Obesity As a Chronic Disease: Understanding and Managing a Complex Condition
Mohamed Aly Elsherif Ibrahim Elsherif, MD, PhD
Assistant Professor of Clinical Medicine, WCM-Q
Consultant Endocrinology and Obesity Medicine, HMC
Obesity is increasingly recognized as a chronic, relapsing, multifactorial disease with complex pathophysiology and significant health implications. It is not merely a lifestyle issue but a neurobehavioral condition characterized by excess adiposity that leads to various metabolic, mechanical, and psychosocial complications.
Global Recognition and Impact
Leading health authorities including the World Health Organization (WHO), the American Medical Association (AMA), and the European Association for the Study of Obesity (EASO) declared obesity a disease. Globally, over 13% of adults have obesity, and the prevalence continues to rise, including in Qatar where national data reflects alarming trends reaching around 40%. Obesity is now seen as a major gateway to other non-communicable diseases such as type 2 diabetes, cardiovascular disease, and certain types of cancer.
Understanding the Mechanisms
Obesity is driven by a complex interplay of genetic, environmental, behavioral, and physiological factors. Central to its development is the dysregulation of appetite and energy balance, involving neurohormonal signals from the gut, like GLP-1, Ghrelin, adipose tissue Leptin, and the central nervous system, particularly the hypothalamus. These hormonal pathways influence hunger, satiety, and energy expenditure.
Assessment and Classification
While Body Mass Index (BMI) remains a standard measure, it lacks specificity for individual risk. Tools like the Edmonton Obesity Staging System (EOSS) help stratify obesity severity based on medical, mental, and functional parameters, aiding clinical decision making.
Health Consequences
Obesity significantly increases the risk of conditions such as sleep apnea, fatty liver disease, osteoarthritis, cardiovascular disease, and various cancers. It is associated with reduced life expectancy and quality of life. The relative risk of comorbidities escalates with increasing BMI, reinforcing the urgency for timely intervention.
Benefits of Weight Loss
A modest weight loss of 5–10% has been shown to significantly improve glycemic control, blood pressure, lipid profiles, and sleep quality, while reducing the risk of type 2 diabetes, cardiovascular events, and mortality. However, long-term weight maintenance remains challenging due to physiological adaptations that promote weight regain.
Management Strategies
Obesity management has evolved from a BMI-centric model to a complication centric approach. Evidence-based treatment includes parallel inclusion of:
- Lifestyle interventions: diet, physical activity, behavioral therapy, sleep and stress management.
- Pharmacotherapy: Agents such as Orlistat, Liraglutide, Tirzepatide, and Semaglutide are now FDA and EMA approved for long-term obesity treatment.
- Bariatric surgery: Reserved for certain cases of severe obesity, or where medical therapy fails. It offers significant, sustained weight loss and comorbidity improvement.
Holistic Approach for Obesity treatment:
Successful long-term obesity management outcomes require a multidisciplinary team approach, combining endocrinology, dietetics, physical therapy, psychology, and sometimes bariatric surgery.
Conclusion
Obesity is a chronic relapsing disease requiring lifelong, individualized, and multidisciplinary care. With advances in our understanding of its mechanisms and treatment modalities, clinicians have an expanding toolkit to help patients achieve better outcomes. A shift in perception from blame to biologically based care is essential to reduce stigma and improve public health.
References:
- Bray GA, Kim KK, Wilding JPH. Obesity: A chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017;18(7):715–723. doi:10.1111/obr.12551
- Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity – 2016. Endocr Pract. 2016;22(Suppl 3):1–203. doi:10.4158/EP161365.GL
- Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(3):254–266. doi:10.1056/NEJMra1514009
- Srivastava G, Apovian CM. Current pharmacotherapy for obesity. Nat Rev Endocrinol. 2018;14(1):12–24. doi:10.1038/nrendo.2017.122