World Obesity Day (March 4)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
Obesity is a chronic disease and leading preventable cause of death worldwide(1). Early control of obesity using routine IVD laboratory tests and application of related practical solutions could be useful for fast and reliable detection of reasons related to obesity and allow for improved patient outcomes(2,3). Obesity has affected people of all ages and from all social groups in developed as well as developing countries(4). Worldwide, obesity among adults has nearly doubled since 1990, and has increased four times among children and adolescents(5,6). The obesity related data also indicates that 44% of adults were overweight in 2023. The root causes of obesity are often a complex mixture of dietary, lifestyle, genetic, psychological, sociocultural, economic and environmental factors. Cutting-age fifth generation IVD point of care tests (POCT) and DOT-BLOT molecular probe tests can differentiate primary (genetic) and secondary (related to a specific disease) causes of obesity. Obesity related risk factors are type 2 diabetes mellitus, cardiovascular diseases, stroke, hypertension, kidney disorders, fatty liver polycystic ovary syndrome (PCOS), formation of gall stones and certain types of cancers(1,2). Timely detection of causes for obesity can impact patient outcomes and overall healthcare costs(9).
Q1. What is the WHO and CDC definitions of overweight and obesity?
ANS: Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. The U.S. Centers for Disease Control and Prevention (CDC) further subdivides obesity based on BMI, with a BMI 30 to 35 called class 1 obesity; 35 to 40, class 2 obesity; and 40+, class 3 obesity(6,7).
Note:
(1) The root causes of obesity are a complex mixture of genetic, environmental, changed lifestyles, dietary, economic, psychological, and sociocultural factors. Obesity can be controlled by appropriate modifications of these factors.
(2) In 2019, an estimated 5 million noncommunicable disease (NCD) deaths were caused by higher-than-optimal BMI.
Q2. What are primary and secondary causes of obesity? What specific profile tests are useful in the diagnosis of various causes of obesity?
ANS:
Primary reasons for obesity is mutation in specific genes such as leptin (LEP), leptin receptors (LEPR), MCR4 genes, etc. These can be diagnosed by RT-PCR tests.
Secondary reasons can be detected by the following body profile tests:
| PROFILE TESTS | OBESITY AND RELATED CLINICAL CONDITIONS |
| Diabetic profile tests | Type 2 Diabetes mellitus (obesity) |
| Thyroid panel tests | Hypoparathyroidism (obesity) |
| Liver function tests | Fatty liver, Gall stones (obesity) |
| Kidney function tests | Autoimmune Kidney disease (Hypercholesterolemia) |
| Lipid profile tests | Hyperlipemia (obesity) |
| Cardiac profile tests | Atherosclerosis (obesity) |
| Adrenal profile tests | Cushing’s disease, Conn’s syndrome (obesity) |
NOTE:
(1) Obesity caused by primary reasons could be controlled by the drugs that act as agonist on specific receptors of mutated genes that cause obesity.
(2) By treating secondary clinical conditions obesity can be controlled well.
Q3. What are the recent innovations in IVD that have significantly impacted the management and monitoring of obesity?
ANS: Advancements in the fifth generation point of care test (POCT) methods for blood and urine can diagnose obesity risk factors by performing blood glucose, serum cholesterol, urea, creatinine, high sensitivity TSH, urine microalbumin, serum troponin determinations, etc. in few minutes with accuracy at patient’s bed side.
CASE STUDY
A 33-year-old obese executive (weight 87 kg, BMI: 37), suffered massive myocardial infarction (MI) and upon admission to the emergency ward, his initial medical examination reports were as follows: Blood pressure (170-100), ECG changes (elevated ST segment). The following were his POCT blood test laboratory values:
| PARAMETER | VALUE | NORMAL VALUES (REFERENCE RANGE ) |
| Blood glucose (random) | 285 mg/dl | 70 – 110 mg/dl |
| Serum total cholesterol | 370 mg/dl | 150 – 250 mg/dl |
| Serum triglycerides | 290 mg/dl | 10 – 190 mg/dl |
| Cardiac Total Troponin (cTnT) | Present | Absent |
| Serum creatinine | 2.3 mg/dl | 0.7 – 1.5 mg/dl |
| Urine microalbumin | Present | Absent |
| High sensitivity serum TSH | 14 pg/ml | < 20 pg/ml |
Evaluation of the laboratory report :
The patient was obese (class 2 obesity), and from the medical examination and laboratory report values it appears that, he was suffering from syndrome X (metabolic syndrome).
