Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight by the square of the person's height, is over , with the range defined as overweight. Some East Asian countries use lower values. Obesity increases the likelihood of various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis and depression.
Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity, and genetic susceptibility. A few cases are caused primarily by genes, endocrine disorders, medications, or mental disorder. The view that obese people eat little yet gain weight due to a slow metabolism is not generally supported. On average, obese people have a greater energy expenditure than their normal counterparts due to the energy required to maintain an increased body mass.
Obesity is mostly preventable through a combination of social changes and personal choices. Changes to diet and exercising are the main treatments. Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat and sugars, and by increasing the intake of dietary fiber. Medications may be used, along with a suitable diet, to reduce appetite or decrease fat absorption. If diet, exercise, and medication are not effective, a gastric balloon or surgery may be performed to reduce stomach volume or length of the intestines, leading to feeling full earlier or a reduced ability to absorb nutrients from food.
Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children. In 2015, 600 million adults (12%) and 100 million children were obese. Obesity is more common in women than men. Authorities view it as one of the most serious public health problems of the 21st century. Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was seen as a symbol of wealth and fertility at other times in history and still is in some parts of the world. In 2013, the American Medical Association classified obesity as a disease.
Abdominal obesity, also known as central obesity, is when excessive abdominal fat around the stomach and abdomen has built up to the extent that it is likely to have a negative impact on health. There is a strong correlation between central obesity and cardiovascular disease. Abdominal obesity is not confined only to the elderly and obese subjects. Abdominal obesity has been linked to Alzheimer's disease as well as other metabolic and vascular diseases.
Visceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes.
Visceral fat, also known as organ fat or "intra-abdominal fat", is located inside the peritoneal cavity, packed in between internal organs and torso, as opposed to subcutaneous fat, which is found underneath the skin, and intramuscular fat, which is found interspersed in skeletal muscle. Visceral fat is composed of several adipose depots including mesenteric, epididymal white adipose tissue (EWAT) and perirenal fat. An excess of visceral fat is known as central obesity, the "pot belly" or "beer belly" effect, in which the abdomen protrudes excessively. This body type is also known as "apple shaped", as opposed to "pear shaped", in which fat is deposited on the hips and buttocks.
Researchers first started to focus on abdominal obesity in the 1980s when they realized it had an important connection to cardiovascular disease, diabetes, and dyslipidemia. Abdominal obesity was more closely related with metabolic dysfunctions connected with cardiovascular disease than was general obesity. In the late 1980s and early 1990s insightful and powerful imaging techniques were discovered that would further help advance the understanding of the health risks associated with body fat accumulation. Techniques such as computed tomography and magnetic resonance imaging made it possible to categorize mass of adipose tissue located at the abdominal level into intra-abdominal fat and subcutaneous fat.
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. It is defined by body mass index (BMI) and further evaluated in terms of fat distribution via the waist–hip ratio and total cardiovascular risk factors. BMI is closely related to both percentage body fat and total body fat.
In children, a healthy weight varies with age and sex. Obesity in children and adolescents is defined not as an absolute number but in relation to a historical normal group, such that obesity is a BMI greater than the 95th percentile. The reference data on which these percentiles were based date from 1963 to 1994, and thus have not been affected by the recent increases in weight. BMI is defined as the subject's weight divided by the square of their height and is calculated as follows.
BMI is usually expressed in kilograms per square metre, resulting when weight is measured in kilograms and height in metres. To convert from pounds per square inch multiply by .
The most commonly used definitions, established by the World Health Organization (WHO) in 1997 and published in 2000, provide the values listed in the table.
Some modifications to the WHO definitions have been made by particular organizations. The surgical literature breaks down class II and III obesity into further categories whose exact values are still disputed.
- Any BMI ≥ 35 or 40 kg/m is "severe obesity".
- A BMI of ≥ 35 kg/m and experiencing obesity-related health conditions or ≥40–44.9 kg/m is "morbid obesity".
- A BMI of ≥ 45 or 50 kg/m is "super obesity".
As Asian populations develop negative health consequences at a lower BMI than Caucasians, some nations have redefined obesity; Japan have defined obesity as any BMI greater than 25 kg/m while China uses a BMI of greater than 28 kg/m.
