Public Health Issue - Obesity: Causes, Consequences and Complications

This essay discusses the causes, consequences and complications of obesity, which has become a global public health issue. It also explores the relation of obesity with cardiovascular disease and the prevalence rate of obesity in Australia.

Running head: PUBLIC HEALTH ISSUE – OBESITY
PUBLIC HEALTH ISSUE – OBESITY
Name of the Student
Name of the University
Author’s Note:

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Introduction:
Obesity and overweight has become a global health issues and burden on the public
health care system in the recent years (Ng et al., 2014). According to the World Health
Organisation (WHO), obesity and overweight can be defined as excessive and abnormal
accumulation of fat which may impairs the normal and natural function of the body system
(Who.int, 2019). As per the World Health Organisation guideline, a person can be termed as
obese if their BMI or Body Mass Index is higher than 30 and an individual can be termed as
overweight if their BMI exceeds 25 (Who.int, 2019). Age plays a significant factor while
defining obesity and overweight. For example, age needs to be in consideration while
defining overweight and obesity among children. In recent years, obesity and overweight has
taken a form one of the most fatal condition around the world (Ahrens et al., 2014). In a
recent WHO estimates in the year 2016, it has been found out that the more than 1.9 billion
people (aged over 18 years or older) were overweight and around 650 million individuals
among them were obese. It this estimates, it has also been reported that the almost 13 per cent
world adult population were obese (Who.int, 2019). Among them, prevalence of obesity in
higher among the female (15 per cent) in comparison with the male counterpart (11 per cent).
In addition to this, an estimation of 41 million children was either obese or overweight in the
year 2016 (Who.int, 2019). There are many factors which are responsible for the cause of
obesity and overweight. Obesity and overweight can be caused by both behavioural and
environmental factors. In addition to this physiological factor like gene composition also
plays a major role in the causation of the obesity and overweight. In a much more detailed
manner, obesity and overweight caused due to a culmination of metabolic, genetic,
environmental, behavioural, socioeconomic, and cultural factors. Among the above
mentioned factors, environmental, and behavioural factors play the most significant role in
the causation of the obesity and overweight (Williams et al., 2015). For the most part,

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overweight and obesity results from inadequate physical activity, large calorie consumption,
dietary habits, and sedentary lifestyles. Due to this, there are many deaths in every year and
once overweight and obesity was considered as a first world disorder, but now it is also
spreading in the developing country and third world countries (Hassanzadeh et al., 2012). In
Australia, the issue of overweight and obesity has become a serious area of concern and this
problem is enhancing day by day as well. Not only this, the issue of obesity and overweight
has also various other risk factors such as heart disease, diabetes, high blood pressure, fatty
liver, some type of cancers. Moreover, it is very important to monitor the chronic conditions
like obesity and overweight as it is associated with various other problems as well. From the
report of Australian Government, it is reported that in 2014-15, almost 11.2 million or 63.4%
of the total Australian population have the problems of obesity and over weight in the
country. Among these total population, 35.5% or almost 6.3 million of Australian adults are
affected by the issue of obesity and overweight. The country is in the fifth position in the list
of obese country. Therefore, it was also reported that, the rate of obesity among the male and
female is almost similar.
Therefore, in this essay the factors responsible for obesity and overweight as well as
its complication, and consequences will be discussed in detail manner in the following
sections. Along with this, the literature review based on the research hypothesis will also be
discussed.
Hypothesis
H0= Obesity is not at all related to cardiovascular disease.
H1= Obesity is related to the onset of cardiovascular disease.
Search Strategy

