KUWAIT CITY, Dec 1: Dermatologist Dr. Mohammad Al-Qasimi highlighted the growing threat of obesity both locally and globally, particularly in light of a recent report by the World Obesity Federation, which warns that half of the world’s population, approximately four billion people, could be obese by 2035.

Dr. Al-Qasimi also highlighted the alarming obesity rates in Gulf countries, with Kuwait ranking first in the Gulf and Arab world and tenth globally, as 45.3 percent of its population are obese.

In an interview, Dr. Al-Qasimi attributed these rising rates to unhealthy eating habits, the widespread consumption of fast food, and a lack of physical activity.

He pointed to statistics on obesity among children in Kuwait, explaining that in 2023, the obesity rates among school children aged 9-13 ranged from 34.4 percent to 40.6 percent for boys, and from 28.3 percent to 26.6 percent for girls.

Definition of Obesity

Dr. Al-Qasimi emphasized that obesity is a chronic disease affecting approximately two billion people worldwide.

He explained that it is a major contributor to various other chronic health conditions. Obesity involves an imbalance in the body’s adipose tissue, which serves as both a basic energy storage organ and a hormonal organ. Adipose tissue secretes hormones and signals that influence cell function, one of which is leptin.

Leptin is a hormone whose secretion is directly proportional to the amount of adipose tissue in the body. As the amount of body fat increases, leptin levels rise. Its primary role is to help regulate food intake, body mass, and metabolism, as well as to modulate hormonal secretion and the production of inflammatory cell stimulants.

When obesity occurs, there is a disruption in the function of leptin, leading to elevated levels of the hormone in the blood. This imbalance prevents the body from maintaining proper regulation between food intake, fat mass, and energy expenditure.

Under normal weight conditions, leptin helps control hunger by regulating energy consumption, ensuring that a person only feels the urge to eat when their body needs energy. Leptin signals satiety, preventing overeating by directly influencing the brainstem and the hypothalamus (the part of the brain responsible for hunger and energy regulation).

However, with weight gain and elevated leptin levels, the body’s cells become resistant to leptin’s effects, a condition known as leptin resistance. This resistance leads to an inability to sense satiety, contributing to continued overeating and difficulty in regulating body weight.

Consequently, the brain becomes less responsive to the effects of leptin due to the continuous and prolonged stimulation from elevated leptin levels. As a result, the individual loses the feeling of satiety and fullness, which drives them to eat more than needed.

The scientific definition of obesity is a chronic inflammatory disease that involves a disruption in both the hormonal and immune systems. This dysfunction leads to a cascade of metabolic issues, contributing to the development of chronic systemic diseases such as high blood pressure, diabetes, elevated blood lipids, atherosclerosis, and others.

Researchers have discovered a substance or an effective element called adiponectin, which plays a role opposite to leptin. Adiponectin levels rise with weight loss and help sensitize cells to insulin, thereby reducing or preventing insulin resistance.

In addition, adiponectin has anti-inflammatory properties, counteracting the pro-inflammatory effects of leptin.

Researchers have studied the interplay between these two molecules to better understand how they contribute to the worsening of obesity-related diseases or conversely their potential improvement and treatment.

Dr. Al-Qasimi affirmed the significance of these discoveries in understanding of the mechanisms behind obesity and the potential for using new laboratory tests for diagnosis, as well as modern medications for treatment.

Currently, obesity treatment primarily focuses on eliminating insulin resistance or reducing hunger, but modern drugs have the potential to target and prevent all the factors that contribute to obesity, including both hormonal imbalances and inflammatory triggers.

Obesity and Skin Diseases

Dr. Al-Qasimi highlighted the strong link between obesity and many skin diseases.

He explained that obesity is linked to approximately 17 different skin conditions. While adipose tissue produces leptin, recent studies have shown that skin cells, including epidermal cells and hair follicle cells, also produce this hormone.

Under normal weight conditions, leptin promotes the renewal and multiplication of skin cells and fibroblasts, as well as the production of collagen, all of which contribute to skin regeneration. This process aids in wound healing and protects against bacterial infections by stimulating the body’s innate immunity.

However, in obesity, elevated leptin levels trigger the activation of inflammatory mediators within skin cells. This can make the skin more susceptible to bacterial and fungal infections and delay wound healing, which in turn contributes to the formation of skin scars.

Lymphedema

Dr. Al-Qasimi explained that obesity leads to physiological changes in the skin, including disorders in the skin barrier. This results in water loss, increased production of sebum (oil), and an overall enlargement of the skin area, which contributes to excessive sweating and dysfunction of the lymphatic vessels beneath the skin, which can lead to lymphedema, a condition characterized by fluid retention and swelling, especially in the limbs.