The degree to which a person is overweight is generally described by the body mass index (BMI). "Overweight" is defined as a BMI of 25 or more, thus it includes pre-obesity defined as a BMI between 25 and 30 and obesity as defined by a BMI of 30 or more. Pre-obese and overweight however are often used interchangeably, thus giving overweight a common definition of a BMI of between 25–30. There are, however, several other common ways to measure the amount of adiposity or fat present in an individual's body.
- Body mass index
- Body volume index
- Simple weighing
- Skinfold calipers or "pinch test"
- Bioelectrical impedance analysis
- Hydrostatic weighing
- Dual-energy X-ray absorptiometry (DEXA)
The most common method for discussing this subject and the one used primarily by researchers and advisory institutions is BMI. Definitions of what is considered overweight vary by ethnicity. The current definition proposed by the US National Institutes of Health (NIH) and the World Health Organization (WHO) designates whites, Hispanics and blacks with a BMI of 25 or more as overweight. For Asians, overweight is a BMI between 23 and 29.9 and obesity for all groups is a BMI of 30 or more.
BMI, however, does not account extremes of muscle mass, some rare genetic factors, the very young, and a few other individual variations. Thus it is possible for an individuals with a BMI of less than 25 to have excess body fat, while others may have a BMI that is significantly higher without falling into this category. Some of the above methods for determining body fat are more accurate than BMI but come with added complexity.
If an individual is overweight and has excess body fat it can create or lead to health risks. Reports are surfacing, however, that being mildly overweight to slightly obese – BMI being between 24 and 31.9 – may be actually beneficial and that people with a BMI between 24 and 31.9 could actually live longer than normal weight or underweight persons.
The body mass index (BMI) does not capture information about percentage body fat (PBF), which is a better predictor of risk due to obesity.
The term "metabolically obese normal weight" (MONW) refers to people with normal weight and BMI, but who display some metabolic characteristics that may increase the risk of developing metabolic syndrome, in the same way as obesity. MONW subjects have excess visceral fat, and are predisposed to insulin resistance, hypertension and cardiovascular disease. These people show benefits from energy restriction and weight loss, for example a 4- to 12-week period of diet and exercise.
Some studies have suggested that the main factor which explains the metabolic abnormalities in MONW individuals is fat distribution. On the basis of these studies, a scoring method has been proposed to identify MONW individuals, based on the presence of associated diseases or biochemical abnormalities related to insulin resistance.
Being overweight is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary.
Excess weight has reached epidemic proportions globally, with more than 1 billion adults being either overweight or obese in 2003. In 2013 this increased to more than 2 billion. Increases have been observed across all age groups.
A healthy body requires a minimum amount of fat for proper functioning of the hormonal, reproductive, and immune systems, as thermal insulation, as shock absorption for sensitive areas, and as energy for future use. But the accumulation of too much storage fat can impair movement, flexibility, and alter the appearance of the body.
Body mass index (BMI) is acceptable for determining obesity for children two years of age and older. It is determined by the ratio of weight to height.
The normal range for BMI in children vary with age and sex. While a BMI above the 85th percentile is defined as overweight, a BMI greater than or equal to the 95th percentile is defined as obesity by Centers for Disease Control and Prevention. It has published tables for determining this in children.
The US Preventive Service Task Force reported that not all children with a high BMI need to lose weight though. High BMI can identify a possible weight problem, but does not differentiate between fat or lean tissue. Additionally, BMI may mistakenly rule out some children who do have excess adipose tissue. It is therefore beneficial to supplement the reliability of a BMI diagnosis with additional screening tools such as adipose tissue or skin fold measurements.
Obesity in pets occurs when excessive adipose tissue accumulates in the body, and is generally defined as occurring when an animal's body weight is at least 20% greater than its optimal body weight. Obesity is associated with metabolic and hormonal changes.
Normal weight obesity is the condition of having normal body weight, but with a high body fat percentage, leading to some of the same health risks as obesity.
The first problems to occur in obese children are usually emotional or psychological. Obese children often experience bullying by their peers. Some are harassed or discriminated against by their own family. Stereotypes abound and may lead to low self-esteem and depression.
Central obesity is associated with a statistically higher risk of heart disease, hypertension, insulin resistance, and Diabetes Mellitus Type 2 (see below). With an increase in the waist to hip ratio and overall waist circumference the risk of death increases as well. Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance, full-blown diabetes, and increased risk of developing cardiovascular disease. It is now generally believed that intra-abdominal fat is the depot that conveys the biggest health risk.
