Article 44: Obesity and Blood Disorders, Sexual Function and Syndrome X

18. Obesity and Blood Disorders

In healthy individuals, various hematological indicators remain stable within a narrow range. However, in obese individuals, certain hematological indicators often fluctuate above or below this range, exhibiting a state of "fluctuation."

(1) Increased white blood cell, red blood cell and hemoglobin levels: The total number of white blood cells, hemoglobin and hematocrit of obese people are slightly higher than those of ordinary people, and the heavier the weight, the higher these three indicators are, and the correlation between the two is very good.

(2) Iron deficiency anemia: The heavier an obese person is, the higher their total iron-binding capacity and the lower their transferrin saturation. In addition to the above two changes, obese women also have lower serum iron levels the heavier they are. The above three indicators are all diagnostic indicators for iron deficiency anemia. Patients with iron deficiency anemia have abnormally high total iron-binding capacity, while transferrin saturation and serum iron are abnormally low.

Of course, while obese individuals may exhibit altered hematological markers, these generally do not yet indicate a blood disorder. Nevertheless, understanding these changes can aid in the diagnosis of certain blood disorders. For instance, a hemoglobin level at or slightly below the normal range might not be clinically significant in a short, thin woman; however, in a tall, obese woman, it suggests more pronounced anemia. This is because obese individuals typically have higher hemoglobin levels than thin individuals; therefore, a hemoglobin level that is not considered low in a thin person would be very low in an obese individual.

19. Obesity and Sexual Function

Obesity can have some impact on sexual function.

In obese men, the level of free testosterone (the physiologically active portion of testosterone) is lower in severely obese individuals than in those of normal weight, and the increase during arousal tests is also significantly less pronounced. On the other hand, estrogen is produced in adipose tissue; the more adipose tissue, the more estrogen is synthesized. Therefore, obese men have higher estrogen levels than men of normal weight, and in some cases, this can even lead to erectile dysfunction and feminizing phenomena such as gynecomastia. In general, obese men may experience a decline in libido and sexual function.

Obese women experience different symptoms than men. Because hyperinsulinemia can stimulate the ovaries to produce excessive androgens, their free testosterone levels may be higher than in women of normal weight. This can lead to masculinizing symptoms such as hirsutism, and may also cause menstrual irregularities, amenorrhea, and infertility. Furthermore, obese women are often prone to acanthosis nigricans, characterized by rough, dark skin on the neck, armpits, and groin. Obese women are also more susceptible to tinea and boils, which, combined with these masculinizing symptoms, significantly impact their appearance and have a negative psychological impact on their sex life.

Obese people are more prone to diabetes. Men with diabetes may develop erectile dysfunction, while women may experience frigidity and vaginitis, which may further affect sexual function.

20. Obesity and Syndrome X

Obesity is closely related to type 2 diabetes, hyperlipidemia, and hypertension, as they share a common genetic or acquired defect-IR. Reaven named this syndrome X, also known as insulin resistance syndrome or metabolic syndrome X. This concept was proposed by a scholar named Reaven in the late 1980s. He observed that with economic development and improved living standards, many traditional diseases, especially infectious diseases, were gradually being replaced by chronic non-communicable diseases such as obesity, hypertension, coronary heart disease, and cerebrovascular diseases. These modern diseases often coexist and share a common pathogenic basis. He termed this group of diseases Syndrome X.

After extensive research and supplementation by numerous scholars, it is now generally accepted that Syndrome X includes at least seven "high" characteristics:

High body weight, high blood sugar, high blood pressure, high blood lipids, high blood clotting, high uric acid, high insulin levels, or insulin resistance.

These seven "highs" all refer to metabolic disorders, leading many to believe that metabolic syndrome is a more appropriate term than syndrome X. In fact, syndrome X ultimately stems from obesity leading to insulin resistance. Insulin resistance causes compensatory hyperinsulinemia, resulting in sodium and water retention and thus hypertension; it also damages pancreatic beta cells, leading to type 2 diabetes; and insulin resistance further reduces the sensitivity of insulin receptors on adipocyte membranes, causing lipid metabolism disorders and resulting in hyperlipidemia. These three factors are mutually causal and influence each other, forming a vicious cycle. Therefore, when various symptoms of syndrome X appear, vigilance is crucial for early diagnosis and treatment.

Furthermore, as can be seen from the above, insulin resistance and hyperinsulinemia are the basis of metabolic syndrome, so some people advocate calling metabolic syndrome insulin resistance syndrome.

If a person has any three of the seven "highs" mentioned above, such as an obese person who also has high blood pressure and dyslipidemia, then he is considered to have metabolic syndrome.

It is now generally accepted that metabolic syndrome is a common cause of many modern diseases, including cardiovascular and cerebrovascular diseases, hypertension, diabetes, and gout. However, research on the etiology, pathology, and clinical prevention of metabolic syndrome has not yet yielded a consensus and requires further investigation. At the very least, it can be said that these diseases share common causes and pathogenic factors, as well as common prevention strategies; preventing one disease can help prevent a range of others.

21. Obesity and Orthopedic Diseases

Obesity can cause varying degrees of bone and joint diseases.

Obesity can cause three main types of bone and joint diseases:

(1) Osteoarthritis.

(2) Diabetic osteoarthritis.

(3) Gouty osteoarthritis.

Among the various bone and joint diseases that obesity may cause, osteoarthritis is the most common and most harmful.

Osteoarthritis primarily affects movable joints and is a chronic degenerative disease. Its manifestations include degeneration and wear of the articular cartilage, as well as the formation of bone spurs and cysts on the articular surfaces. Obesity is a significant risk factor for osteoarthritis, but it is easier to eliminate than other risk factors; therefore, weight loss is beneficial for the prevention of osteoarthritis.

Osteoarthritis caused by obesity primarily affects the knee joint, and can also affect the hip and finger joints.

Osteoarthritis is more common in obese women than in obese men. A study of a group of middle-aged women showed that obese women were 18 times more likely to develop osteoarthritis in both knees than women of normal weight! And among middle-aged women who do develop osteoarthritis, obesity may be the cause in 65% of cases.

The mechanism by which obesity causes osteoarthritis is not yet fully understood, but it is currently believed that there may be three main reasons:

(1) Obesity increases the burden on the joint surfaces, causing the joint structure to wear down and age faster, leading to osteoarthritis.

(2) Obesity can indirectly affect joints through other metabolic complications, such as impaired glucose tolerance, lipid dyslipidemia, etc.

(3) Obese people often have an unreasonable diet, which can also affect their joints. For example, high fat intake can not only cause obesity, but also have adverse effects on bone, cartilage and joint structure.

Osteoarthritis is the leading cause of disability. Some patients have such severe joint disease that they have to undergo surgery to replace their knee or hip joints, and a significant portion of these cases are due to osteoarthritis.

Therefore, the dangers of obesity, such as lower back pain, lumbar lordosis, intervertebral disc damage, sciatica, osteoporosis, and osteoarthritis of the knee, should be given special attention. Whether weight loss can improve existing osteoarthritis is currently uncertain; however, weight loss can certainly prevent the onset of osteoarthritis. Losing 5 kg over 10 years can reduce the risk of developing osteoarthritis by 50%.