More Morbidity — Coming Storms

Many medical professionals have spoken up about the urgency of recognizing the increased risk to health and life when obesity combines with other physical ailments. For instance, Dr. Aparna Govil Bhasker:

Obesity must be taken very seriously because it affects almost every organ in the body. Effects of obesity can be divided into metabolic and hormonal issues, bio-mechanical problems and organ-specific diseases.

An extensive Swedish study that we will be talking about more ended up with a dire Conclusion:

This prospective cohort study shows that individuals who had obesity in childhood already have an increased risk of death by early adulthood, compared with a population-based comparison group. Among those who had obesity in childhood, 1 in 4 had obesity recorded as a cause of death. Identifying specific factors that may impact the risk of early mortality in individuals with obesity in childhood is important, to enable preventive actions and to promote long-term health.

Recently we spoke of the very high odds that any case of childhood obesity either co-exists with, or soon will co-exist with, a co-morbidity. Together, they add up to a whole that is more than the sum of its parts. The number of potential co-morbidities is quite large. They can affect the entire body or various parts and systems, and interact with obesity to the patient’s detriment:

• Brain — reduced executive functioning and working memory, increased impulsiveness, poor cognitive function
• Cancer — obesity has been linked to at least 13 types of malignancies
• Cardiovascular — problems including, but not limited to, essential hypertension, coronary artery disease, ventricular hypertrophy, venous varicosities, impaired microvascular function
• Central nervous system — decreased sympathetic nervous system responses, multiple sclerosis
• Cutaneous (skin) problems — intertrigo, acanthosis nigricans, hidradenitis suppurativa, hirsutism, increased risk for cellulitis, carbuncles
• Eyes — myopia, intraocular pressure
• Gastrointestinal — gall bladder disease, non-alcoholic steatohepatitis, fatty liver infiltration, reflux esophagitis
• Metabolic syndrome — diabetes, insulin resistance, systemic low-grade inflammation
• Orthopedic — bone damage, joint damage, defective cartilage, osteoarthritis, slipped capital femoral epiphyses, fractures, chronic lumbago, deformed feet, osteoarthritis
• Periodontal disease
• Psychological — anxiety, depression, addiction
• Reproductive, obstetric, perinatal — potential problems too numerous to mention here
• Respiratory — obstructive sleep apnea, increased predisposition to respiratory infections, increased incidence of bronchial asthma

Your responses and feedback are welcome!

Source: “Understanding The Health Conditions And Diseases Associated With Obesity,” NDTV.com, 01/17/21
Source: “Association of childhood obesity with risk of early all-cause and cause-specific mortality,” PLOS.org, 03/18/20
Image by Robert Sullivan/Public Domain

Let’s Talk More About Morbidity

“Threat multiplier” is a term that refers to something that needs to be taken into consideration when preparing for defense. A military installation might have a plan in place to protect the buildings, equipment, communications, and personnel. But climate change is a threat multiplier that needs to be also taken into consideration. What if a flash flood occurs? Both the attackers and the defenders had better give some thought to how their operations will be handled in case of an unexpected weather event.

In the same way, in conjunction with any number of disease processes, obesity is a threat multiplier. It works both ways, and while it has become fairly obvious how pre-existing obesity can negatively impact the treatment of many conditions in adulthood, not enough is known about problems in childhood (aside from overeating) that can contribute to obesity in the short term. As one group of researchers described the situation in a paper about the hip disorder, slipped capital femoral epiphysis,

Long-term outcomes of childhood obesity are well described; however, there is poor understanding of short-term outcomes that may cause early childhood disability.

When taken together with already existing obesity, many common conditions will function as threat multipliers. In many cases, the whole becomes more than the sum of its parts. Obesity alone needs A, B, and C in the management plan. Cancer alone needs D, E, and F. But for an obese patient who develops cancer, the treatment and management plans will probably need more than A, B, C, D, E, and F. When the patient’s life is threatened by more than one morbidity, the problems can become exponential.

