Obesity is not just a matter of body type; it is a complex health problem that can have far-reaching consequences. It is important to focus on the urgent need for awareness and action in managing this health crisis.
Obesity, a growing epidemic:
The global rise in obesity is alarming, affecting millions of people and posing serious health risks beyond the surface. According to the National Family Health Survey 5, 22.9% of men and 24% of women in India are overweight. In an interview with HT Lifestyle, Dr Aparna Govil Bhaskar, Consultant Bariatric and Laparoscopic Surgeon at Metaheal – Laparoscopy and Bariatric Surgery Centre in Mumbai and Saifee, Apollo and Namaha Hospitals in Mumbai, shared, “It is not just about weight gain, but a cascade of health challenges associated with it, including metabolic (diabetes, hypertension, cholesterol problems), cardio-vascular (heart disease), orthopaedic (joint pain), lung and liver diseases, risk of certain cancers, PCOD and mental health issues such as depression and anxiety.”
Effects on kidney health:
Dr. Aparna Govil Bhaskar explained, “A lesser known but important effect of obesity is on kidney health. The role of obesity in diabetes and high blood pressure further increases this risk, making kidney problems a major risk for people struggling with weight problems.” She explained some of the ways in which obesity adversely affects the kidneys –
- Proteinuria: Proteinuria is often a sign of kidney damage. It is significantly associated with central obesity. It often goes undiagnosed because it has no clinical symptoms.
- Sub-nephrotic syndrome: Patients suffering from obesity may develop subclinical nephrotic syndrome. Unlike the usual acute onset of nephrotic syndrome, this condition progresses slowly over several years. Nevertheless, obesity increases the risk of kidney dysfunction in affected individuals.
- Progression of end-stage kidney disease (ESKD): Individuals with obesity have a threefold increased risk of developing ESKD compared to individuals of normal weight.
- Kidney stone: People who are obese have a higher risk of developing kidney stones.
- Problems during dialysis: Obese individuals face greater challenges with IV line insertions due to higher levels of fatty tissue under the skin. The time needed for dialysis and its frequency may also be longer. It is also more difficult to regain dry weight after dialysis.
- kidney transplant: Transplant recipients with severe obesity have higher rates of delayed graft function, wound infection and rejection. Although BMI cut off limits for transplantation have been raised, it is still one of the leading reasons for inactivity on the transplant list.
- cancer: Overweight individuals have a 35% higher risk of kidney cancer than those of normal weight, while obese individuals have a 76% higher risk, regardless of gender.
- Fatty kidney: Accumulation of fat around the kidneys in obese individuals is said to play a role in kidney dysfunction. This can have a toxic effect on the kidneys and increase the likelihood of kidney damage.
- Other effects: Obesity is associated with obstructive sleep apnea and non-alcoholic fatty liver disease (NAFLD). Both of these conditions have been shown to decrease kidney function.
Understanding the mechanism:
Dr. Aparna Govil Bhaskar explains, “Obesity damages the kidneys in three ways: by causing inflammation that directly damages kidney tissue, by disrupting hormonal balance (such as insulin and leptin), and by accumulating excess fat around the kidneys, which affects their function. Additionally, obesity is often associated with conditions such as diabetes and hypertension, both of which can independently damage the kidneys. These combined effects emphasize the critical importance of managing obesity to protect kidney health.”
Tackling obesity for kidney health:
Emphasising on a holistic approach to tackle obesity and focusing on sustainable lifestyle changes rather than quick solutions, Dr Aparna Govil Bhaskar advised, “Small but consistent adjustments such as increasing physical activity, choosing whole foods over processed foods, and addressing emotional eating patterns are important. Individuals can also explore the role of anti-obesity medications under the guidance of their nephrologist.”
Role of Metabolic/Bariatric Surgery in Kidney Disease:
Dr. Aparna Govil Bhaskar explains, “Metabolic/bariatric surgery comprises surgical procedures aimed at reducing obesity and correcting metabolic abnormalities. The most common surgeries in India include vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and mini gastric bypass. Choosing the most appropriate procedure requires consultation with a nephrologist as well as the bariatric surgery team. Surgical interventions for obesity have significantly improved the management of chronic kidney disease (CKD) in both diabetic and non-diabetic patients, reducing the rate of decline in kidney function towards end-stage kidney disease (ESKD).”
He elaborated, “Even in established ESKD cases, bariatric surgery remains a generally safe intervention with low complication rates. Bariatric surgery can also be performed before kidney transplantation for an obese patient. This increases the chances of receiving a transplant and subsequently having better outcomes. Similarly, it may offer benefits as a treatment option for potential obese kidney donors. The impact of obesity on kidney health is a serious concern that needs to be addressed.”
With informed choices, support from health professionals, and a commitment to lifestyle changes, individuals can pave the way toward a healthier, kidney-friendly future. For more information and guidance on managing obesity and kidney health, consult a qualified health care professional.
