What is a weight-related comorbidity?

Obesity leads to a pro-inflammatory state [2]. What is a pro-inflammatory state? This means your body has chronic inflammation, leading to the continuous mobilization of immune cells [3,4]. When immune cells are activated for a long time, your immune system can become dysfunctional and damage healthy tissue [3,4]. This damage can lead to multiple chronic health conditions. The following are some examples of comorbidities related to obesity.

Cancer

Obesity increases the risk of esophageal, breast, liver, kidney, and colorectal cancers [5]. Obesity causes chronic inflammation, resulting in DNA damage. When DNA is damaged, the body cannot regulate cell growth properly, leading to tumor formation [5]. Having obesity doesn't mean you will develop cancer, but rather you have a greater chance of developing cancer.

Heart disease

Obesity is linked to multiple forms of heart disease, including coronary artery disease (CAD), myocardial infarctions (MIs), heart failure (HF), and atrial fibrillation (AF) [6,7]. Obesity occurs when an individual has a body mass index greater than 30 [8]. Aside from obesity, your waist circumference can impact your risk of heart disease independent of your BMI [6,7]. Your risk of heart disease increases if you are a man with a waist greater than 40 inches or if you are a woman with a waist greater than 35 inches [8].

High blood pressure

Obesity frequently leads to high blood pressure, which is often referred to as the "silent killer," as many people do not experience any symptoms [6,9]. The Framingham Heart Study found obesity leads to high blood pressure for 78% of men and 65% of women with obesity [9]. High blood pressure can lead to heart disease, including AF, which is the leading risk factor for strokes [6].

Obstructive sleep apnea (OSA)

Obesity can lead to a common sleeping disorder called obstructive sleep apnea (OSA). OSA occurs when your upper airway becomes blocked and is characterized by periods of oxygen deprivation (apnea) or a reduction in oxygen (hypopnea) [10-12]. The primary cause of OSA is obesity [12]. Multiple studies indicate weight loss can improve OSA [10,12].

Type 2 diabetes (T2DM)

Approximately 90% of people with obesity also have Type 2 diabetes (T2DM) [14]. T2DM causes elevated blood sugar levels and insulin resistance [15,16]. Adipose (fat) cells secrete nonesterified fatty acids (NEFAs), which are elevated in people with obesity and T2DM [16].

Other comorbidities

Along with the conditions discussed above, weight-related comorbidities include [16]:

• Hypertriglyceridemia
• Nonalcoholic fatty liver disease
• Hypercholesterolemia
• Gastroesophageal reflux disease
• Decreased HDL cholesterol
• Male hypogonadism
• Osteoarthritis
• Female infertility
• Depression
• Polycystic ovary disease
• Stress urinary incontinence

• Body mass index (BMI): The higher your BMI, the greater your risk of comorbidities [8]. However, an elevated BMI doesn't always correlate with increased disease risk. Muscular athletes may have an overestimated BMI, while older patients who have lost muscle may have an underestimated BMI [8].
• Waist Circumference: Your BMI is not the only measurement of your risk of a weight-related comorbidity. The way you carry adipose cells also impacts your risk. Individuals who carry more adipose cells around their waist (central adiposity) are more likely to experience weight-related comorbidities [8].
• Genetics: Genes impact how you carry adipose cells [16]. Your waist circumference is partially attributed to your genetics, in addition to lifestyle choices and hormones [16]. The amount of adipose tissue around your waist increases your risk of heart disease and T2DM [8]. Additionally, multiple gene alterations are linked to an increased risk of obesity [10].
• Physical Activity: Obesity and maintaining a sedentary lifestyle can significantly increase your risk of weight-related comorbidities [10].
• Diet: A diet high in processed foods and sugar-sweetened beverages (SSBs) is associated with a greater risk of obesity and, consequently, diseases attributed to excess weight. Making home-cooked meals may decrease your risk of obesity [17].

The primary treatment of weight-related comorbidities is lifestyle modification. Weight management programs can assist you with lifestyle modifications and determine if you need additional treatments such as medication or surgery.

• Weight management programs: In our digital world, you have many options for weight management programs. Synchronous telehealth visits and apps are two options for weight management.
• Lifestyle: Increasing your daily physical activity and incorporating more plant-based foods into your diet are two ways to decrease your risk of weight-related comorbidities.
• Medications: GLP-1s are a class of medications indicated for T2DM and obesity [18]. GLP-1s are only available through a healthcare provider, who will review your health history to determine if you are eligible for medication.
• Surgery: Surgery is considered the last option if other interventions are unsuccessful. Bariatric surgery is the primary type of weight loss surgery for patients with obesity.

Everlywell's weight management program provides clinical support and medication to help you lose weight and reduce your risk for long-term health issues. During your virtual care visit, your healthcare provider will create a customized plan for you to achieve your weight goals. While medication is available for weight management, not everyone is eligible for medication, and prescriptions are based on your healthcare provider's clinical judgment. Speak with your healthcare provider to determine the best options for you.

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