Obesity i.e overweight is a common condition the world over, including in India. It is not altogether wrong to say that there is almost an epidemic of obesity particularly noticeable in the developed countries. Even the developing countries are not spared of the menace of over-weight.
Obesity is common among adults as well as children. It is largely attributed to a sedentary life-style and excessive use of ‘junk foods’ rich in fats, carbohydrates and calories. Even though a good weight is surely a sign of a healthy body, overweight is considered as a ‘medical problem’ or a ‘disease’ in itself. Excessive weight is an unnecessary burden on the body which poses risks for almost all body systems. In particular, it is responsible for muscle and joint problems and diseases of the heart and the lungs.
Effects on the respiratory system
Obesity affects
the respiratory system in multiple ways. The lung function is poorer in the
overweight persons. To a large extent, the lung capacity is adversely affected
by excess body weight. Thoracic and lung expansion is restricted due to the
mechanical effects of fat on the chest wall and diaphragm in the obese people.
Clinically significant restriction is generally present whenever there is
massive obesity defined by the patient’s weight-to-height ratio of 0.9-1.0
kg/cm or greater. Obese people may complain of breathlessness due to poor lung
function even in the absence of a definite lung disease. It is important to
assess lung function with the help of breathing tests such as spirometry,
Diffusion Capacity and exercise testing done at a good lung function laboratory. Other tests may also be required as advised
by your chest physician.
There is important
association of asthma and chronic obstructive pulmonary disease (COPD) with
obesity. Obese asthmatics have more significant symptoms of breathlessness,
wheezing and cough. Moreover, asthma is difficult to control in obese patients.
This is particularly worrisome in obese children who present with a severe form
of asthma. COPD is a progressive form of airway obstructive disease which is
more commonly seen in smokers. Obesity is usually not a problem with most
patients of COPD who often complain of significant weight loss and muscle
wasting. Obesity may however be present in patients with chronic bronchitis in
whom it will add to the symptoms of breathlessness.
One of the most
important problems seen in obese people is Obstructive sleep apnea (OSA) which
is characterized by intermittent obstruction of the upper respiratory tract
especially during sleep. The obstruction occurs due to loss of tone and
inability of the pharyngeal muscles during sleep to keep the airways open and
thus resulting in its partial closure. It causes momentary cessation of
breathing and fall in oxygen saturation, snoring and other physiological
effects. In due course of time, OSA is responsible for hypertension, diabetes,
cardiovascular and cerebro-vascular diseases.
Obesity is an
important risk-factor for OSA, a potential fatal disease. OSA can cause sudden
death; some of the celebrities had in fact had succumbed to this problem
recently. Patients with OSA tend to fall to sleep within minutes and even while
driving resulting in frequent and sometimes fatal accidents. Undoubtedly, OSA
is the most serious complication of obesity. Weight reduction is an important
component of treatment of OSA. Mild OSA may even be reversed with treatment of
obesity.
OHS is
characterized by hypoventilation i.e. decreased (than normal) amount of air entering
the lungs with each breath resulting in lower oxygen saturation and increased
carbon dioxide pressure in the blood. In the long run, the condition leads to
failures of the respiratory and cardiovascular systems. Weight reduction is the
most important component of treatment.
Management
Weight reduction
is the most significant component of all forms of problems associated with
obesity. Dietary control and physical exercise are important but often
difficult to achieve. Frequently, one
has to resort to other measures of weight reduction. The doctor can advise
about the type of management required in a case. Standard treatment of the
respiratory disease associated with obesity should be done as appropriate for
the individual patient. People suspected to suffer from OSA must see the best chest doctor and also get a full sleep-study done.