Obesity
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Obesity is a chronic metabolic disease characterized by an excessive accumulation of adipose tissue, which leads to impaired functioning of the body and increases the risk of developing numerous lifestyle diseases. It is not solely an aesthetic problem nor a consequence of excessive calorie intake, but a complex disorder with a hormonal, genetic, environmental, and neurobiological basis. Modern medicine recognizes obesity as a chronic disease requiring diagnostics, treatment, and long-term control. Excessive body weight affects not only the cardiovascular system, hormonal balance, or glucose metabolism, but also the appearance of the skin, body proportions, and tissue aging processes. Obesity can lead to structural changes in the skin, disorders of tissue tension, and permanent deformations of body contours.
Obesity - what it is
Obesity means a pathological increase in the amount of adipose tissue in the body. Adipose tissue performs important physiological functions, including storing energy, participating in the production of hormones, and protecting internal organs. The problem arises when its excessive growth occurs along with the disruption of the metabolic functions of adipocytes, i.e., fat cells.
In clinical practice, obesity is most often defined based on the BMI (Body Mass Index), which is the ratio of body weight to height:
BMI | Classification |
|---|---|
18.5-24.9 | normal weight |
25-29.9 | overweight |
30-34.9 | class I obesity |
35-39.9 | class II obesity |
≥40 | class III obesity |
However, BMI does not accurately reflect body composition or fat distribution. Visceral obesity, which is the accumulation of adipose tissue within the abdominal cavity, is particularly clinically significant. Visceral fat exhibits high metabolic activity and is associated with a higher risk of type 2 diabetes, atherosclerosis, hypertension, and chronic inflammation.
Nowadays, obesity is treated as a chronic disease with a tendency to relapse. Weight reduction alone does not mean a permanent cure, because the body triggers hormonal mechanisms promoting the regain of adipose tissue.
Obesity - how it is diagnosed
Obesity diagnostics includes the assessment of body weight, body composition, and fat distribution. The BMI index remains the primary tool, however, more precise metabolic assessment methods are of increasing importance.
Diagnostics utilize, among others:
- waist circumference measurement,
- body composition analysis using the bioimpedance method,
- assessment of body fat percentage,
- laboratory tests,
- assessment of comorbidities.
An abnormal waist circumference is considered to be:
- above 80 cm in women,
- above 94 cm in men.
These values indicate an increased metabolic risk associated with abdominal obesity.
Laboratory diagnostics usually includes:
- lipid profile,
- glycemia and insulin,
- glycated hemoglobin HbA1c,
- thyroid hormones,
- liver function tests,
- inflammatory markers.
An important element is also the analysis of the causes of excessive weight gain. The doctor assesses, among other things, lifestyle, physical activity level, sleep quality, chronic stress, medications taken, and possible hormonal disorders.
In advanced diagnostics, the assessment of adipose tissue composition in imaging studies, such as magnetic resonance imaging or computed tomography, is also used, especially when significant visceral obesity is suspected.
Obesity - types and classification
Obesity can be classified by severity, distribution of adipose tissue, and the causes of its development.
The most commonly distinguished are:
Android obesity
Called abdominal obesity or “apple” type. Adipose tissue accumulates mainly within the abdomen and internal organs. This type is associated with the highest metabolic and cardiovascular risk.
Gynoid obesity
Referred to as the “pear” type. Excess fat is located primarily in the area of the hips, buttocks, and thighs. It occurs more frequently in women.
Visceral obesity
Refers to the accumulation of fat around abdominal organs. It can develop even with a normal BMI and constitutes a significant metabolic risk factor.
Subcutaneous obesity
It involves excessive deposition of adipose tissue under the skin. It is of greater aesthetic than metabolic significance, although it also affects the functioning of the body.
Based on etiology, the following are distinguished:
- simple obesity,
- hormonal obesity,
- drug-induced obesity,
- genetic obesity,
- obesity secondary to neurological or metabolic disorders.
Modern research indicates that obesity constitutes a heterogeneous group of disorders, therefore effective treatment requires an individual assessment of the patient and the mechanisms leading to the increase in adipose tissue.
Obesity - causes and mechanisms
The development of obesity results from a long-term positive energy balance, but the mechanism of the disease is much more complex than simple “overeating”. Body weight is influenced by numerous hormonal, neurobiological, and environmental processes.
The most important causes include:
- excessive calorie intake,
- low physical activity,
- chronic stress,
- sleep disorders,
- insulin resistance,
- hormonal disorders,
- genetic predisposition,
- the effects of certain medications,
- gut microbiota disorders.
A key role is played by the appetite regulation system in the hypothalamus. Hormones such as leptin, ghrelin, insulin, or the GLP-1 peptide affect the feelings of hunger and satiety. In the course of obesity, leptin resistance often develops, which is a state in which the body does not respond properly to the satiety signal.
Chronic stress increases cortisol levels, which promotes the accumulation of visceral fat and increases appetite for high-calorie products. Chronic inflammation developing within adipose tissue is also important. Adipocytes secrete pro-inflammatory cytokines that affect metabolism and the functioning of blood vessels.
An increasing role is also attributed to environmental factors:
- highly processed diet,
- sedentary lifestyle,
- sleep deprivation,
- chronic mental overload,
- disruption of the circadian rhythm.
Obesity and aesthetic changes - impact on skin and silhouette
Obesity affects not only metabolic health, but also skin structure, facial proportions, and body contour. Excessive stretching of tissues leads to the weakening of collagen and elastin fibers, which increases the risk of skin laxity and permanent loss of firmness.
Common aesthetic changes associated with obesity include:
- stretch marks,
- cellulite,
- skin laxity,
- deformation of the facial oval,
- double chin,
- localized fat deposits,
- lymphatic edema,
- impaired skin tension.
Chronic inflammation and microcirculation disorders worsen skin quality and slow down regenerative processes. In individuals with high body weight, the following are more frequently observed:
- skin thickening,
- increased tendency for hyperpigmentation,
- acanthosis nigricans,
- excessive sweating,
- problems with wound healing.
Rapid weight loss, especially after pharmacological treatment with GLP-1 agonists or after bariatric surgery, can lead to excess loose skin and loss of facial tissue volume. This leads to changes colloquially referred to as “Ozempic face”, including sunken cheeks, deepening of folds, and increased gravitational aging.
In aesthetic medicine and plastic surgery, various methods are used to support the improvement of skin quality and body contouring after weight reduction. These include, among others:
- treatments stimulating collagen production,
- radiofrequency technologies,
- HIFU ultrasound,
- endermology,
- fat reduction treatments,
- surgical removal of excess skin.
However, causal treatment of obesity and long-term weight stabilization are of key importance, as aesthetic results usually remain limited without metabolic control.