Central obesity can be a feature of lipodystrophies, a group of diseases that is either inherited, or due to secondary causes (often protease inhibitors, a group of medications against AIDS). Central obesity is a symptom of Cushing's syndrome and is also common in patients with polycystic ovary syndrome (PCOS). Central obesity is associated with glucose intolerance and dyslipidemia. Once dyslipidemia becomes a severe problem, an individual's abdominal cavity would generate elevated free fatty acid flux to the liver. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.
Recent validation has concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and BVI calculations correlate significantly with all biomarkers of cardio-vascular risk.
Ghroubi et al. (2007) examined whether abdominal circumference is a more reliable indicator than BMI of the presence of knee osteoarthritis in obese patients. They found that it actually appears to be a factor linked with the presence of knee pain as well as osteoarthritis in obese study subjects. Ghroubi et al. (2007) concluded that a high abdominal circumference is associated with great functional repercussion.
Weight gain will occur when an animal is in a positive energy balance, meaning energy provided as calories in the diet exceed calories expended. Evidence suggests that middle-aged cats and dogs, especially those between the ages of 5 and 10, may be at an increased risk of obesity. This is supported by studies showing that as cats age from 2 years to approximately 11.5 years of age their energy requirements decreased. Weight gain will occur if calories from the diet do not decrease with the animal’s energy requirements.
Obesity in pets is usually due to excessive food intake or lack of physical exercise. Owners may view food as a way to reward and treat their pets, which contributes to overfeeding. Pets confined to a house or small yard which are not regularly exercised are more prone to obesity.
The risk of obesity in dogs (but not in cats) is related to whether or not their owners are obese.
In cats, neutering increases the risk of obesity, partly because the alteration in sex hormones after neutering lowers the basal metabolic rate, and partly because neutered cats have a reduced inclination to roam compared to non-neutered cats.
Unintentional weight loss may result from loss of body fats, loss of body fluids, muscle atrophy, or even a combination of these. It is generally regarded as a medical problem when at least 10% of a person's body weight has been lost in six months or 5% in the last month. Another criterion used for assessing weight that is too low is the body mass index (BMI). However, even lesser amounts of weight loss can be a cause for serious concern in a frail elderly person.
Unintentional weight loss can occur because of an inadequately nutritious diet relative to a person's energy needs (generally called malnutrition). Disease processes, changes in metabolism, hormonal changes, medications or other treatments, disease- or treatment-related dietary changes, or reduced appetite associated with a disease or treatment can also cause unintentional weight loss. Poor nutrient utilization can lead to weight loss, and can be caused by fistulae in the gastrointestinal tract, diarrhea, drug-nutrient interaction, enzyme depletion and muscle atrophy.
Continuing weight loss may deteriorate into wasting, a vaguely defined condition called cachexia. Cachexia differs from starvation in part because it involves a systemic inflammatory response. It is associated with poorer outcomes. In the advanced stages of progressive disease, metabolism can change so that they lose weight even when they are getting what is normally regarded as adequate nutrition and the body cannot compensate. This leads to a condition called anorexia cachexia syndrome (ACS) and additional nutrition or supplementation is unlikely to help. Symptoms of weight loss from ACS include severe weight loss from muscle rather than body fat, loss of appetite and feeling full after eating small amounts, nausea, anemia, weakness and fatigue.
Serious weight loss may reduce quality of life, impair treatment effectiveness or recovery, worsen disease processes and be a risk factor for high mortality rates. Malnutrition can affect every function of the human body, from the cells to the most complex body functions, including:
- immune response;
- wound healing;
- muscle strength (including respiratory muscles);
- renal capacity and depletion leading to water and electrolyte disturbances;
- thermoregulation; and
- menstruation.
In addition, malnutrition can lead to vitamin and other deficiencies and to inactivity, which in turn may pre-dispose to other problems, such as pressure sores.
Unintentional weight loss can be the characteristic leading to diagnosis of diseases such as cancer and type 1 diabetes.
In the UK, up to 5% of the general population is underweight, but more than 10% of those with lung or gastrointestinal diseases and who have recently had surgery. According to data in the UK using the Malnutrition Universal Screening Tool ('MUST'), which incorporates unintentional weight loss, more than 10% of the population over the age of 65 is at risk of malnutrition. A high proportion (10-60%) of hospital patients are also at risk, along with a similar proportion in care homes.
