The Call-On-Doc Guide to Obesity

Body Mass Index (BMI) is a commonly used measurement to assess the relationship between body weight and height. It is calculated by dividing a person's weight in kilograms by the square of their height in meters (BMI = weight in kg / (height in meters)²).

BMI is often used as an indicator of body fatness and is useful for identifying potential weight-related health risks, including obesity. While not perfect in all cases, one of the best methods to determine obesity with BMI is including waist circumference, with higher BMI being riskier in women with a 35-inch or greater and in men with a 40-inch or greater (2). 

• Underweight: BMI less than 18.5
• Normal weight: BMI between 18.5 and 24.9
• Overweight: BMI between 25 and 29.9
• Obesity (Class 1): BMI between 30 and 34.9
• Obesity (Class 2): BMI between 35 and 39.9
• Obesity (Class 3): BMI 40 or higher (also known as severe or morbid obesity)

It should be noted that there is a limitation of BMI based on ethnicity and muscle mass. At the time of its invention, the index was developed with those of European descent in mind and requires adjustment when measuring those of other races. A specific example is those of South Asian descent, who on average, have a smaller cutoff in the above data. (16) Additionally, BMI does not take into consideration muscle mass, meaning those with high muscle mass may be considered obese when only measured by the body mass index. 

When used alongside data that includes race, waist circumference, and muscle mass, BMI allows for a greater understanding of a person’s health. Not just for consideration of obesity, but also to accurately estimate some of the chronic diseases a person may develop. 

Obesity affects range differently from person to person; however, when it develops, there are symptoms that can be felt or seen and those that may not be noticed until they progress into a later stage chronic disease. (3) Such symptoms include: 

• Breathlessness: Excess weight puts additional strain on the respiratory system, making it harder for the chest muscles and diaphragm to expand and contract effectively during breathing. Obesity can lead to decreased lung volumes and reduced lung compliance, limiting the amount of air that can be inhaled and exhaled. Increased fat deposition in the upper body can compress the chest cavity and impede the movement of the lungs. Obesity is associated with a higher metabolic demand, which requires increased oxygen intake, putting additional stress on the respiratory system. Breathlessness is a symptom of obesity because it reflects the compromised respiratory function and the body's struggle to meet the increased oxygen demands, especially during physical activity.
• Frequent exhaustion: Carrying excess weight requires additional effort and energy expenditure, leading to increased fatigue. Obesity is often accompanied by poor sleep quality and sleep apnea, which can disrupt restorative sleep, leading to persistent tiredness. The condition is associated with metabolic and hormonal imbalances that can contribute to feelings of fatigue. It can lead to reduced physical fitness and endurance, making everyday activities more challenging and exhausting. Frequent exhaustion is a symptom of obesity as it reflects the overall burden on the body and the increased energy demands required to carry excess weight.
• High blood glucose: Excess adipose tissue, particularly abdominal fat, leads to insulin resistance, where the body's cells become less responsive to insulin's effects. This results in reduced glucose uptake by cells and increased glucose levels in the bloodstream. Obesity is often accompanied by an imbalance in adipokines, hormones secreted by adipose tissue, which can further impair insulin function and contribute to elevated blood glucose. Unhealthy dietary habits and sedentary lifestyles often associated with obesity can lead to excessive caloric intake and poor blood sugar control. The condition is frequently linked to the development of type 2 diabetes, where chronic high blood glucose levels are a defining characteristic.
• High blood pressure: Excess body weight increases the volume of blood that needs to be circulated, resulting in higher blood pressure to maintain proper blood flow. Obesity is associated with increased production of hormones and substances that constrict blood vessels, leading to elevated blood pressure. Adipose tissue releases inflammatory substances that can damage blood vessels and disrupt normal blood pressure regulation. Obesity is often accompanied by other risk factors for high blood pressure, such as unhealthy dietary habits and a sedentary lifestyle. High blood pressure is a symptom of obesity as it reflects the strain on the cardiovascular system and the increased resistance to blood flow caused by excess weight.
• Increased body weight: Increased body weight in individuals with obesity develops due to a combination of genetic, environmental, and lifestyle factors. Consuming more calories than the body needs leads to energy imbalance, and the excess energy is stored as fat, causing weight gain. Sedentary behavior and lack of physical activity contribute to reduced calorie expenditure, further promoting weight gain. Genetic factors can influence metabolism, fat storage, and appetite regulation, making some individuals more susceptible to obesity. Increased body weight is a symptom of obesity as it indicates an abnormal accumulation of fat that exceeds what is considered healthy for a person's height and body composition.
• Joint pain: Excess body weight puts increased stress on the joints, particularly weight-bearing ones such as the knees, hips, and ankles, leading to wear and tear on the joint surfaces. The condition is associated with chronic low-grade inflammation, which can further contribute to joint pain and inflammation. Obesity-related conditions like osteoarthritis, which involves the breakdown of joint cartilage, can be more prevalent in individuals with obesity. The mechanical and inflammatory effects of obesity can impair joint function and cause discomfort. Joint pain is a symptom of obesity as it reflects the impact of excess weight on the musculoskeletal system and the resulting strain on the joints.
• Sleep apnea: Excess weight, especially around the neck and upper airway, can obstruct the airflow during sleep, leading to episodes of interrupted breathing. Obesity is associated with increased fat deposition in the throat area, which narrows the airway and further contributes to airway obstruction. Adipose tissue releases inflammatory substances that can contribute to airway inflammation and decrease the stability of the upper airway. Sleep apnea is a symptom of obesity as it reflects the physical and anatomical changes in the airway caused by excess weight, resulting in disrupted breathing patterns during sleep.
• Unhealthy cholesterol: Obesity is associated with an imbalance in lipid metabolism, leading to increased production and decreased clearance of LDL cholesterol. Excess adipose tissue releases inflammatory substances that can negatively impact cholesterol metabolism and promote the accumulation of LDL cholesterol. Obesity is often accompanied by unhealthy dietary habits, including high intake of saturated and trans fats, which contribute to elevated LDL cholesterol levels. Bad cholesterol is a symptom of obesity as it reflects the dysregulation of lipid metabolism and the increased risk of cardiovascular diseases associated with high levels of LDL cholesterol.

