Overweight and obesity

How weight is assessed

Body mass index (BMI) is calculated as weight in kilograms divided by the square of height in meters. Overweight is defined as BMI 25–29.9 and obesity as BMI 30 or above; in some ethnic groups the thresholds are lower. BMI is a guide, but it does not directly distinguish fat from muscle mass. Assessment is supplemented by waist circumference (visceral abdominal fat is riskier than subcutaneous fat; a practical rule is that the waist should be below half the height), the history of weight change and a search for complications. A person can have metabolic risk even when the change in weight seems small.

Why obesity develops

Biological and genetic factors (appetite regulation in the hypothalamus, satiety hormones), nutrition, physical activity, sleep, environment and some drugs (corticosteroids, some antidepressants and antipsychotics, insulin) all contribute. It is not a simple matter of willpower. Some endocrine diseases may contribute to weight gain, such as hypothyroidism, Cushing’s syndrome and PCOS, but not every weight gain has a hormonal cause. Tests are chosen according to symptoms and examination.

What problems it may accompany

Obesity can raise the risk of type 2 diabetes, arterial hypertension, dyslipidemia, fatty liver, sleep apnea and joint problems. