Written by admin on 2009-05-08T11:45:48+0000">May 8, 2009 – 11:45 am
There is also a range of other less obvious problems associated with obesity, and particularly abdominal obesity. One of these is obstructive sleep apnoea (OSA). OSA is an interruption to sleep caused by blockages to the windpipe producing breathing disruption. The problem is often characterised by heavy snoring. Typically, there is a period of snoring followed by a short period of silence when the breathing ceases and then it starts again with a stutter. The apnoea (lack of breathing) occurs when the person enters the deepest stage of sleep and the tongue relaxes, obstructing the airway.
Obesity is often associated with increased fat deposition in the tongue and throat structures and this can cause the airway obstruction in many sleep apnoea sufferers. Reducing body fat— even by as little as 10 per cent in some people—can reduce the problems of OSA. OSA is most common in men and has a direct role in injury, particularly in the workplace. Disruption of the deepest stage of sleep at night can lead to excessive daytime sleepiness (EDS), which results in a vicious cycle of reduced exercise capacity, stress, over-eating and hence an even greater level of obesity. Daytime tiredness is now known to increase the risk of injury; truck drivers with OSA are now banned from driving in some countries.
In many instances of OSA it may be necessary to improve sleep patterns before the patient has sufficient daytime energy to break the cycle and carry out physical activity which can lead to fat loss. Devices such as a constant peak airways pressure (CPAP) machine, which keeps the breathing passage open by maintaining a positive pressure in the airways, can be valuable. Although dealing only with symptoms, this allows a patient to feel rested and suffer less excessive daytime sleepiness and thus perhaps to be more active during the day, potentially decreasing the overfatness which caused the problem.
Joint problems, such as knee pain, are also common in very big people. This is because of the extra pressure put on the joints by carrying excessive weight. Often this can be a limiting factor in getting big people to exercise. However, it’s not uncommon to find that these problems improve on a fat reduction program as the individual begins to lose fat, and hence some body weight.
Skin infections can be a further problem. A fungal infection called intertrigo which causes itchiness and a rash, can flourish in the hot, damp environment under the ‘apron’, or fold of belly fat in very big people. Fungal infections are also common on the insteps of the feet, which often never see the light of day, because of the extra weight forcing them into and against the inner surface of the shoes and the heat created by synthetic socks and leather shoes. This is one reason why big men often insist on wearing thongs’ or sandals which air the feet, without knowing that it is their obesity which is causing the problem. Tinea pedis, an infection between the toes or under the feet, is also more common in fat men because of the hot and sweaty micro-environment of the feet. Pitted keralysis is a bubbling form of rash under the soles of the feet, also common in the obese, which causes the feet to smell. Regular washing only aggravates the problem as this reduces the skin’s natural oiliness and dries it out even more. Regular airing by wearing open shoes or punching holes in the insteps of shoes with a nail punch can help overcome the problem. Acanthosis nigrocans is another skin problem, characterised by velvety, pigmented patches around the underarms, sides of the trunk, knuckles and groin. Acanthosis is occasionally a sign of severe insulin resistance.
Finally, sexual difficulties and psycho-social problems can also result from excessive body fatness. In relation to sexual difficulties, poor self-esteem, lack of fitness and lack of flexibility all combine to make this a significant psychological problem. Recent research has also shown that abdominal fatness in men is associated with a decrease in testosterone levels. This is quite contrary to the notion of a ‘pot belly’ being a proxy indication of manhood. Other psycho-social problems come from the widespread prejudice against fatness. Obese people are often judged to be lacking willpower and to be lazy, over-indulgent and stupid; fatness is strongly associated with ugliness.
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