Additionally, obesity can be directly linked to or have a huge factor in the development of chronic conditions that can exacerbate health problems. Such conditions linked to obesity include: 

• Cancer: Excess adipose tissue produces and releases hormones and inflammatory substances that can promote the growth of cancer cells. Obesity is associated with chronic low-grade inflammation, which can create an environment favorable for cancer development. The condition is often accompanied by insulin resistance and elevated levels of insulin and insulin-like growth factors, which can stimulate cell growth and increase the risk of cancer. Additionally, obesity can influence immune function and impair the body's ability to detect and eliminate cancer cells. 
• Cardiovascular disease: Excess body weight puts additional strain on the heart, leading to increased workload and potential cardiac dysfunction. It is associated with dyslipidemia, characterized by high levels of triglycerides and low levels of HDL cholesterol, which increases the risk of atherosclerosis and coronary artery disease. Obesity is linked to insulin resistance, which can lead to elevated blood sugar levels and inflammation, further promoting the development of cardiovascular disease. Additionally, obesity is often accompanied by hypertension (high blood pressure), another significant risk factor for cardiovascular problems. Collectively, these factors increase the risk of conditions such as heart attacks, strokes, and heart failure.
• Dyslipidemia: Excess body weight, especially abdominal obesity, is associated with increased production of triglycerides by adipose tissue and decreased clearance of triglycerides from the bloodstream, resulting in elevated triglyceride levels. Obesity is often accompanied by insulin resistance, which can disrupt lipid metabolism and increase triglyceride and LDL cholesterol levels. Obesity-related inflammation can alter lipid metabolism, promote the production of pro-inflammatory lipid particles, and decrease the levels of protective HDL cholesterol. These factors collectively contribute to the development of dyslipidemia in individuals with obesity.
• Fatty liver: Obesity can lead to a fatty liver, a condition known as non-alcoholic fatty liver disease (NAFLD). Excess body weight increases the accumulation of fat in the liver. Through insulin resistance associated with obesity, there is an increased release of fatty acids from adipose tissue that leads to their uptake and storage in the liver. Obesity-related inflammation and oxidative stress contribute to liver damage and the progression of fatty liver disease. Additionally, obesity-related metabolic disturbances, such as dyslipidemia and elevated triglyceride levels, further promote the development of fatty liver. 
• Gastroesophageal reflux disease: Obesity can cause Gastroesophageal Reflux Disease (GERD) due to increased pressure on the stomach caused by excess abdominal fat, which can lead to the backflow of stomach acid and contents into the esophagus. Additionally, obesity is associated with the relaxation of the lower esophageal sphincter, a muscle that normally prevents acid reflux, further contributing to the development of GERD. A condition treated by CallonDoc, the symptom is known to be common in those with obesity. 
• Hypertension: Obesity can cause hypertension (high blood pressure) due to the increased workload on the heart and blood vessels caused by excess body weight. Additionally, obesity is associated with metabolic changes, including insulin resistance and inflammation, which can contribute to the development of hypertension. A common condition easily treatable with CallonDoc, the signs of hypertension often go unnoticed until its in the later stages. 
• Osteoarthritis: Excess body weight places increased stress on the joints, particularly weight-bearing joints such as the knees and hips, leading to accelerated wear and tear of the joint cartilage. Obesity-related inflammation can further contribute to joint damage and the breakdown of cartilage. Additionally, metabolic changes associated with obesity, such as insulin resistance and elevated levels of certain hormones, may negatively impact joint health and contribute to the development or progression of osteoarthritis. 
• Type 2 diabetes: Obesity can lead to type 2 diabetes primarily through the development of insulin resistance, where the body's cells become less responsive to the effects of insulin. Excess adipose tissue, particularly in the abdominal area, releases inflammatory substances and hormones that interfere with insulin's ability to regulate blood sugar levels, resulting in chronically elevated blood glucose and the development of type 2 diabetes. While typically going unnoticed till the later stages of the condition, type 2 diabetes can be easily treated by CallonDoc. 

Metabolic syndrome is a cluster of conditions that occur together and increase the risk of cardiovascular diseases, type 2 diabetes, and stroke. It is characterized by a combination of factors such as obesity or excess abdominal fat, insulin resistance, high blood pressure, dyslipidemia, and elevated fasting glucose levels. Obesity plays a significant role in the development of metabolic syndrome. Excess body weight, particularly abdominal obesity, contributes to insulin resistance, where the body's cells become less responsive to insulin. Obesity also leads to chronic low-grade inflammation, hormonal imbalances, and adipose tissue dysfunction, all of which further disrupt metabolic processes and contribute to the development of metabolic syndrome. (5)

Yes, being overweight can contribute to feelings of sickness due to various factors. Excess weight can strain the body's systems, leading to conditions such as high blood pressure, high cholesterol, and insulin resistance, which increase the risk of developing illnesses like heart disease, diabetes, and fatty liver disease. Additionally, carrying extra weight can cause inflammation throughout the body, leading to symptoms such as fatigue, joint pain, and gastrointestinal discomfort. Furthermore, obesity is associated with hormonal imbalances that can affect mood and energy levels, contributing to feelings of sickness and overall malaise. 

The cause of obesity is multifactorial and can vary from person to person. It is typically a result of a combination of genetic, environmental, behavioral, and metabolic factors. (6)

Genetic factors play a role in determining an individual's susceptibility to weight gain and obesity. Certain genes can influence appetite, metabolism, and fat storage, making some people more prone to gaining weight.

Environmental factors, such as an obesogenic environment with easy access to high-calorie processed foods and a sedentary lifestyle, contribute to obesity. Factors like unhealthy dietary patterns, excessive consumption of sugary drinks, and a lack of physical activity all contribute to weight gain.

Behavioral factors, including eating habits, portion sizes, eating out frequently, emotional eating, and lack of regular physical activity, can also contribute to obesity. Psychological factors like stress, depression, and inadequate sleep may also influence weight gain and obesity.

Metabolic factors, such as hormonal imbalances, insulin resistance, and impaired energy metabolism, can affect weight regulation and contribute to obesity.

On top of using BMI and waist circumference, doctors will additionally assess the patient's body fat percentage, measure skinfolds, review medical history, and conduct a physical examination (7). In some cases, doctors may order additional tests or assessments, such as blood tests to evaluate metabolic markers, lipid profile, glucose levels, and liver function, among others, to assess the impact of obesity on overall health and identify any underlying conditions associated with obesity.