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For this literature review section multiple databases such as CINAHL and search
engines such as Google Scholar was used. Along with this, report related to obesity and
cardiovascular disease was also used in the review of literature section. For searching the
articles from the online databases the keywords like “obesity”, “cardiovascular disease”,
“obesity in Australia”. For searching more articles “obesity risk factors in Australia”,
“prevalence of obesity in Australia” were used.
Review of Literature
Key Issues
Obesity is considered as one of the most prevalent issue present within the Australian
population that further develops the risk of cardiovascular disease, development of
musculoskeletal condition like cancer and type 2 diabetes mellitus (Australian Institute of
Health and Welfare, 2019). Due to increasing weight, the risk of developing this condition
also increase, as being overweight will affect the capability of an individual to manage or
control the side-effects of these chronic health condition. Approximately every 2 in 3
individual suffer from obese in Australia in the year 2014-15 (Aihw.gov.au, 2019). There are
various key issues that result in the condition of obesity and are included as highest
contributor towards burden of disease in Australia.
According to Accredited Practising Dieticians (APDs), there are various risk factors
that result in the condition of obesity such as genetics, consuming excess calories of drinks
and foods such as pastries, pies, doughnuts, chips, high sugar-sweetened alcohol and
beverages, continuously eating food that has more energy content as compared to the total
energy that is required by an individual per day, regain of weight after weight loss, less
physical activity and following the restricting weight loss diet (Www1.health.gov.au, 2019).

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The total rate of obesity condition is increasing world-wide, thereby affecting the children
and adults.
According to the Australian Institute of health and Welfare (AIHW), there are various
health determinants that influence the wellbeing and health of an individual. The set of
factors that affect the health of an in an negative way are considered as the risk factors such
as extreme obesity might result in the condition of developing cardiovascular illness. The risk
factors that result in the condition of obesity and overweight are classified into 4 different
groups. The first group that is included under the risk factors leading to obesity are
environmental and society risk factors that includes the socioeconomic characteristics of an
individual associated with lack of employment and education. Environmental risk factors
comprise of bad living condition with poor level of hygiene that affects the dietary plan of an
individual, therefore resulting in high risk of obesity (Australian Institute of Health and
Welfare, 2019).
Lack of proper education is the major risk factor as the individual has no prior
knowledge on what should be eaten or consumed in order to be healthy. Hence, this factor
affect the individual’s psychological and physical health. As the individual who is developing
the risk of obesity face certain psychological changes that have a negative influence on their
overall health condition (Cdc.gov, 2019). There are two different types of risk factors
namely modifiable risk factors and non-modifiable risk factors. The modifiable risk factors
are those factors whose effects can be modified and changed according to time and non-
modifiable risk factors are those risk factors whose effect cannot be changed and altered.
Obesity is considered as the modifiable risk factors for cardiovascular illness, which states
that an individual can manage their health condition for obesity and reduce the risk of
cardiovascular illness.

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Non-modifiable risk factors considered for obesity are age, family history and sex.
The prior information regarding these non-modifiable risk factor will help the individual to
prevent the onset of the condition and they can determine the effective prevention strategies
with appropriate medical services to prevent the health condition (Aihw.gov.au, 2019).
Biomedical risk factors are also considered as one of the major risk factors that result in the
condition of obesity and influence the health behaviour of an individual such as high blood
cholesterol level might result in the accumulation of diet that comprise of high started fats
(Daa.asn.au, 2019). Bio medical risk factors can also be modified and controlled through
effective physical activity and taking up effective strategy to reduce the condition like self-
management, health intervention and health promotion.
The major risk that was identified for causing obesity is obesogenic environmental
risk factor that is made up of different complex relationship of factors including bad
infrastructure, food economies, poor access to healthy and fresh food, lack of effective
advertisement, food environment and poor working arrangement (Cdc.gov, 2019). The higher
risk of obesogenic factor increases the condition of obesity and overweight. Bad lifestyle and
environmental set-up is therefore the primary rusk factor that lead to the condition of obesity
and overweight. Poor access to any health promotion activity therefore increase the risk of
obesity as the Australian population fails to access any promotional activity and gain no
knowledge on the risk factors, thereby increasing the chances of bad health condition within
Australia (Aihw.gov.au, 2019).
The prevalence rate is measured as the level of disease characteristic affecting the
population within the given specific time. The concept of incidence rate is different from the
prevalence rate, as incidence rate refers to the total number of people who are affected due to
bad health condition within a specific time and prevalence rate is considered as the direct
product of survival and incidence. In order to evaluate any health illness, it is very crucial to