Disease-related malnutrition can be considered in four categories:
Weight loss issues related to specific diseases include:
- As chronic obstructive pulmonary disease (COPD) advances, about 35% of patients experience severe weight loss called pulmonary cachexia, including diminished muscle mass. Around 25% experience moderate to severe weight loss, and most others have some weight loss. Greater weight loss is associated with poorer prognosis. Theories about contributing factors include appetite loss related to reduced activity, additional energy required for breathing, and the difficulty of eating with dyspnea (labored breathing).
- Cancer, a very common and sometimes fatal cause of unexplained (idiopathic) weight loss. About one-third of unintentional weight loss cases are secondary to malignancy. Cancers to suspect in patients with unexplained weight loss include gastrointestinal, prostate, hepatobilary (hepatocellular carcinoma, pancreatic cancer), ovarian, hematologic or lung malignancies.
- People with HIV often experience weight loss, and it is associated with poorer outcomes. Wasting syndrome is an AIDS-defining condition.
- Gastrointestinal disorders are another common cause of unexplained weight loss – in fact they are the most common non-cancerous cause of idiopathic weight loss. Possible gastrointestinal etiologies of unexplained weight loss include: celiac disease, peptic ulcer disease, inflammatory bowel disease (crohn's disease and ulcerative colitis), pancreatitis, gastritis, diarrhea and many other GI conditions.
- Infection. Some infectious diseases can cause weight loss. Fungal illnesses, endocarditis, many parasitic diseases, AIDS, and some other subacute or occult infections may cause weight loss.
- Renal disease. Patients who have uremia often have poor or absent appetite, vomiting and nausea. This can cause weight loss.
- Cardiac disease. Cardiovascular disease, especially congestive heart failure, may cause unexplained weight loss.
- Connective tissue disease
- Neurologic disease, including dementia
- Oral, taste or dental problems (including infections) can reduce nutrient intake leading to weight loss.
Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country's population. India is following a trend of other developing countries that are steadily becoming more obese. Unhealthy, processed food has become much more accessible following India's continued integration in global food markets. This, combined with rising middle class incomes, is increasing the average caloric intake per individual among the middle class and above income households. Obesity is a major risk factor for cardiovascular disease, NGOs such as the Indian Heart Association have been raising awareness about this issue.
While studying 22 different SNPs near to MC-R gene, scientists have identified a SNP (single nucleotide polymorphism) named rs12970134 to be mostly associated with waist circumference. In this study more than two thousand individuals of Indian origin participated and the aforementioned SNP is highly prevalent in this group.
Internationally, a BMI over 25 kg/m2 is considered overweight. Due to genetic tendency of Indians towards abdominal obesity and its associated risk of related lifestyle diseases like Diabetes & Heart Disease, Guidelines for diagnosis of obesity and abdominal obesity for India have been published in JAPI (2009) that a BMI over 23 kg/m2 is considered overweight. Further definitions: Normal BMI: 18.0-22.9 kg/m2, Overweight: 23.0-24.9 kg/m2, Obesity: >25 kg/m2.
The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss. Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue. Many people, however, have no symptoms during the first few years and are diagnosed on routine testing. A small number of people with type 2 diabetes mellitus can develop a hyperosmolar hyperglycemic state (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).
Obesity has been observed throughout human history. Many early depictions of the human form in art and sculpture appear obese. However, it was not until the 20th century that obesity became common — so much so that, in 1997, the World Health Organization (WHO) formally recognized obesity as a global epidemic. Obesity is defined as having a body mass index (BMI) greater than or equal to 30 kg/m, and in June 2013 the American Medical Association classified it as a disease, with much controversy.
In countries of the Organisation for Economic Co-operation and Development (OECD), one child out of five is overweight or obese. Once considered a problem only of high-income countries, obesity rates are rising worldwide. Globally, there are now more people who are obese than who are underweight, a trend observed in every region over the world except parts of sub-Saharan Africa and Asia. In 2013, an estimated 2.1 billion adults were overweight, as compared with 857 million in 1980. Of adults who are overweight, 31% are obese. Increases in obesity have been seen most in urban settings.
