I. Non Physical Problems

1. Psychological Distress

As any overweight person can attest to, obesity adds additional stress to the normal range of daily negative emotions. Most non-obese people simply don’t know that being overweight is caused largely by one’s genetic makeup. Discrimination against the obese is still common. Feelings of guilt, inadequacy, embarrassment, and failure often build up. The resulting anxiety may lead to overeating which compounds the problem.  The most common clinical result of this is depression.

2. Impaired Social Function

Even if an overweight person is relatively free of physical or emotional problems associated with obesity, he or she may still experience impaired social function. Airline seats may be too small. Workplace environments might be without armless chairs. Stairs might be too steep. Ones friends or peers might not relate to the causes and experience of obesity, mistaking it as a character flaw. Other non-obese peers might feel sorry for overweight colleagues or neighbors but be too embarrassed or uncomfortable to react positively. Added together, these factors often lead overweight people to become socially isolated, with this itself leading to decreased social skills and comfort.      

II. Respiratory Problems

1. Sleep Apnea

“Apnea” means “without breath.”  Sleep apnea is when people literally stop breathing during their sleep, usually for many seconds at a time. This disorder is almost always associated with obese anatomy of the neck region, and may be associated with snoring. People with this disorder may literally “choke” on their own airway literally hundreds of times during the night, their sleep being interrupted without their remembering it in the morning. The most noticeable result is extreme fatigue and day time drowsiness. People with sleep apnea are 5 times more likely to die behind the wheel of a car due to an increased risk of falling asleep while driving. Other problems include extreme fatigue, hypertension, heart rhythm disorders and sometimes sudden death.

2. Obesity Hypoventilation Syndrome

When sleep apnea is left untreated, it may cause this disorder where carbon dioxide levels build up to toxic levels in the blood. This leads to a wide range of metabolic imbalances. This condition, along with sleep apnea, are often related to a disorder called “Pickwickian Syndrome”, named after a character in a 19^th century Charles Dickens novel who exhibited signs of the problem.

3. Respiratory Insufficiency

A third, related breathing disorder related to obesity is respiratory insufficiency. Suffers may find themselves constantly out of breath upon any type of exertion. Lung capacity is diminished due to reduced strength and size. The oxygen requirements of normal activities exceed the body’s ability to supply it.

4. Asthma

Asthma can be made much worse by obesity. Acid reflux associated with heartburn may irritate the lungs. Oversized body mass can interfere with breathing.

III. CardioVascular & Related Problems

1. Hypertension

Hypertension, or high blood pressure, is associated with obesity. This disorder over time leads to vascular problems as blood vessels and organs are gradually damaged by higher pressure than they are able to handle. Hypertension tends to worsen arteriosclerosis. Other organs particularly at risk include the kidneys and, especially in the case of diabetics, the eyes.

2. Venous Stasis Disease

Whereas the heart pumps blood out to the body under pressure, we rely on a series of one-way valves in our veins to get blood back “uphill” to our heart. Normal physical motion squeezes vein segments, pushing blood up to the next level. Large fat deposits, however, hamper this process, especially for blood returning from the feet and lower legs. Edema (swelling) and skin problems, including ulceration, can result.

3. High Cholesterol

Because of the way that the body breaks down fat stores, overweight individuals are likely to have higher than average blood cholesterol levels. This condition speeds up the rate at which arteriosclerosis or other arterial diseases progress, which , in turn, increase one’s risk of stroke or heart attack.

4. Heart Disease

Heart disease is about 6 times more common in morbidly obese individuals.  Hypertension, high cholesterol, arteriosclerosis (all part of this list) make the heart more susceptible to excess strain as it struggles to push blood through the body. This strain often leads to rhythm disorders which can lead to sudden death.

5. Diabetes

People with a BMI over 40 are 15 times more likely to develop type II diabetes than people with a BMI below 27 (or, “normal weight” individuals). Insulin is a chemical that the body releases which enables cells to use glucose. Type-II diabetics, however, are resistant to this process – thus the associated term “insulin resistance.” Having a high body fat content increases the chance of people having this problem. After meals, glucose is released into the blood, but is unable to enter cells. Chronically elevated levels of glucose in the blood cause damage to many tissues and organs, and can lead to blindness, toe & limb amputation, and kidney failure.

IV. Joint Disorders

1. Spinal Degeneration

Few people have spinal columns strong enough to bear the stress of an excessively overweight build. Cartilage between the vertebrae starts to wear out, especially with frequent physical exertion such as lifting or carrying. Degeneration can take the form of accelerated arthritis, or of a slipped disk where cartilage between vertebrae actually slides out. These conditions can result in very painful nerve damage (which may run down nerves in the leg) and which may be very difficult to repair with surgery.

2. Arthritis of Weight-Bearing Joints

As one can imagine, all weight bearing joints are at increased risk of wearing out in overweight individuals. Arthritis and painful inflammation most common in the knees but also in the hips ankles and feet can render previously active people largely immobile. This type of arthritis makes it very difficult for overweight people to engage in physical activity, thus contributing to their weight problem. Moreover, the common practice of joint replacement for arthritis is often contraindicated in obese people due to a high failure rate in that population.

  V. Other Problems

1. Heartburn

A common misconception, “heart burn” is not associated with the heart – although referred pain might sometimes make it seem like this. Rather, heart burn is the result of stomach acids breaking the protective barrier between the stomach and the esophagus. Overweight individuals may have fat stores that push their stomach anatomy so that this barrier – actually, a valve – is put under high strain. With time, it may weaken and leak, exposing the esophagus to burning stomach acid. This acid is strong enough to burn a hole through carpet. While your stomach has a protective lining of mucous, your esophagus doesn’t and cellular damage begins to occur.

This can lead to several problems. First of all, acid can go back down through one’s wind pipe, causing severe irritation and sometimes pneumonia. More commonly, scarring of the esophagus can lead to constriction, which causes dysphasia, or difficulty swallowing. Worse, continued scaring of tissue may lead to a pre-cancerous condition called Barrett’s esophagus which requires close monitoring.

2. Urinary Stress Incontinence

A very large percentage of severely obese women suffer from urinary stress incontinence, especially if they have had children. The pelvic muscles become relaxed and displaced by a heavy abdomen, causing a weakening of the urinary valve. Leakage may result during laughing, coughing, sneezing or lifting.

3. Gallbladder Disease

Gallbladder disease is more than three times more common in obese people than non-obese people. This condition usually results from repeated attempts at dieting. Painful stones may develop which need to be removed.