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estimate the prevalence as well as the incidence rate of the disease (Aihw.gov.au, 2019). The
prevalence and incidence rate will help the health care administrator in Australia to identify
how often and to what extent does this condition affect the population of Australia, which
will play a significant role in determining the illness and preventing the health condition. If
the Australian population exhibit high survival and high incidence rate then it states that the
prevalence rate is also high that ultimately result in the condition of overweight and obesity
(Foundation, 2019). The health practitioners will highlight the incidence rate of a particular
disease affecting the Australian population within the specified time that will exhibit if the
prevalence rate is also high for obesity within Australia or not. Different data sources are
available that will help the health practitioner to estimate the prevalence rate of obesity
affecting the overall Australian health condition.
Data Gaps
From the findings of the key issues, a few gaps can be identified in case of the obesity
and its relation to the cardiovascular disease. From the most of the data available in the
Government of Australia websites, it is reported that, most of information is based mainly on
the self-reported data of the respondents. Along with this, there is several evidences that
suggest that the information related to the alcohol intake, physical activity, fruit and
vegetable intake cannot be relied on at all. According to the study of Mihrshahi et al. (2018),
it is reported that, the lack of accurate data and presence of self-reported data in most of the
cases has reduced the reliability of the available data set. Apart of that, the study of
Livingston and Callinan (2017), it is observed that, the public health survey results can
underestimate the consumption of alcohol among the population of the Australia and the
amount was almost 30% less than that of the actual values. Along with this, the study of
Davy and Estabrooks (2015), reported in their study that, in most of the people with a higher
BMI, there is a higher chances of providing inaccurate data and thereby causing wrong

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estimation of certain risk factors related to the obesity and overweight. This study findings
were also supported by the study of Elliott et al. (2014) and in this study the risk factors of
obesity such as energy intake, physical activity. The discrepancy in the self-reported data
regarding the over reporting of the good behaviour among the selected subject population of
the country. The study also reported about the bad behaviour of the public that is eating of
unhealthy foods among the population of Australia is another gap in the knowledge process
as well. Moreover the study of King et al. (2018), identified that the eating fast foods is one
of the primary bad behaviour and most of the people hide the data of eating behaviour
among the population of Australia.
On the other hand, while analysing the prevalence of the obesity and related
cardiovascular disease in Australia, it can be also pointed out that there are a few knowledge
gaps as well. In this section, some participants of the study opted to be out from the study
and thereby increasing the rate of non-response population in the overall study population as
well. For instance, it can be said that in the year of 2017 to 2018 NHS, did not even know
about their weight, height or both data. Along with this, almost 35% of the total respondents
did not have any knowledge regarding the waist circumference. So, it can be said that,
missing any kind of profounding data related to obesity and onset of cardiovascular disease
may affect the actual study result as well. Another gap in the data set, is the accuracy of the
collected height and weight data of the study population. In a recent data, it was reported that,
the people of Australia who have undertaken the height and weight measurement, those
people are healthier than that of the people who have not enrolled for those tests (Riaz et al.,
2018). On the other hand study of Strugnell et al. (2018), it is reported that more passive opt-
out candidates in the study population can encourage more people to have their
measurements of body weight, body height and waist circumferences and thereby can
simultaneously help in the reduction of study bias as well. In addition, it is reported that,

