Obesity

Overview

Obesity is a chronic, relapsing, and progressive disease characterized by excessive or dysfunctional adipose (fat) tissue that adversely affects physical, metabolic, and psychological health. It is no longer defined solely by excess body weight but by abnormal fat distribution, metabolic dysregulation, hormonal imbalance, and chronic low-grade inflammation [1,4].

Global and national data indicate a rapid rise in obesity prevalence. In Pakistan, a substantial proportion of adults are overweight or obese, with central (abdominal) obesity being especially common and strongly linked to metabolic disease risk [1&ndash;3]. Modern medical frameworks now recognize obesity as an adiposity-based chronic disease (ABCD) that requires structured diagnosis, staging, and long-term management rather than short-term weight reduction alone [4,5].

Causes

Obesity develops through a complex interaction of biological, behavioral, environmental, and genetic factors. It is not simply the result of excess calorie intake.

Key contributors include:

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	Genetic predisposition affecting appetite regulation, fat storage, and energy expenditure
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	Hormonal dysregulation involving appetite, satiety, and insulin sensitivity
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	Sedentary lifestyles and prolonged sitting
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	High intake of calorie-dense, ultra-processed foods
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	Sleep deprivation and poor sleep quality, disrupting metabolic hormones
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	Chronic stress, promoting fat accumulation through neuroendocrine pathways
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	Environmental and socioeconomic factors limiting healthy lifestyle choices
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</ul>

Dysfunctional adipose tissue becomes metabolically active, releasing inflammatory mediators that worsen insulin resistance and systemic disease, reinforcing obesity as a self-perpetuating condition [4].

Signs & Symptoms

Obesity may present with visible physical changes as well as internal metabolic and functional disturbances. Symptoms often develop gradually.

Common features include:

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	Excess body fat, particularly around the abdomen
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	Progressive weight gain or repeated weight regain
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	Early fatigue and reduced stamina
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	Shortness of breath with mild exertion
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	Joint and back pain, especially in weight-bearing joints
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	Excessive sweating and heat intolerance
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	Sleep disturbances, loud snoring, or daytime sleepiness
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	Reduced mobility and physical function
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Many individuals remain asymptomatic until obesity-related complications emerge. Obesity affects multiple organ systems, increasing the risk of numerous chronic diseases. Evidence shows obesity is associated with multisystem dysfunction, not isolated weight gain [4].

Major complications include:

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	Type 2 diabetes mellitus and insulin resistance
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	Cardiovascular disease, including hypertension, coronary artery disease, and stroke
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	Metabolic dysfunction&ndash;associated steatotic liver disease (MASLD/MASH)
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	Obstructive sleep apnea and hypoventilation syndromes
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	Osteoarthritis and reduced musculoskeletal function
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	Chronic kidney disease
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	Reproductive and hormonal disorders, including PCOS and infertility
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	Certain cancers, such as breast, colon, liver, and endometrial cancer
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	Mental health conditions, including depression, anxiety, and reduced self-esteem
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</ul>

Risk increases with central adiposity and longer disease duration.

Diagnosis

Current clinical guidance emphasizes that obesity diagnosis should extend beyond BMI alone.

Evaluation may include:

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	Body Mass Index (BMI) assessment
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	Waist circumference or waist-to-height ratio, particularly for central obesity
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	Clinical assessment of obesity-related complications
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	Metabolic investigations, including blood glucose, lipid profile, and liver enzymes
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	Assessment of functional, psychological, and quality-of-life impact
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</ul>

The European Association for the Study of Obesity (EASO) recommends diagnosing obesity using both anthropometric measures and clinical consequences, recognizing increased risk even at lower BMI thresholds when abdominal fat or complications are present [4,5].

Management

The treatment of obesity focuses on long-term improvement in metabolic health, physical function, and quality of life, rather than short-term weight loss alone.

Current evidence-based treatment approaches include:

<h4>Lifestyle and Behavioral Interventions</h4>

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	Nutritionally balanced dietary patterns
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	Regular physical activity tailored to individual capacity
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	Sleep optimization and stress management
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	Behavioral strategies to support long-term adherence
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</ul>

<h4>Medical and Structured Care Approaches</h4>

Modern clinical frameworks recognize that lifestyle interventions alone may be insufficient for many individuals. Treatment decisions should be guided by disease severity, fat distribution, and presence of complications, rather than BMI alone [4,5].

Medical therapies may be considered for individuals with:

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	Obesity accompanied by metabolic, cardiovascular, or mechanical complications
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	High central adiposity with functional or metabolic impairment
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	Repeated failure of lifestyle-only interventions
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</ul>

<h4>Individualized, Stage-Based Management</h4>

The EASO and ABCD frameworks emphasize personalized, stage-based treatment, integrating behavioral strategies, medical therapies, and where appropriate procedural interventions, with the goal of sustained health improvement rather than rapid weight reduction [4,5].

Early intervention improves outcomes and reduces progression to obesity-related complications.

Conclusion

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	Obesity is a chronic, relapsing metabolic disease, not a cosmetic issue
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	Diagnosis requires assessment beyond BMI, including fat distribution and health impact
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	Obesity increases the risk of multisystem chronic diseases
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	Central obesity carries particularly high cardiometabolic risk
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	Long-term, individualized treatment is essential for sustained health outcomes
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</ul>

<h3>References</h3>

<ol>
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	World Health Organization. (2025, December 8). Obesity and overweight &ndash; Fact sheet. World Health Organization. <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight?utm_source=chatgpt.com" rel="noopener" target="_new">https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight</a>
	</li>
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	International Diabetes Federation. (2024). IDF country profile: Pakistan. International Diabetes Federation. <a href="https://idf.org/our-network/regions-and-members/middle-east-and-north-africa/members/pakistan/" rel="noopener" target="_new">https://idf.org/our-network/regions-and-members/middle-east-and-north-africa/members/pakistan/</a>&nbsp;
	</li>
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	World Obesity Federation. (2025). World Obesity Atlas 2025. World Obesity Federation. <a href="https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2025?utm_source=chatgpt.com" rel="noopener" target="_new">https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2025</a>
	</li>
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	Busetto, L., Dicker, D., Fr&uuml;hbeck, G., Halford, J. C. G., Sbraccia, P., Yumuk, V., &amp; Goossens, G. H. (2024). A new framework for the diagnosis, staging and management of obesity in adults. Nature Medicine, 30(2395&ndash;2399). https://doi.org/10.1038/s41591-024-03095-3
	</li>
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	European Association for the Study of Obesity. (2024). A new framework for the diagnosis, staging and management of obesity in adults. EASO. <a href="https://easo.org/a-new-framework-for-the-diagnosis-staging-and-management-of-obesity-in-adults/?utm_source=chatgpt.com" rel="noopener" target="_new">https://easo.org/a-new-framework-for-the-diagnosis-staging-and-management-of-obesity-in-adults/</a>
	</li>
</ol>

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