On top of getting a general measurement through BMI, there are also other types of obesity that can be determined based on how the condition develops in the body. Here are four common classifications: 

• Android or abdominal obesity: Also known as central obesity, this type is characterized by the excess accumulation of fat around the abdomen and upper body. It results in an apple-shaped body appearance, with a significantly larger waist circumference than the hip circumference. Android obesity is often associated with increased health risks, including cardiovascular disease, type 2 diabetes, and metabolic syndrome.
• Gynoid or gluteofemoral obesity: This type involves the accumulation of fat predominantly in the hip and thigh area, resulting in a pear-shaped body appearance. Gynoid obesity is more commonly observed in women. While it may still be associated with certain health risks, such as osteoarthritis, it is generally considered to be less detrimental to health than android obesity.
• Mixed or combined obesity: This type of obesity refers to a more even distribution of excess fat throughout the body, without a predominant central or peripheral pattern. Mixed obesity may present with both abdominal and hip/thigh fat accumulation, leading to a combination of apple and pear-shaped body characteristics.
• Visceral obesity: Visceral obesity specifically refers to the accumulation of fat within the abdominal cavity, surrounding internal organs like the liver, intestines, and pancreas. It is associated with higher levels of intra-abdominal fat, increased waist circumference, and a greater risk of metabolic disorders, including insulin resistance, high blood pressure, and cardiovascular disease.

Obesity treatment is designed to get someone down to a healthy weight that can be managed in the long term. Doctors thereby have a number of options available for their patients that need to reduce their weight, with the most common examples including (8):

Doctor’s recommendations: Using well-established data and studies about obesity, doctors will first recommend guidance that a patient should follow to reduce their weight. While a patient can take the initiative with these plans and services on their own, greater success is often seen when a supportive social environment or team is put together to help. 

• Behavioral Therapy: Also known as behavioral weight management or behavior modification, is a therapeutic approach that focuses on identifying and modifying unhealthy behaviors and habits related to eating, physical activity, and lifestyle. It involves working with healthcare professionals, such as psychologists or counselors, to address the psychological, emotional, and environmental factors that contribute to overeating and sedentary behavior. Behavioral therapy aims to help individuals develop healthier habits, improve self-control, manage emotional triggers, and establish sustainable behavior change strategies to support long-term weight management.
• Dietary Counseling: Involves working with a registered dietitian or healthcare professional who specializes in nutrition to develop a personalized eating plan tailored to an individual's specific needs and goals. The counselor provides guidance and education on healthy food choices, portion control, meal planning, and strategies to improve dietary habits. Dietary counseling aims to promote a balanced, calorie-controlled diet that supports weight loss or weight management, while ensuring adequate nutrition and promoting long-term lifestyle changes for sustainable results.
• Physical Activity Guidance: Involves working with healthcare professionals, such as exercise physiologists or fitness trainers, to develop an individualized exercise plan to support weight loss or weight management. It includes assessing an individual's current fitness level, discussing activity preferences, setting realistic goals, and providing guidance on appropriate exercises and intensity levels. Physical activity counseling aims to promote regular physical activity, improve fitness, burn calories, and enhance overall health. It focuses on finding enjoyable activities and incorporating them into daily routines to support long-term adherence and sustainable weight management.

Prescription Medications: Typically, when the above guidance does not work or proves less effective, a healthcare provider will prescribe medications specifically meant to help with weight loss. Coming in oral and injectable forms, the medication often does change the way a person feels when eating, they are still meant to be taken alongside doctor-approved healthy exercise and eating habits. Here are some of the most common prescriptions: 

• Contrave: It combines two active ingredients, bupropion and naltrexone, which work together to suppress appetite and reduce food cravings. Bupropion affects brain chemistry to reduce food cravings, while naltrexone targets the reward system to decrease the desire for certain foods, leading to reduced calorie intake and potential weight loss. (9)
• Plenity: A hydrogel capsule that, when ingested, expands in the stomach, creating a feeling of fullness and reducing hunger. By promoting a sense of satiety, Plenity can help individuals consume fewer calories. (10)
• Wegovy: It works by mimicking the action of a hormone called GLP-1 in the body, which helps regulate appetite and food intake. (11)

Bariatric Procedures: Bariatric procedures are surgical interventions designed to treat severe obesity by modifying the size or function of the stomach and/or digestive system. By altering the anatomy of the gastrointestinal tract, bariatric procedures restrict food intake, promote early satiety, and may also affect nutrient absorption. While they have proven to be immediately effective, such procedures are only considered after lifestyle modifications and prescriptions have failed. 