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under estimation of overweight and obesity prevalence in the population may cause more
difficulties to the public health problems of Australia.
Relation of Obesity and Cardiovascular Disease
The onset of cardiovascular disease and problem of obesity and overweight. In recent
past, the relation of obesity and cardiovascular disease is exposed in a wide manner. In past
times, both the disease is treated as a consequence of lipid accumulation in the body and
along with this, it is also reported that, the both the disease is associated with the formation of
the atherosclerosis. However, in recent time, with the advancement of the research processes,
it is observed that, both the disease is a chronic inflammatory disease. In multiple studies, it is
reported that obesity has a very close relation along with the coronary artery disease or
coronary atherosclerosis. In a study it is reported that, the Atherosclerotic vascular lesions
along with higher BMI patients are more common and advanced while comparing with the
subjects with normal body weight. In this, study, it is reported that ,the a rise of body weight
with per 10 kg rise will also simultaneously enhance the risk of coronary artery disease by
12% approx. Along with this, with the enhancement of the body weight, the blood pressure is
also affected. It is reported that, the rise in the systolic blood pressure is almost enhanced by
3mm hg and the diastolic blood pressure may enhance by almost 2.3 mm hg as a part of the
body weight increase (Csige et al., 2018; Csige et al., 2018). Moreover, among the young
adults, it is reported that, due to enhancement of the body weight, the chances of Non ST
segment elevated Myocardial Infarction (NSTEMI) is also increased. While, analysing the
reason of this, it is reported that, along with the increment in the body weight, the chances of
higher BMI also enhances and thereby promotes the onset of NSTEMI. However, the same
mechanism is also applicable for the onset of STEMI as well. According to the study of
NHMRC (2013), it is reported that, the obesity is one of the most independent risk factors of
the cardiovascular disease and increase in the BMI of an individual by one unit will cause

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enhancement of risk of cardiac ischemia by 4% and risk of haemorrhagic strokes by almost
6% (NHMRC, 2013).
The incidents of heart failure is also associated with the cases of obesity among the
patients and it has become one of the major causes of deaths in the world as well. The study
of Reisch et al.(2013), also supported that increase in the body weight can promote the risks
of heart failure among the patients. From the data of the Framingham Heart Study, it is
reported that, the increase of BMI by 1kg/ m2 will simultaneously enhance the risk of heart
failure by 5% among men population and in case of women this risk is enhanced by 7%. In
multiple studies it is reported that 32- 49% of patients with cases of heart failure are obese
and on the other hand the 31-40% of people with heart failure are overweight (Elliott et al.,
2014). From this, given data, it is reported that , the patients who are facing the issue of heart
failure are mostly have high level of BMI and they are more prone to have heart failure in
comparison with the people with normal BMI level. After the 20 years of obesity history
patients have higher chances of having heart failure by 70% and in case of 30 years the
chances of heart failure enhances by 90% (Riaz et al., 2018). The Framingham Heart Study
marked that obesity is responsible for development of heart failure by 11% in case of males
and in case of females this amount is almost 14% (Sahoo et al., 2015). Along with this, the
study of Timmins et al. (2018), also identified that, the issue of obesity is also associated with
the changes in the structure of blood vessels and thereby enhances the chances of ventricular
hypertrophy, systolic ventricular dysfunction and dysfunction of the cardiac system as well.
Higher production of Inflammatory cytokines (IL-1, IL-6, TNF-α, , IL-8) during the obesity
condition, also play an significant role in the progress of heart failure (Riaz et al., 2018). The
acute-phase proteins and inflammatory mediators in flow can also cause myocardial fibrosis,
that upsurges myocardial stiffness and may thereby promote the diastolic failure and later to
systolic heart failure as well and this effect is mediated by the direct metabolic effect on the

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tissue structure, metabolism, and the extracellular matrix, adiponectin and leptin has direct
contribution to the myocardial transformation. The accumulation of triglyceride in the
cardiac muscle should regularly be checked in case of obese patients and assists the
formation of toxic metabolic particles such as diacylglycerol and ceramide. Therefore, this
process can enhance the chances of apoptosis in the cardiomyocytes (Mihrshahi et al., 2018).
The integrity of skeletal muscle bulk is vital for holding the physical action. This procedure
shows an significant role in the development of CVD in the patients with obesity and
overweight (Riaz et al., 2018). Along with this, diet related obesity has been reported to
endorse muscle catabolism and atrophy. Not only this, the along with the chances of heart
failure, the issue of obesity also has promoted the chances of several co morbidity factors
among the patients with overweight and obesity as well. Changes in lipid metabolism
increase cases of atherosclerosis and simultaneously also enhances the chances of ischemic
cardiomyopathy among the patients with overweight and obesity. Apart from that, in
multiple studies, it is also reported that the due to the presence of obesity and overweight
among the patients, the risks of coronary artery disease is also enhanced among those patients
while comparing with the non-obese patients. Accumulation of myocardial lipid and higher
amount of fibrosis can also show a crucial part pathogenically in the origin of numerous
cardiac arrhythmias, that may contribute to the onset of heart failure (Townshend & Lake,
2017; Davy & Estabrooks, 2015 ).
Not only the aforesaid problems but, the obesity and overweight is also a major
contributing factor to the sudden cardiac death cases among the patients with obesity and
overweight. In multiple studies, the association of obesity and sudden cardiac death is
reported in a well manner (OECD, 2013; King et al., 2018)). According to the study of
VicHealth (2014), it is reported that Obesity is one of the major independent risk factors in
the progression of ventricular tachyarrhythmias. The structural modification in the ventricular