Obesity can also cause mechanical factors that contribute to skin issues, such as increased pressure on the feet due to weight gain. This can cause the soles of the feet to thicken, crack, and develop skin ulcers.

Hair Loss and Alopecia

Researchers have discovered the presence of leptin and its DNA in various components of hair during obesity, which negatively affects the stages of hair growth.

Dr Al-Qasimi said, “This is compounded by hormonal imbalances and the chronic inflammation associated with obesity. As inflammatory stimuli increase within hair follicles, they contribute to the understanding of hair loss and alopecia. This knowledge opens the door to new treatments that target and counteract the negative effects of inflammation on hair health.”

Psoriasis

Dr. Al-Qasimi said psoriasis is one of the most common skin diseases linked to obesity, affecting about three percent of the population both locally and globally.

He elaborated that psoriasis is a chronic skin condition influenced by genetic, autoimmune, and metabolic factors, all of which are exacerbated by weight gain.

Scleroderma

Dr. Al-Qasimi also highlighted the strong link between obesity and scleroderma, pointing to factors like hormonal imbalance as contributing causes.

He said there are two types of scleroderma - cutaneous and systemic, adding that laboratory analysis of leptin protein could be used to assess the state of sclerosis, as leptin is considered a marker indicating the activity of the disease.

Lupus

Dr Al-Qasimi explained that recent studies by the American Lupus Foundation have shown that obesity is a disease that carries health risks, including internal conditions such as type 2 diabetes, dyslipidemia, high blood pressure, and heart and arterial diseases. It also contributes to the rapid onset of lupus, even in the early stages of weight gain, due to the increased levels of inflammatory mediators it causes.

Skin Tumors

He highlighted the increased likelihood of developing skin tumors and cancers, such as melanoma, due to elevated levels of leptin.

Dr. Al-Qasimi explained that leptin promotes the growth of blood vessels, contributing to tumor development and metastasis. While leptin has been linked to the progression of other skin cancers, such as carcinoma, studies have not yet proven its role in the development of basal cell carcinoma, a type of cancer that is generally low in metastasis and treatable.

Studies have also confirmed a direct link between skin appendages and obesity. High levels of leptin, along with resistance to its receptors on skin and tissue cell membranes, contribute to the growth of blood vessel tissue. This process promotes the development and enlargement of skin appendages.

Hydro Adenopathy and Acne

Dr. Al-Qasimi stressed that obesity contributes to the development of acne and hidradenitis suppurativa, conditions that affect areas such as the armpits and other skin folds, adding that researchers have identified a direct link between obesity and the worsening of atopic eczema, with obesity increasing both the severity and frequency of flare-ups.

Acanthosis Nigricans

Among other skin conditions associated with obesity, Dr. Al-Qasimi highlighted acanthosis nigricans, a disease that affects areas such as the neck, armpits, and groin. It is characterized by the thickening of the skin and brown pigmentation, often accompanied by insulin resistance. This condition impacts skin cells and fibroblasts.

Studies have shown that the hormone leptin plays a significant role in causing acanthosis nigricans.

Skin Striation

Dr. Al-Qasimi explained that obesity can also cause skin striation, which refers to atrophic skin lines that appear on areas such as the breasts, abdomen, thighs, and buttocks. These lines are initially red-purple in color and run in a direction opposite to the natural tension lines in the skin. Over time, they turn white. Obesity is considered one of the primary causes of this condition.

Hirsutism in Women

Hirsutism in women is a skin condition commonly associated with obesity. Hirsutism is characterized by excessive hair growth in areas typically seen in men, such as the beard area. This condition tends to worsen with obesity, as the enlargement of adipose tissue leads to hormonal imbalances, causing an increase in male hormones (androgens), which are directly proportional to the level of obesity in the body.

Dercum

Dr. Al-Qasimi highlighted the Dercum’s disease, which is a condition that often affects women, particularly those who are postmenopausal and obese. It is characterized by painful, multiple fatty tumors that typically appear in the extremities, abdomen, and back, accompanied by thin skin and blue bruising.

Varicose Veins

Obesity also leads to increased pressure within the abdomen, which impairs the return of venous blood from the lower extremities. This causes dysfunction in the valves of the veins, leading to their expansion and stagnation, known as varicose veins. As a result, fluid leaks out of the veins into the surrounding tissue, contributing to conditions like venous eczema and stasis ulcers.