Note:
(1) Syndrome X (metabolic syndrome) is a group of clinical conditions and laboratory findings consisting of hyperglycemia, dyslipemia, hypertension, insulin resistance and hyperinsulinemia caused by obesity.
(2) Due to obesity, the patient suffered from: Atherosclerosis (high serum cholesterol), hypertension (renal dysfunction), insulin resistance (type 2 diabetes mellitus), hormonal imbalance (hyperglycemia), leptin resistance (high BMI), and early stage of kidney disease (high serum creatinine, presence of microalbumin in urine)
(3) Timely control of obesity by life-style changes (diet and regular exercises) and yearly routine medical examinations with body profile tests could have prevented the patient from the episode of myocardial infarction.
Q4. What are the 4th and 5th generation IVD POCT blood cardiac markers useful in identifying risks for patients with obesity?
ANS:
(1) Cardiac Troponin T (cTnT): Detection of MI within 2-3 minutes.
(2) Cardiac Troponin I (cTnI): Detection of MI within 2-3 minutes.
(3) Myoglobin: Detection of MI within 2-3 minutes.
(4) Brain natriuretic peptide (BNP) and NT-ProBNP: Increases indicate acute congestive heart. failure (CHF) and asymptomatic or symptomatic left ventricular dysfunction.
(5) Heart fatty acid-binding protein: Rapid rise in acute myocardial infarction (AMI).
(6) High sensitivity hsCRP: Increased values indicate cardiovascular disease (CVD).
(7) Small dense LDL: High values indicate increased risk of MI.
(8) Homocysteine: Increased levels indicate vascular and cardiovascular disease.
Q5. How do latest IVD tests impact patient outcomes and overall healthcare costs?
ANS: Obesity costs India Rs 2.8 lakh crore a year, over 1% of total GDP. Overweight conditions and obesity, the two common lifestyle problems that plague nearly 17% of India’s population. These annually cost the country $35 billion(9).
References
(1) “One in eight people are now living with obesity”. World Health Organization. 1 March 2024. Retrieved 1 March 2024.
(2) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.
(3) Godkar PB, Godkar DP. Medical Biochemistry, Theory and Practicals (1st edition, 2024), CBS Publishers, New Delhi,India.
(4) Adeyemi Okunogbe, Rachel Nugent, Garrison Spencer , Johanna Ralston , John Wilding. Economic impacts of overweight and obesity: current and future estimates for eight countries.BMJ Glob Health. 2021 Sep 30;6(10):e006351. doi: 10.1136/bmjgh-2021-006351.
(5) Shammi Luhar, Poppy Alice Carson Mallinson, Lynda Clarke, Sanjay Kinra. Trends in the socioeconomic patterning of overweight/obesity in India: a repeated cross-sectional study using nationally representative data.BMJ Open. 2018 Oct 21;8(10):e023935. doi: 10.1136/bmjopen-2018-023935.
(6) CDC (21 March 2022). “Causes and Consequences of Childhood Obesity”. Centers for Disease Control and Prevention. Archived from the original on 15 April 2022. Retrieved 18 August 2022.
(7) “Obesity and overweight Fact sheet N°311”. WHO. January 2015. Retrieved 2 February 2016.
(8) Obesity-Symptoms and causes”. Mayo Clinic. Retrieved 30 November 2021.
(9) Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. (2023) Jul 15;402(10397):203-234. doi: 10.1016/S0140-6736(23)01301-6
