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The Tea on the Science of Obesity



I am excited to share this episode with you on a topic that’s near and dear to me.


Today, I’ll be spilling the tea on the science of Obesity and why it is indeed a chronic disease. I completed my fellowship training in Obesity Medicine about 4 years ago. This emerging field has always been of personal interest to me and my family; and being someone who is a reader, researcher, and scientist at heart, I wanted to know and learn more.


–Statistics

In the United States, the weight loss market is a billion-dollar industry. It is estimated that 45 million Americans start some form of diet plan each year and that in 2021 Americans spent over 70 billion dollars on weight loss products.


However, it is still reported that nearly 2/3rds of Americans fall into an overweight or obese body mass index category.


Now, let’s break this statistic down further with data from the United States Department of Health and Human Services.

Nearly 1 in 3 adults (30.7%) are overweight.

More than 1 in 3 men (34.1%) and more than 1 in 4 women (27.5%) are overweight.

More than 2 in 5 adults (42.4%) have obesity (including severe obesity).

About 1 in 11 adults (9.2%) have severe obesity.

The percentage of men who are overweight (34.1%) is higher than the percentage of women who are overweight (27.5%).

The percentage of women who have severe obesity (11.5%) is higher than the percentage of men who have severe obesity (6.9%).


Among adults ages 20 and over, there are no significant differences in the prevalence of obesity by sex or age group. This tells us that regardless of gender or age, the high prevalence of obesity is across the board.


More than 2 in 5 non-Hispanic white adults (42.2%) have obesity.

Nearly 1 in 2 non-Hispanic Black adults (49.6%) have obesity.

More than 1 in 6 non-Hispanic Asian adults (17.4%) have obesity.

Nearly 1 in 2 Hispanic adults (44.8%) have obesity.

Obesity affects more than 2 in 5 non-Hispanic white men (44.7%), more than 2 in 5 non-Hispanic Black men (41.1%), more than 1 in 6 non-Hispanic Asian men (17.5%), and more than 2 in 5 Hispanic men (45.7%).

Nearly 2 in 5 non-Hispanic white women (39.8%), more than half of non-Hispanic Black women (56.9%), more than 1 in 6 non-Hispanic Asian women (17.2%), and more than 2 in 5 Hispanic women (43.7%), have obesity.


And some other interesting findings from the Centers for Disease Control and Prevention, CDC, showed that “Fewer than 1 in 10 children and adults eat the recommended daily amount of vegetables.”; Just 1 in 4 adults meet the recommended physical activity guidelines of 30 minutes of moderate to vigorous exercise on 5 days per week and 2 days of strength training.


So this shows us that lack of quality dietary intake and lack of sufficient movement is certainly playing a role here.


–Science of Obesity

However, let’s talk about the science of Obesity. As we previously discussed, Obesity is classified as having a body mass index or BMI greater than 30.

Obesity is further broken down into classes.

Class 1 Obesity is having a BMI of 30 to 34.9. Class 2 Obesity is having a BMI of 35 to 39.9.

Class 3 Obesity is having a BMI of 40 or higher. Class 3 obesity is sometimes categorized as “severe” obesity for purposes of insurance, risk factor stratification, and qualification for certain medications and procedures.


In episode 2 of the Essence of Health Tea Time Podcast titled “The Tea About Why The Scale Is Not Your Friend,” I discussed some of the pitfalls of BMI and a variety of other ways that can be used to determine the actual health of an individual. However, for today’s discussion and since much of the language surrounding the disease of Obesity is BMI based; we’ll be using BMI for the classification of this disease.


Obesity is a chronic, manageable, health condition that is caused by a variety of contributing factors. It can be challenging to treat and manage because it is far more complex than diet and willpower alone.


The Obesity Medicine Association has formally defined obesity as:

“A chronic, progressive, relapsing, and treatable multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”


The CDC has released data showing that “More than half of Americans don’t live within half a mile of a park.” “40% of all US households do not live within 1 mile of healthier food retailers.”


Some of the causes of Obesity include genetics, psychological factors, socioeconomic factors, environmental factors, sleep disruption, appetite dysregulation, chronic stress, hormonal imbalance, and prescription medications. People do not choose to have Obesity so let’s put that thought to rest right now.


Drug manufacturers have been hard at work on providing medication options to help combat obesity. And we will certainly delve into these available options in a future episode.


But first, we must understand the science; the how and why of Obesity. So let’s explore just 3 of the causes that may contribute to the development of Obesity.


–Genetics:

Let’s start by discussing the genetic factor. Scientists have identified variants in several genes that may contribute to obesity by increasing hunger and food intake. This factor alone was found to be a significant contributing factor to obesity in 5-10% of individuals with Obesity.


Regarding the category of severe obesity, rare disorders including Leptin Deficiency, POMC Deficiency, and MC4R Deficiency have been found to be genetic contributors to this category of Obesity.


