Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change. (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)
This week, she discusses obesity and reaches out to Dr. Brian R. Landzberg, clinical assistant professor of medicine in the Division of Gastroenterology and Hepatology at the Weill Medical College of Cornell University — a gastroenterologist in private practice in New York City and a member of our Medical Advisory Board — for answers to Maria’s questions.
Dear Dr. Pat,
I was diagnosed with fatty liver one year ago. I had blood drawn at my annual visit and my blood tests for liver function were slightly abnormal. I had more blood tests for hepatitis and all the other diseases that can cause abnormal liver tests, which were normal. An ultrasound of my liver showed that I had fat throughout the liver. I saw a gastroenterologist about the fatty liver issue and he told me that I needed to stop all alcohol and to lose weight.
I didn’t think much about the fat in my liver until the recent scare from the news media about the dangers of liver failure and the need for a liver transplant in patients with some kinds of fatty liver, so I saw my GP again recently. My blood tests for liver function are a bit worse, my blood pressure is starting to climb and now I have “pre-diabetes.” I am 47 and am overweight at 180 pounds (I am 5 feet 5 inches). I have a glass of wine every night, but not more. We really like to cook and entertain in my extended family, and I am a real foodie. Everyone in my family is overweight. I have had no success losing weight. I go down 10 pounds and back up again.
I am a successful person in all other aspects of my life. Why can’t I manage to lose weight? Is it true that the fatty liver I have can cause cirrhosis or liver cancer as well? How does being overweight cause the liver to fail?
Obesity is no longer considered a cosmetic issue or a moral failing that is caused by overeating and a lack of self-control. The World Health Organization, along with national and international medical and scientific societies, now recognize obesity as a chronic progressive disease resulting from multiple environmental and genetic factors. Obesity is a disease that causes many other serious health issues.
The prevalence of obesity among adults has more than doubled since the early 1960s, increasing from 13.4 percent to 35.7 percent in U.S. adults age 20 and older. About 46 percent of adults in the United States in the early 1960s fell into the categories of overweight, obesity and extreme obesity. About 32 percent of adults were overweight, about 13 percent were obese and about 1 percent had extreme obesity. By 2010, the percentage of adults considered overweight, obese, or extremely obese had climbed to about 75. About 33 percent were considered overweight, about 36 percent were considered obese and about 6 percent were considered extremely obese.
Obesity is considered a disease that has many causes and often has a strong genetic component. Acting upon a genetic background are a number of hormonal, metabolic, psychological, cultural and behavioral factors that promote fat accumulation and weight gain.
When the amount of calories consumed (energy intake) exceeds the amount of calories the body uses (energy expenditure) in the performance of basic biological functions, daily activities, and exercise, weight gain occurs. In the past, health care professionals and patients attributed weight gain just to overeating or by not getting enough physical activity. However, there are other conditions that affect weight gain and fat accumulation that do not involve deliberate excessive eating or sedentary behavior. These include:
1. Chronic sleep loss
2. Consumption of foods that, independent of caloric content, cause metabolic/hormonal changes that may increase body fat. These include foods high in sugar or high fructose corn syrup, processed grains, fat and processed meats. Americans also tend to have high-fat diets, often putting taste and convenience ahead of nutritional content when choosing meals.
3. Low intake of fat-fighting foods, like fruits, vegetables, legumes, nuts, seeds and quality protein
4. Stress and psychological distress: Psychological factors may also influence eating habits. Many people eat in response to negative emotions, like boredom, sadness, or anger.
5. About 30 percent of those who seek treatment for serious weight problems have difficulties with binge eating. During a binge eating episode, people eat large amounts of food while feeling they can’t control how much they are eating
6. Genetic factors: Obesity tends to run in families, suggesting that it may have a genetic cause. However, family members share not only genes but also diet and lifestyle habits that may contribute to obesity. Separating these lifestyle factors from genetic ones is often difficult. Still, growing evidence points to heredity as a strong determining factor of obesity.
7. Many types of medications
8. Other diseases and disorders that affect metabolism
9. Sedentary lifestyle