• Gastric Banding: Gastric banding is a surgical procedure for weight loss that involves placing an adjustable silicone band around the upper part of the stomach, creating a small pouch. This restricts the amount of food the stomach can hold, leading to a feeling of fullness with smaller portions and helping individuals consume fewer calories, resulting in weight loss.
• Gastric Sleeve Surgery: Also known as sleeve gastrectomy, is a surgical procedure for weight loss in which a portion of the stomach is permanently removed, leaving a smaller sleeve-shaped stomach. This reduces the stomach's capacity to hold food, resulting in decreased appetite, reduced calorie intake, and weight loss.
• Gastric Bypass Surgery: A surgical procedure for weight loss that involves creating a small pouch at the top of the stomach and bypassing a portion of the small intestine. This restricts food intake and reduces nutrient absorption, leading to significant weight loss and changes in hormone regulation, which can help improve metabolic health and control appetite.

Metabolic and Bariatric Surgery: Proven to be the most effective for those with severe obesity needing weight loss, metabolic and bariatric surgeries are reserved for worse cases that may require intervention. (12)

• Biliopancreatic Diversion: A type of weight loss surgery that involves removing a large portion of the stomach and rerouting the small intestine to limit both food intake and nutrient absorption. This procedure promotes significant weight loss by restricting the amount of food that can be consumed and reducing the absorption of calories and nutrients from the digestive system.
• Duodenal Switch: A type of weight loss surgery that combines a sleeve gastrectomy with intestinal rerouting. The procedure involves removing a portion of the stomach to create a smaller sleeve-shaped stomach and rerouting the small intestine to reduce the absorption of calories and nutrients, leading to significant weight loss and improvements in metabolic health.

The only "best treatment" option for obesity is the right treatment for you and your goals. The first step is to learn about the options available and compare it with your situation and health needs.

A challenging part of obesity is learning how to incorporate a healthy meal plan and daily movement to meet your needs. It can be difficult on where to start, but meals should be nutritious and proportional. Studies have shown that a diet focusing more on protein instead of carbohydrates and fats helps to support a healthy lifestyle meant to support exercise while burning off weight. (14)

Those with obesity should start exercising on a regular basis as that is one of the best ways to reduce weight at a regular rate. However, depending on the severity, you might need to start at a place that is best for your specific condition. The most common examples of this have to do with maintaining cardiac, respiratory, and joint health. Those with more severe cases of obesity should avoid high-impact/high-intensity workouts until their weight is at a more manageable level. (15)

When it comes to the best diet and exercise for your obesity treatment, we recommend getting tips from your personal doctor to best manage your specific case. Alongside that, here are our best tips to help you in your weight loss journey:

Behavior Modification: Addressing psychological and behavioral factors that contribute to overeating and sedentary behavior. Strategies may include identifying triggers, developing coping mechanisms, practicing portion control, self-monitoring, and setting achievable goals.

Healthy Eating: Adopting a balanced, calorie-controlled diet that focuses on whole foods, fruits, vegetables, lean proteins, and whole grains. Portion control, mindful eating, and reducing the consumption of high-calorie, processed foods and sugary beverages are important.

Regular Physical Activity: Engaging in regular physical activity that includes a combination of aerobic exercise, strength training, and flexibility exercises. Aim for at least 150 minutes of moderate-intensity aerobic activity per week, along with muscle-strengthening activities on two or more days.

Support and Accountability: Seeking support from healthcare professionals, such as registered dietitians, psychologists, or support groups, to provide guidance, motivation, and accountability throughout the weight management journey.

Weight Tracking: An important aspect of managing obesity as it helps individuals monitor their progress, assess the effectiveness of lifestyle changes, and make necessary adjustments to their weight management plan. Regularly tracking weight can provide valuable feedback, motivation, and accountability in the journey toward achieving and maintaining a healthy weight.

Preventing obesity from happening or returning requires a comprehensive and proactive approach that encompasses healthy eating habits, regular physical activity, lifestyle modifications, education, and supportive environments. By adopting a balanced diet, engaging in regular exercise, making sustainable lifestyle changes, promoting awareness, and creating environments that facilitate healthy choices, you can make significant changes to your overall health and longterm wellness.

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10. Giruzzi, Nicholas. “Plenity (Oral Superabsorbent Hydrogel).” Clinical diabetes : a publication of the American Diabetes Association vol. 38,3 (2020), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364464/. 
11. Anekwe, Chika. “A new treatment for obesity.” Harvard Health, 10 September 2021, https://www.health.harvard.edu/blog/a-new-treatment-for-obesity-202109102589. 
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