Complications of obesity: diabetes, coronary heart disease, cerebrovascular disease

**10. What is the relationship between obesity and diabetes?**

Diabetes mellitus is primarily caused by an absolute or relative deficiency of insulin, leading to a series of metabolic disorders affecting carbohydrates, fats, proteins, water, and electrolytes. Clinically, it is characterized by hyperglycemia and positive urine glucose. Prolonged illness can lead to chronic complications of diabetes.

Long-term persistent obesity significantly increases the incidence of diabetes. Among type 2 diabetes patients, 80% are obese, and 60% have impaired glucose tolerance. Obese individuals often have hyperinsulinemia and insulin resistance. Obesity and diabetes are closely related. Why are obese people more prone to diabetes? It is currently believed that when a person is obese, the body's response to both endogenous and exogenous insulin is reduced. Because obesity increases the insulin requirement, the pancreatic islet cells are overburdened, causing them to hypertrophy and proliferate. Ultimately, this leads to fatigue and even damage of the pancreatic β cells, preventing them from producing sufficient insulin, thus triggering diabetes. Therefore, obesity is one of the causes of diabetes. Clinical observations show that obese patients with a history of obesity for more than 10 years have an incidence of diabetes of approximately 34%. For obese patients with diabetes, efforts to lose weight can help control the condition.

**11. What is the relationship between obesity and coronary heart disease?**

Coronary heart disease, also known as ischemic heart disease, is a heart condition caused by narrowing or blockage of the coronary arteries due to coronary atherosclerosis or coronary artery spasm, leading to myocardial ischemia, hypoxia, or myocardial necrosis.

Obese individuals have a high incidence of coronary heart disease. According to reports, the incidence of coronary heart disease in obese middle-aged men is twice that of men of the same age with normal weight. Furthermore, those with a high waist-to-hip ratio have a 3-4 times higher risk of developing coronary heart disease than those with normal weight. The main mechanisms by which obesity induces coronary heart disease include: ① Reduced physical activity in obese individuals leads to weakened collateral circulation in the coronary arteries and decreased cardiac compensatory capacity. ② Elevated blood lipids and blood sugar levels associated with obesity increase blood viscosity, reduce the oxygen-carrying capacity of red blood cells, and cause insufficient oxygen supply to myocardial cells. ③ Hyperlipidemia and abnormal lipid metabolism lead to atherosclerosis, ventricular wall thickening, decreased myocardial compliance, and fat deposition in myocardial cells. ④ Fat accumulation in obese individuals increases the cardiac workload and causes hypertension.

**12. What is the relationship between obesity and cerebrovascular disease?**

Cerebrovascular disease is a general term for various cerebrovascular diseases caused by different etiologies. It includes hemorrhagic cerebrovascular diseases such as cerebral hemorrhage and subarachnoid hemorrhage, and ischemic cerebrovascular diseases such as cerebral infarction and transient ischemic attack. Obese individuals have an increased incidence of hypertension, hyperlipidemia, diabetes, coronary heart disease, and atherosclerosis, all of which are risk factors for cerebrovascular disease. Furthermore, obese individuals have increased blood viscosity, thus the incidence of cerebrovascular disease in obese patients is significantly higher than in normal-weight individuals of the same age.

**13. What is the relationship between obesity and fatty liver?**

The liver is the site of lipid transformation, utilization, and synthesis in the human body, but it is not a depot for large-scale fat storage. In a normal person, the total fat content in the liver is approximately 3% to 5% of its wet weight. When, for some reason, fat synthesis in the liver increases, breakdown and utilization decrease, or fat transport is impaired, fat will be excessively stored in liver cells, leading to fatty liver. Obese patients with fatty liver may experience symptoms such as general weakness, loss of appetite, discomfort in the liver area, and abdominal distension. The liver may be enlarged to varying degrees, with a smooth surface, blunt edges, and tenderness upon palpation. Laboratory tests will show abnormal liver function and elevated blood lipids. Ultrasound examination can confirm the diagnosis. Early or mild to moderate fatty liver may improve. Late-stage fatty liver can lead to liver fibrosis due to increased liver fibrosis. Statistics show that the incidence of fatty liver in obese individuals is 18.5%, and the incidence is as high as 30.5% in those with a waist-to-height ratio greater than 0.5. Those with a "beer belly" are more prone to fatty liver.

**14. What is the relationship between obesity and gallstones?**

Cholelithiasis is a disease characterized by the formation of stones in the biliary system, including the gallbladder and bile ducts, and often coexists with cholecystitis. The clinical manifestations of cholelithiasis depend on the location of the stones and whether they cause obstruction or infection. Ultrasound examination can confirm the diagnosis of cholelithiasis.

Obese individuals often experience elevated blood lipids and cholesterol levels due to overnutrition. When cholesterol levels in bile reach a certain concentration, it precipitates in the gallbladder or biliary system, forming gallstones. Statistics show that the incidence of gallstones is significantly higher in obese individuals than in those of normal weight. Obese women have a three times higher incidence of gallstones than those of normal weight, while obese men have a twice the incidence.

**15. What is the relationship between obesity and cancer?**

Epidemiological surveys have found that obese women have a 2-3 times higher incidence of endometrial cancer than women of normal weight. Obese women also have a significantly increased incidence of breast and uterine cancer. Women who are more than 15 kg over their ideal weight are 3 times more likely to develop uterine cancer than those of normal weight; if they are more than 25 kg over their ideal weight, their risk is 10 times higher.

Obese men have a higher incidence of colon cancer, rectal cancer, and prostate cancer than men of normal weight.

Obese men and women have a higher risk of developing colon and rectal cancer. This is because obese individuals have excessive fat in the mesentery, which affects normal intestinal peristalsis, easily leading to constipation. This prevents intestinal contents from being expelled from the body in a timely manner, causing carcinogens to remain in the body for too long, thus increasing the risk of colon and rectal cancer.

**16. What is the relationship between obesity and sexual dysfunction?**

Obesity affects sexual function in both men and women. Obese men have reduced androgen levels and increased estrogen levels, leading to an imbalance in the androgen-estrogen ratio, which can result in decreased sexual function, impotence, decreased libido, and difficulties in erection, intercourse, and ejaculation.

Obesity has a significant impact on ovarian function in women, significantly affecting their menstrual cycle and fertility. Obese women experience premature menopause and early amenorrhea. Higher estrogen levels in obese women can suppress the pituitary gland's secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), leading to menstrual cycle disorders. Among obese women, 16.4% experience amenorrhea, 28.7% experience oligomenorrhea, and 5.5% experience menorrhagia. Obese women also experience varying degrees of sexual dysfunction, primarily due to decreased estrogen secretion. Lower libido is commonly observed in obese women, closely related to their low estrogen levels. Furthermore, obese women may experience complications such as abnormal follicular development and ovulation dysfunction. Reports indicate that approximately 50% of obese women experience amenorrhea, irregular menstruation, oligomenorrhea, and infertility.

**17. What is the relationship between obesity and skin diseases?**

Obese patients often have poor peripheral circulation and weak skin resistance, making them prone to skin conditions such as dermatitis, eczema, and chilblains. Furthermore, the increased sweating in summer significantly amplifies the incidence of these skin diseases.