For instance, there is extensive literature on the subject of anesthesia when an obese patient needs a surgical intervention. In 2012, bioengineering students at Rice University had to invent a device that used suction cups to hold up a patient’s abdominal fat so his lungs could expand and take in oxygen during surgery.

After interviewing heart surgeon and electrophysiologist Mehdi Razavi, journalist Brian Alexander wrote,

Medicine is struggling to make accommodations. Doctors often check blood pressure using cuffs meant for thighs… Surgical tools have to be enlarged in order to reach through layers of fat. Obese patients require higher doses of radiation during imaging tests like CT scans.

Some patients won’t fit into MRI scanners. Surgical tables have been redesigned to handle patients weighing up to 450 pounds. Needles for injections have made been longer so they can penetrate fat layers and reach muscles. Even lab test results have to be interpreted differently.

Dr. Razavi also pointed out that if a patient needs a higher dose of radiation to effectively perform a test, the doctors and other medical personnel are also exposed to higher doses, a risk factor they do not welcome.

Your responses and feedback are welcome!

Source: “Childhood Obesity and Slipped Capital Femoral Epiphysis,” PublicationsAAP.org, October 2018
Source: “Too fat for anesthesia? Suction cups hold up patients’ guts during surgery,” NBCNews.com, 05/10/12
Image by Presidencia de la República Mexicana/CC BY 2.0

Globesity and the Permacrisis

Back in 2014, The Lancet reported that despite raised awareness of global obesity, the numbers from 188 countries indicated that “no national success stories have been reported in the past 33 years,” and that urgent action and leadership would be needed.

A Commission on Ending Childhood Obesity was established to develop a set of recommendations. In 2016, the Commission’s final report noted that progress had been “slow and inconsistent” and called for the implementation of several recommendations, involving healthy foods, physical activity, preconception and pregnancy care, and weight management. It also said,

Driven by globalization and urbanization, exposure to unhealthy (obesogneic) environments is increasing in high-, middle- and low-income countries and across all socioeconomic groups. The marketing of unhealthy foods and non-alcoholic beverages was identified as a major factor in the increase in numbers of children being overweight and obese, particularly in the developing world.

Earlier this week Dr. Hans Henri P. Kluge, the World Health Organization’s Regional Director for Europe, summed up the current situation. He first noted that for at least a century, Europe has “grappled with multiple, momentous crises.” One feature of what some call the “permacrisis” is that its pace has been accelerating. Climate change brings catastrophic weather events, wildfires, unbearable heat, drought, desperate water shortages, crop failure, and hunger. Then, there are the wars, the most noticeable in recent months being the one in Ukraine.

Infectious diseases rampage through populations. Much as we might wish to forget about COVID-19, it has not forgotten us, and in fact, seems likely to become a permanent feature of the world health-scape. Then, there are monkeypox and polio. One effect of the COVID pandemic years has been the closure of, in some countries, up to 50% of HIV testing services.

Noncommunicable diseases are also destroying the health and ending the lives of millions of people, and among those morbidities Dr. Kluge names “cancer, heart disease, alcohol- and tobacco-related disease, and the epidemic of obesity.” He goes on to say,

One out of every four children in primary school in our region is living with overweight or obesity.

A ray of hope is that WHO is setting up a Pan-European Summit of First Ladies and First Gentlemen to tackle childhood obesity, whose first session will meet next year in Croatia. Dr. Kluge says of the whole permacrisis situation that it demands a dual-track response, as spelled out below:

On one hand, we must urgently prepare for health emergencies like pandemics, climate-related crises and conflicts. On the other hand, we must urgently strengthen our current health systems and essential services to address the permacrisis of noncommunicable diseases and HIV. One cannot be sacrificed for the other. It requires investment in the health workforce and mental health.

Your responses and feedback are welcome!

Source: “Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013,” TheLancet.com, 05/28/14
Source: “Commission presents its final report, calling for high-level action to address major health challenge,” WHO.int, 01/26/16
Source: “Statement: The European Region is in a ‘permacrisis’ that stretches well beyond the pandemic, climate change and war,” WHO.int. 09/17/22
Image by Sébastien Bertrand/CC BY 2.0