Obesity

Obesity (Obesity)

1) Disease Description (Causes and Symptoms)

• Definition: A condition in which excessive body fat accumulates, with greater metabolic and cardiovascular risks as fat accumulation within the abdominal cavity (visceral fat) becomes more severe.
• Main causes: Energy intake > energy expenditure (chronic energy imbalance), lack of exercise, excessive food intake, irregular eating habits, genetic predisposition, endocrine diseases (e.g., hypothyroidism, Cushing syndrome), medications (some antidepressants and antipsychotics, etc.), psychological factors, and others.
• Pathophysiology summary: Excessive adipose tissue causes insulin resistance, chronic low-grade inflammation (cytokine secretion), and metabolic syndrome, thereby increasing the risk of complications such as cardiovascular disease and diabetes. Visceral fat is particularly more harmful metabolically.
• Main symptoms: Weight gain, weakness and fatigue, joint pain, shortness of breath and sleep apnea, hypertension, menstrual irregularities and infertility, etc. (Various symptoms may occur depending on complications.)
• Diagnostic criteria (general criteria; differences exist by ethnicity):
  • Body mass index (BMI) = weight (kg) / height (m)^2. Among Asians, a BMI ≥25 is generally considered obesity.
    • Reference classification (example for Asians): BMI 18.5–22.9 normal, 23.0–24.9 overweight, 25.0–29.9 obese, ≥30 severely obese.
  • Body fat percentage (BIA): Considered obesity when >25% in men and >30% in women.
  • Waist circumference (supplementary indicator of abdominal obesity): ≥90 cm in men and ≥85 cm in women (some medical societies also propose 80 cm for women).
  • Detailed testing: Visceral-fat-type obesity can be assessed using abdominal CT, such as a visceral fat/subcutaneous fat ratio ≥0.4.

2) Treatment Methods and Precautions

• Treatment goal: Not weight itself, but prevention and improvement of complications (blood pressure, fasting blood glucose, lipids, sleep apnea, etc.) and improvement of function and quality of life.
• First-line treatment (basic): Lifestyle modification
  • Dietary therapy: Restriction of total calories (reducing daily intake), balanced meals, control of meal frequency and portion size, and limiting excessive carbohydrates and processed foods.
  • Exercise therapy: Combine aerobic exercise (at least 150 minutes per week is recommended) with strength training to maintain muscle mass.
  • Behavioral therapy: Food diary, goal setting (an initial small goal of losing 2–3 kg), avoiding tempting situations, and managing sleep and stress.
• Pharmacological treatment (after a doctor's prescription):
  • Lipase inhibitor: Orlistat — partially blocks fat absorption; diarrhea and steatorrhea may occur as side effects.
  • Appetite suppressants (centrally acting) — use short-term or cautiously (risk of side effects and misuse).
  • GLP-1 agents (e.g., liraglutide, semaglutide): Shown to reduce appetite and body weight. Used as injectable medications; caution is needed regarding side effects (nausea, vomiting, possible pancreatitis, etc.).
  • GIP/GLP-1 agonists (e.g., tirzepatide): Strong weight-loss effects have been reported (the approved indications and use should be checked according to each country's regulatory status).
  • The choice of medication is individualized according to comorbidities (diabetes, cardiovascular disease, kidney function, etc.) and the side-effect profile.
• Surgical treatment (bariatric surgery):
  • Indications (general criteria): Usually considered for BMI ≥40 or BMI ≥35 with severe obesity-related complications. Lower BMI criteria may be applied to Asians, so individual assessment is necessary.
  • Representative surgeries: Sleeve gastrectomy, Roux-en-Y gastric bypass, etc.
  • Effects: Effective for weight loss and improvement of glucose metabolism, but lifelong follow-up is necessary because of the risk of nutritional deficiencies and complications.
• Precautions and points to keep in mind for self-management:
  • Avoid extreme fasting or rapid weight loss, as these can cause muscle loss, nutritional deficiencies, and weight regain.
  • Do not use medications without a doctor's instructions (risk of side effects and interactions).
  • After bariatric surgery, nutritional supplements, medical checkups, and lifelong lifestyle management are necessary.
  • Monitoring for complications (cardiovascular disease, diabetes, gallstones, sleep apnea, joint disease, etc.) is essential.

3) Checklist Before an Outpatient Visit (Including Preparation Materials and Example Questions)

• Preparation/materials:
  • List of all medications currently being taken (including nutritional supplements)
  • Records of recent changes in weight and waist circumference (a weight graph if possible)
  • Previous test results: Blood tests (fasting blood glucose, HbA1c, lipids, liver function), blood pressure records, sleep and breathing-related tests (if sleep apnea is suspected), and imaging or records related to musculoskeletal pain, etc.
  • Past medical history (endocrine diseases, cardiovascular disease, surgical history) and family history (obesity, diabetes, cardiovascular disease)
  • Lifestyle information: Eating patterns, exercise frequency, sleep duration, alcohol consumption and smoking status, and stress level
• Symptoms that should be reported to the doctor in advance during the outpatient visit:
  • Rapid weight gain/loss, shortness of breath, daytime sleepiness, snoring (suspected sleep apnea), menstrual irregularities, depressed mood, signs of an eating disorder, etc.

Example questions (questions for the patient to write down before the outpatient visit)

• "How should I set my target weight based on my weight change over the past six months?"
• "Could the medications I am currently taking (e.g., antidepressants) affect my weight?"

4) General Example Questions to Ask the Doctor

• "Based on my current BMI, waist circumference, and test results, how should I set my weight-management goals?"
• "What diet and exercise programs are recommended? What should I be careful about when starting?"
• "What are the advantages and disadvantages of the medications that can be prescribed, and what side effects can be expected?"
• "How high is my risk of obesity-related complications (cardiovascular disease, diabetes, etc.)? Do I need any additional tests or follow-up?"

5) Examples of Disease-Specific Questions

• "I have significant abdominal obesity (waist circumference/visceral fat). What are the priority strategies for reducing visceral fat?"
• "Could you explain whether GLP-1 therapy (such as semaglutide) is suitable for me and what the expected benefits and risks (pancreatitis, nausea, etc.) are?"
• (When considering surgery) "Do I meet the indications for bariatric surgery, and how will expected weight loss and long-term complication management be handled after surgery?"

Additional information: The treatment plan varies depending on the individual's BMI, body fat distribution, comorbidities, living environment, and preferences. Please consult the treating doctor in the clinic based on a physical examination and test results for an accurate diagnosis and treatment decision.