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myocardium of overweight and obese patients consequences in hypertrophy in left ventricle
and also dysfunction of systolic and diastolic ventricles. Fibrosis, focal myocardial disarray,
myocardial hypertrophy, and increased amount of epicardial fat are also parts of the
pathological procedure. Obesity may also be related with elongated and inhomogeneous
ventricular repolarization, which may obvious in the elongation of the QT interval and QT
interval modified to the heart rate (QTc) measured by using 12-lead surface
electrocardiogram. Therefore, these ECG considerations are identified as autonomous
indicators of cardiovascular mortality, and their pathological continuation may cause an
increased risk of ventricular arrhythmias among the patients with obesity and overweight. In
the progress of the pathologically elongated and inhomogeneous repolarization reported in
overweight and obesity and the electrical variability involved as a consequence as well
(Strugnell et al., 2018). The main roles in the obesity cardiomyopathy is associated with the
transformed function of voltage-dependent potassium channels, and also with the autonomic
dysregulation (Winter et al., 2014). The concept of obesity paradox is also correlated with
the onset of cardiac problem and various cardiovascular problems as well. In a meta-analysis
process, it is reported that in a study comprising of 28,209 patients altogether, along with a
follow-up time of 2.7 years on the average, overall death rate was 16% lower and
cardiovascular death rate was 19% lesser while comparing with the control group and all the
study participants were overweight persons with heart failure. The aforesaid data was more
prominent in case of the obese patients along with the problem of heart failure (Riaz et al.,
2018). Overall mortality rate in case of the obese patients along with the cardiovascular
disease was almost 33% and the cardiovascular mortality rate was almost 40% in comparison
with the normal weight healthy individuals (Timmins et al., 2018). The association of the
obesity paradox and the increased cardiovascular risks showed that, the higher amount of
adiponectin in the body and the enhanced catecholamine response may decrease the chances

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of survival among the obese and overweight patients. So it can be said that, the reduced levels
of catecholamine reaction may enhance the likelihoods of survival among the patients as
well. Along with this, the haemodynamic changes and various other cardiac consequences
are also triggered by the cases of obesity and overweight among the patients (Wirth,
Wabitsch & Hauner, 2014).
Stress is another factor that related with obesity can cause functional and structural
changes in the cardiomyocytes. The circulating blood volume is enhanced and thereby the
enhanced cardiac output takes place mainly due to the elevated stroke volume .The aforesaid
mechanisms often can cause hypertension in the patients with obesity and overweight (Riaz
et al., 2018).
Conclusion
Hence, it can be said that, the overweight and obesity is highly correlated with the
onset of cardiovascular disease and thereby causing various other complication related to
obesity and overweight. This issue of overweight and obesity related consequences of
cardiovascular problem has become one of the serious causes of mortality around the world
and as well as in Australia. There are multiple risk factors as well that can promote the onset
of disease among the patients with obesity and overweight as well. However, there are many
instances, in which knowledge gap regarding the cardiovascular disease and obesity have
been identified as well. So, it is quite evident that those gaps should be identified in a priority
manner as well. Hence, it can be said that the specified alternative hypothesis is correct as in
multiple studies the correlation of these two factors are identified in a well manner.
Therefore, it can be said that, obesity and overweight is one of the major public health issues
in Australia and that should be addressed in a basis of priority.

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