Let’s discuss the why here. For example, when the MC4R, or melanocortin 4 receptor, is deficient or not working properly, affected children feel extremely hungry and become obese because of consistent overeating.

In these instances or rare disorders like Leptin Deficiency, POMC Deficiency, and MC4R Deficiency, individuals are typically diagnosed with severe obesity before the age of 2 years old and have extreme difficulty with regulating their appetite, feeling excessively hungry, and frequently overeating. MC4R has been identified in less than 5% of individuals with obesity in various ethnic groups.


The study of identifying genetic markers that contribute to obesity and utilizing these findings to bring about change through medication therapy or through other modalities is still very new and emerging.


Now, I don’t present the genetic factors of Obesity to give any of us a pass (if you will) to not improve our health because as I previously stated, 1) this field is still emerging; 2) so far our familial genes alone only seem to contribute to some of obesity not all; and 3) we know that weight loss is still possible even when genetic factors are involved.


In most people with obesity, no single genetic cause can be identified. Most obesity seems to be multifactorial, meaning it is the result of complex interactions among many genes and environmental factors.


An article published in 2018 on the Obesity Medicine Association website revealed that “people who have obesity have multiple genes that predispose them to gain excess weight. One such gene is the fat mass and obesity-associated or FTO gene, which is found in up to 43% of the population.”


The FTO gene if present within your genetic makeup has been shown to present challenges within the individual in regulating their caloric intake by increasing hunger; decreasing the ability to feel full; having less control over when to start and stop eating; having an increased tendency to be sluggish; and have an increased tendency to store body fat.


So now that we have some of this information, what do we do about it?


We don’t typically test for these genetic factors, especially not in adults, because the treatment will still be the same; to work on developing a sustainable nutrition plan for food consumption; be mindful of adding movement in the form of exercise into your regular weekly routine; and being mindful of the mental health aspects that may be playing a part in your weight gain and overall health.


–Psychological Factors:

With that in mind, let’s pivot to the psychological factors that contribute to Obesity. Studies have shown a strong correlation between obesity and depression. Depression can contribute to obesity by changing your eating and physical activity habits; as well as being a result of obesity.


Mental stress is another psychological factor that contributes to Obesity. The effects of mental stress increase inflammation within the body; affects one’s ability to gain quality sleep; affect one’s ability to focus and concentrate thereby affecting one’s ability to be mindful of the type of food they may be consuming. Mental stress also physically affects the body by upsetting the balance of one’s immune system, hormones, and metabolism thereby contributing to obesity.


One article I recently reviewed pointed out that “individuals experiencing chronic mental stress may find the sources of their stress, for example, their work, their family,” or other pressing issues, overtake their nutritional and physical activity-related goals and lead to impairment of self-regulation with regards to the food they are consuming.


This is also another example of the “double-edged sword” phenomenon of obesity, much like we talked about with the correlation between depression and obesity; Stress can contribute to mental and physical changes that increase an individual’s risk for Obesity; and chronic stress can be a result of having Obesity.


There are certain portions of our brain that help us to regulate our food consumption and feelings of hunger and feelings of satiety or the ability to feel full. If these portions of the brain are affected or not functioning at their best, then this psychological factor may also contribute to obesity.


There are additional psychological disorders related to Obesity. Studies have shown a link between untreated Attention Deficit Hyperactivity Disorder (ADHD) and obesity. Some components of ADHD include inattentiveness which can contribute to initially skipping meals or not being mindful of the food you are consuming; impulsivity which may present as the sudden craving and need to consume food, particularly unhealthy foods; and ADHD has been shown to affect one’s ability to achieve quality sleep in some individuals which in turn can contribute to the sleep related and stress related factors of obesity.


Binge Eating Disorder is another particular type of psychological condition that can contribute to an individual developing obesity. The National Eating Disorders Association states that Binge Eating Disorder is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress, or guilt afterward; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.


Now here’s some sobering tea from the National Institutes of Health, NIH. “Binge eating disorder is the most common eating disorder in the United States, and it affects people of all racial and ethnic groups.”


“About 1.25% of adult women and 0.42% of adult men have binge eating disorder.”

“About 1.6% of teens age 13 to 18 years old are affected by binge eating disorder.”

And, “The average age at which binge eating disorder first occurs is 25 years old.”


Not everyone who enjoys eating has Binge Eating Disorder, however, there are definitive criteria that your doctor can use to determine if this disorder may be contributing to your condition of Obesity.


–Environmental Factors:

Next, let’s chat about the environmental factors that contribute to Obesity. Reality is; in America, there are neighborhoods, cities, states, and generations of families with insufficient access to quality food, healthy food, safe places to exercise, and safe places to rest and get quality sleep. These are all environmental factors that contribute to Obesity, especially amongst disenfranchised and minority populations.


Geographically states within the south and midwest have the highest rates of obesity and are also the same states with the highest rates of metabolic syndrome and other associated chronic diseases that accompany severe obesity.


