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Questions and answers on obesity with Dr. Fatima Cody Stanford

A physician in obesity medicine at Massachusetts General Hospital

10/10/2013, 6 a.m.
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Fatima Cody Stanford, M.D., M.P.H. Obesity Medicine & Nutrition Fellow Massachusetts General Hospital

Can a person be obese and healthy?

A person can be obese and have good metabolic health. This means that excess weight has not resulted in chronic diseases such as type 2 diabetes, hypertension or obstructive sleep apnea. It is important to realize, however, that obesity in itself is a risk factor for increased risk of these diseases and mortality. As a result, people with obesity should address this disease process with their physician just as they would any other chronic disease.

Why is obesity linked to sleep apnea?

There are two primary types of sleep apnea: obstructive and central. Obesity is linked to obstructive sleep apnea due to the fact that persons who carry excess weight have fat that compresses their upper airway while they sleep. When a person loses a significant amount of weight, they are likely to have less compression of the upper airway. However, it is important to realize that all persons with obstructive sleep apnea are not obese; it is just much more common in this population group.

Is there a genetic cause of obesity?

Yes. There are several genetic causes of obesity, and scientists continue to discover more genes that are linked to excessive weight gain. As our knowledge about obesity continues to increase, we will improve our ability to prevent, diagnose and treat this disease.

Why does lack of sleep affect one’s weight?

A part of the brain called the hypothalamus regulates hunger and the sense of fullness called satiety. This part of the brain also regulates sleep. When a person has poor quality sleep, they are likely to experience more hunger which can result in increased food intake to feel full. As a result, persons with poor sleep may overeat, which will lead to increased weight.

Are some cases of overweight and obesity caused by medical conditions?

Yes. There are several medical conditions that can lead to overweight and obesity. For instance, polycystic ovarian syndrome, a common hormonal disorder among women of reproductive age, is manifested by infrequent or prolonged menstrual periods, excess hair growth, acne and obesity. An underactive thyroid can lead to weight gain as well.

Will children of obese parents be obese as well?

Children of parents who are obese will have a higher likelihood of obesity since genetics is one of the many factors that lead to struggle with weight. Environmental factors such as poor sleep, stress, inactivity and poor diet quality may play a role in a child developing obesity as well.

Why does obesity increase the risk of cancer?

While it is not entirely clear why obesity increases cancer risk, persons with obesity are more likely to be diagnosed with certain cancers such as breast, colon and pancreatic. One possible explanation is that insulin resistance, which is more common in people with obesity, may fuel cancer cell growth. In addition, fat produces estrogen, which may increase the possibility of breast and uterine cancer, especially in post-menopausal women.

Is it possible to eliminate fat cells once they are formed?

You can not eliminate fat cells once they are formed, but you can reduce their size through weight loss.

Fat that accumulates around the waist is more threatening to one’s health. Is it possible to reduce that fat?

It is true that persons who carry weight in their midsection, termed central adiposity, have a higher risk of disease. There is no way to target the elimination of central fat preferentially over other fat in the body. When one loses weight, they will lose weight throughout the body.