A recent report by the Niti Aayog has said that the incidents of obesity are rising rapidly in Indian children, adolescents and women. According to the National Family Health Survey, the rate of obesity in women has increased to 24% in 2019-20 from 20.6% in 2015-16. People with obesity are at risk of developing multiple medical conditions like type-2 diabetes, high blood pressure, heart disease, obstructive sleep apnoea, joint pains, PCOD, infertility, certain cancers and so on. Additionally, obesity has a detrimental effect on lung health and is a major risk factor for “bronchial asthma”.

What the doctor says

Laparoscopic and bariatric surgeon Dr Aparna Govil Bhasker says: “People with a body mass index (BMI) greater than 27.5 Kg/m2 fall in the obese category. Women with obesity are twice more likely to develop asthma as compared to their lean counterparts whereas men with obesity are almost 1.5 times more likely to develop asthma.

“People with obesity not only have increased risk of developing asthma, but they also tend to have more symptoms, more frequent and more severe episodes. They also have reduced response to medications and generally have a poorer quality of life,” she adds.

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The connection between obesity and asthma

  • Obesity leads to a reduction in lung volume and tidal volume which in turn promotes narrowing of the airway.
  • Obesity is a state of low-grade systemic inflammation that may lead to the exacerbation of asthma.
  • Changes in adipose-derived hormones, like leptin and adiponectin, may enhance the inflammatory state of obesity.
  • Diseases associated with obesity, such as dyslipidemia, gastroesophageal reflux (GERD), sleep-disordered breathing, type-2 diabetes, or hypertension may exacerbate asthma.
  • Obesity and asthma may share common genetics, common in utero conditions, or common predisposing dietary factors (foods high in sugar, diet poor in vegetables etc).
  • Breastfeeding has been associated with a lower risk of both obesity and asthma.

The takeaway

Weight loss is an essential part of the treatment in patients with obesity and asthma. A minimum of 5% total body weight loss is needed for significant improvement in the control of asthma. The more the weight loss, the better asthma control is.

Diet and lifestyle intervention: It is advisable to follow a well-balanced diet and a moderate exercise routine to maintain an optimum weight. At the same time, one must work on reducing stress levels and maintaining good sleep hygiene. Increased stress levels and poor sleep hygiene have also been implicated in weight gain and can lead to asthma. Exercise helps to release endorphins which in turn help to beat stress to a large extent.

Medical treatment for weight loss: At times, diet and lifestyle modification alone may not be enough for achieving weight loss and more support may be needed. Soon, potentially good weight loss medication is expected which may be of help in shedding some weight.

Bariatric surgery: In patients with clinically severe obesity and asthma, bariatric surgery has shown good results. Presently bariatric surgery is the only effective method for sustained weight loss in patients with severe obesity. Most studies have reported very significant improvements in asthma control, airway reactivity and lung function after bariatric surgery. Bariatric surgery has been shown to decrease the episodes of asthma by 60%. Surgery induced weight loss also decreases the risk of infections like influenza and bacterial pneumonia, which also play a role in reducing asthma exacerbations.

Dr Bhasker adds: “Obesity is an important risk factor for asthma in both children and adults. As we work on improving our understanding of the mechanisms that lead to asthma in obesity, we must focus on healthy living. Prevention of obesity is a must. However, we must also work on the stigma against obesity so that people with obesity can seek medical help without any delay. Weight reduction is an integral part of the medical management for obese asthmatics.”

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