Since body fat can be measured in several ways, statistics on the epidemiology of obesity vary between sources. While BMI is the most basic and commonly used indicator of obesity, other measures include waist circumference, waist-to-hip ratio, skinfold thicknesses, and bioelectrical impedance. The rate of obesity increases with age at least up to 50 or 60 years old.
The OECD notes that — given the health, economic, and social consequences of obesity — many countries have built multi-stakeholder networks involving civil society and the business sector in order to devise appropriate public health policies and solutions for obesity prevention.
Lack of exercise along with sugar-sweetened foods and drinks have caused one out of six five-year-olds in Sweden to be overweight or obese. The breakdown is 12.9% of children are considered overweight and 4.3% are considered obese.
Like many other medical conditions, obesity is the result of an interplay between environmental and genetic factors. Studies have identified variants in several genes that may contribute to weight gain and body fat distribution; although, only in a few cases are genes the primary cause of obesity.
Polymorphisms in various genes controlling appetite and metabolism predispose to obesity under certain dietary conditions. The percentage of obesity that can be attributed to genetics varies widely, depending on the population examined, from 6% to 85%. As of 2006, more than 41 sites on the human genome have been linked to the development of obesity when a favorable environment is present. The involvement of genetic factors in the development of obesity is estimated to be 40–70%. Some of these obesogenic or leptogenic genes may influence obese individuals response to weight loss or weight management.
Obesity in Canada is a growing health concern, which is "expected to surpass smoking as the leading cause of preventable morbidity and mortality … and represents a burden of Can$3.96 (US$3.04/€2.75) billion on the Canadian economy each year."
There are often no visible symptoms of hyperinsulinemia unless hypoglycaemia (low blood sugar) is present.
Some patients may experience a variety of symptoms when hypoglycaemia is present, including:
- Temporary muscle weakness
- Brain fog
- Fatigue
- Temporary thought disorder, or inability to concentrate
- Visual problems such as blurred vision or double vision
- Headaches
- Shaking/Trembling
- Thirst
If a person experiences any of these symptoms, a visit to a qualified medical practitioner is advised, and diagnostic blood testing may be required.
The percentage of overweight Ukrainians is at 53% of the population and the percentage of Ukrainians who meet the definition of obese is 20%. Statistics show that Ukrainians continue to gain weight. Doctors claim that the regions with the ""thickest Ukrainians"" are Donetsk and Poltava regions. Crimea is considered ""the most slender region of the country"" The percentage of overweight people in Crimea is 49,7% and the percentage of people who meet the definition of obesity is 12,3%.
Maternal obesity refers to obesity (often including being overweight) of a woman during pregnancy. Parental obesity refers to obesity of either parent during pregnancy.
Maternal obesity has a significant impact on maternal metabolism and offspring development. Insulin resistance, glucose homeostasis, fat oxidation and amino acid synthesis are all disrupted by maternal obesity and contribute to adverse outcomes. Modification of lifestyle is an effective intervention strategy for improvement of maternal metabolism and the prevention of adverse outcomes.
Obesity is defined as having a Body Mass Index (BMI) of 30 or greater. A 5-foot-5-inch tall woman would be considered obese if she weighs 180 pounds or more and a 5-foot-8-inch tall woman would be considered obese if she weighs 200 pounds or more.
Obesity in Mexico is a relatively recent phenomenon, having been widespread since the 1980s with the introduction of processed food into much of the Mexican food market. Prior to that, dietary issues were limited to under and malnutrition, which is still a problem in various parts of the country. Following trends already ongoing in other parts of the world, Mexicans have been foregoing traditional whole grains and vegetables in favor of a diet with more animal products, more fat, and more sugar much of which is a consequence of processed food. It has seen dietary energy intake and rates of overweight and obese people rise with seven out of ten at least overweight and a third clinically obese.
Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life expectancy. This is partly due to a number of complications with which it is associated, including: two to four times the risk of cardiovascular disease, including ischemic heart disease and stroke; a 20-fold increase in lower limb amputations, and increased rates of hospitalizations. In the developed world, and increasingly elsewhere, type 2 diabetes is the largest cause of nontraumatic blindness and kidney failure. It has also been associated with an increased risk of cognitive dysfunction and dementia through disease processes such as Alzheimer's disease and vascular dementia. Other complications include acanthosis nigricans, sexual dysfunction, and frequent infections.