESSIVE DISORDER (MDD) INCREASED 1.5 TO 2 TIMES MORE IN OBESE INDIVIDUALS .IT INCREASED FROM 6.5 TO 25.9 % WITH AN INCREASE IN BMI FROM 25 TO 35 KG/M2 .WEIGHT LOSS IMPROVES DEPRESSION IN MAJORITY OF THE PEOPLE .