At what point does carrying extra weight stop being a health risk and start becoming a disease by itself? For some, obesity is silent. No symptoms, no struggles. But for others, it creeps into the joints, the lungs, the heart, and even the liver. This is not just about weight anymore. This is about damage. Real damage. Today I’m going to show you the moment obesity crosses the line from something you could manage by yourself by adjusting your lifestyle into something that must be treated like any other illness.
Preclinical Obesity vs Clinical Obesity
We’re going to be talking about two concepts: preclinical obesity and clinical obesity. So let’s start with a concept that’s not often discussed: Preclinical obesity. This is when a person has obesity, but this has not developed into any obvious organ damage or physical limitation. At this stage, obesity is a risk factor. Many people at this stage feel generally fine. They will be active, maybe working and not taking any particular medications. The risk is simmering in the background, but generally, they are okay. What about the other type of obesity, clinical obesity? This is when the excess fat that you have from obesity could start to kind of cause damage around your organs, not make them function the way they should, and maybe limit your ability to perform daily activities that should be normal for your age. At this stage, obesity is no longer just a risk factor, but a disease in itself. Medical surveys suggest that about 50% of patients with obesity are not aware of possible medical problems which could happen due to the excess fat. This figure is quite concerning. It just tells us how much we are failing as a medical community in educating our patients.
I will tell you a little bit more about diseases that could be associated with obesity, and certainly, the list is very long, but I will focus on seven organs which are directly affected by excess weight, with very strong medical evidence to suggest that this could develop dysfunction in one of your organs.
I - Joints
So let’s start with the first thing, which is joints: osteoarthritis(joint pain) will particularly affect the large joints. So if you have a lot of weight, then that would affect your hips and knees because these are the big joints that hold all the weight that you have. So if you have a little bit more weight for these joints to help, then over time they could be affected, and they start having a little bit more wear and tear than they should for the time, and that leads to what we call osteoarthritis. So the symptoms that you might have will be something around pain in the joints, kind of restricting your mobility and ability to walk around, and that could unfortunately lead to further weight gain because you can’t walk, you can’t exercise as normal, and that becomes more like a vicious circle. So joint arthritis is something to watch for.
II - Airways
Now, the second thing we’re going to talk about is how the airways could be affected by excess weight and excess fat. So what would happen, usually, is that if you are sleeping, then this kind of fat around your neck will press a little bit more on the airways, and that would lead to a little bit of a stoppage of the breathing in the night. So this stoppage of breathing in the night, we call it sleep apnea. So what would happen is that during the night, as you stop breathing, you kind of sleep and then wake up, then sleep and then wake up. That interrupted sleep would lead to you feeling generally tired during the day. So things that you need to watch out for to know whether you have sleep apnea would be very loud snoring. It might be that your partner noticed that you stop breathing during the night. So if you develop any of these things that you could be having what we call sleep apnea. Sleep apnea is manageable, but the management usually relies on having a breathing mask during the night that keeps the pressure in the airways high so can breathe throughout using a CPAT machine.
III - The heart
The third organ we’re going to talk about is the heart. So the heart, as you know, functions as a pump that kind of pushes the blood across the whole body. And one of the things that could happen with the heart in people with obesity is that it could get weakened. If you have a weakened heart, then that would lead to you feeling much more short of breath when you’re doing exercises and maybe even when you are lying flat in bed. It’s one of the dangerous things that could develop from obesity, and you certainly need to have that checked by your doctor.
IV - The pancreas
The other organ that we need to talk about is the pancreas. It is the organ that produces the hormone called insulin. Insulin is the hormone that brings the sugar out of the blood into the different organs to be used. Now, if your insulin is not working well, then what will happen is that the sugar will build up in your blood, and you will have high blood sugar. High blood sugar is a disease that we call diabetes. So, how obesity affects this is that the excess fat can cause what we call insulin resistance. So the insulin level in your blood is high, but the organs are not kind of reacting to the insulin the way they should be. So as the insulin goes higher, they are resisting the work of the insulin. So the sugar is not going into the different organs to be us, and sugar is building up in your blood, and if it builds up in your bloodstream, you’re going to have a high sugar level, or what we call diabetes.
V - The liver
The next organ, which is a very essential organ, we’re going to talk about is the liver. [Music] So the liver is the big factory that sits around the upper part of your tummy. And this is the factory thagetset rid of most of the toxins in your body. Now, if the fat builds up with deposits in the liver, you have what we call fatty liver. So, fatty liver means that a lot of fat is deposited in the liver. At the early stages it might not be dangerous but if you have more fat depositing in the liver that could cause more inflammation in the liver and the liver start having problem with the function and that could develop from what we call fatty liver disease or what we call fibrosis and then cerosis and in very rare cases but they do happen patient might have liver failure. So that is again a very essential organ that could be affected by obesity.
VI - The brain
The other organ that is very essential and could be affected by obesity is the brain. So, in some people, particularly women of reproductive age, they could develop what we call idiopathic intracranial hypertension. It just means that the pressure of the fluid around the brain is very high. And if that happens, then they could have a lot of symptoms, including severe headaches and blurred vision. In some cases, if that condition is not treated well, these patients might, unfortunately, develop blindness. So it is one of the conditions that are directly linked with obesitand it does improve significantly once the patients lose weight.
VII - Reproductive organs
That will take us to the last organ I’m going to talk about today, which could be affected by obesity, and this is the reproductive organ. I’m talking here about sexual hormones and fertility. Men who have excess fat could develop what we call hypochondriasis. So this is a condition where men have lower levels of testosterone, leading to reduced muscle mass and then erectile dysfunction and lower levels of sperm. And this is again one of the conditions that are directly related to obesity and could improve if the weight is addressed. In females there is a condition of what we call polycystic ovary disease. Again, there is a strong association between that condition and obesity. This is where the women will have higher weights, and they struggle with ovulation. The period becomes very irregular, and could lead to problems with fertility.
Managing obesity
In pre-clinical obesity, we could have supervised programs where you could follow a diet, but maybe be part of a group or have somebody to watch your diet to educate you a little bit more about your health options, rather than trying to do it yourself. In some cases, you might need medication, and some patients might go for weight loss surgery as a preventative measure. If you have clinical obesity, it’s a different thing, because that is a disease by itself. And at this stage, we need to treat it like we treat any other diseases with evidence-based treatment options. So, think about it as if you have diabetes, asthma, or any other medical problems, you would go to your doctor and seek help. If you have clinical obesity, then you are required to be reviewed by a doctor who is a specialist in treating obesity. Management options might include supervised program lifestyle changes, as we talked about before in the pre-clinical obesity, but you might also need medications. You might even need weight loss surgery based on the assessment that you will have by the specialist at the time. Why does this shift in thinking matter? When we recognise the time when obesity moves from being a risk factor to a disease, it’s not just about labelling, it’s about accessing treatment. If we only wait until complications appear, we are already too late. But if we can identify patients and treat clinical obesity early, we can prevent strokes, diabetes, heart failure, infertility, and certainly help a lot of people reclaim their quality of life.
The next time someone says obesity is just about willpower, you will know better. It’s about biology, organ function, and timely treatment. If you found this video helpful, make sure to like, subscribe, and share it with someone who might need to hear this. I am Dr. Qutayba Almerie, a bariatric surgeon, helping you understand the science behind obesity and your health. See you next time.