Studies have shown that there are higher rates of obesity within low socioeconomic status groups. High-calorie, prepared foods are frequently found with ease in communities of low socioeconomic status which contributes to poor dietary consumption and increased rates of Obesity.


Areas with higher crime rates have also been associated with higher rates of Obesity. Higher crime rate areas typically lack safe spaces for outdoor exercise for both children and adults. One study showed that people living in areas of high crime have a 28% less chance of achieving adequate levels of exercise activity.


Rural areas also have higher rates of obesity due to these areas tending to have farther distances between homes and supermarkets, less access to healthcare, and fewer recreational opportunities available, which affects an individual’s ability to practice healthy behaviors that prevent the effects of obesity. Comparatively urban areas with walking friendly and cycling friendly zones, these areas have been shown to have healthier populations.


Another environmental factor that can contribute to Obesity is one’s work environment. Many individuals gained weight at the height of the COVID-19 pandemic due to more people working from home and not experiencing the daily movement of getting ready for work, walking around the office, and busying themselves with different locations within their office building for meetings. Overall, more of our jobs have become more sedentary requiring one to sit for long periods of time in front of a computer. While technology has enhanced many things in our lives, the convenience of technology can also contribute to expanding our waistlines and increasing rates of Obesity.


So as you can see, there is nothing simple about the condition of Obesity. In most instances there are a variety of contributing factors, so being knowledgeable of one’s risk and mindful of the action steps you need to take to reduce your risk, is key in combating this complex condition.


This brings us to the discussion of weight loss.


–Weight Loss Medications

These statistics are provided to us from a 2022 article titled “Anti-Obesity Medications and Investigational Agents: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022” which was published in the journal Obesity Pillars.


Studies have shown that even a 2.5% reduction in one’s weight can improve your blood sugar, decreasing risk for diabetes; improve your triglyceride levels, reducing your risk for fatty liver disease; and improve polycystic ovarian syndrome or PCOS, thereby reducing your risk for infertility complications.


A 5% reduction in one’s weight has been shown to improve one’s overall Quality-of-Life, reduce depression; improve one’s mobility, improve knee functionality reduce knee pain related to osteoarthritis; reduce complications of fatty liver disease; improve urinary incontinence; improve sexual function; Increase in high-density lipoprotein (HDL), “good” cholesterol level; and reduce one’s overall health care costs.


A 10% reduction in one’s weight has been shown to improve sleep apnea and have even greater improvement in fatty liver disease.


And a weight reduction of over 16% was shown to potentially reduce one’s risk for heart disease and reduce one’s overall risk of death related to complications of obesity.


What these statistics and facts tell us is that the focus here is and should be health versus disease and is far more complex and important than the numbers on the scale when it comes to the disease of Obesity.


One of the many reasons The Essence of Health Coaching Program is 12 months long is because it takes time to make sustainable change in a holistic manner as this program provides.


Another 2022 article titled “Thirty Obesity Myths, Misunderstandings, and/or Oversimplifications: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022”, also published in the journal Obesity Pillars noted that “many current non-surgical weight reduction interventions net an average of about 10% to 15% initial weight reduction from initial body weight, often with only about 50% of the weight reduction maintained after one year. It goes on to state that “Successful weight reduction maintenance usually requires a combination of interventions required for initial weight reduction including Appropriate nutrition, Routine physical activity, Behavior training, and When appropriate, initiation or continuation of anti-obesity medication therapy and/or consideration of bariatric surgery.” So a 1-year program with ongoing tools for sustainable change is truly what’s necessary for success.


Now, over the few past years, there has been incredible excitement within the Obesity Medicine community with the introduction of new medications being developed to give individuals promise in treating the disease of Obesity. Stay tuned to future episodes of the Essence of Health Tea Time Podcast as we discuss the details of the medication options available to treat obesity.


Now, let’s move to our Ask The Expert segment of the podcast.


Today’s Ask The Expert question is


–Ask The Expert - “Is it true that drinking water can help you to lose weight?” This is a common question that I encounter in the weight loss world so let me get you this fluid-filled, hydrating tea.


Yes, water can help you to lose weight. Here’s why: 1) water is a zero-calorie beverage so it doesn’t require any energy to burn it off; 2) water increases one’s ability to feel full thereby preventing overeating; and 3) studies have shown that water can reduce fat storage by increasing the body’s ability to breakdown fat.


One should aim to consume at least 64 ounces of water per day. This should be plain water and not water that is added to prepackaged juices and sodas. You can also boost your hydration with hydrating foods like watermelon, dark leafy greens, apples, oranges, peppers, and celery.


Ultimately, you should discuss your daily water intake with your doctor as there are some detrimental health conditions that can be caused by excessive water intake; and there are some health conditions where one should drink LESS than the average recommended intake of 64 ounces per day.


But yes, adequate hydration is one key to a healthy weight.


The Essence of Health is in You!



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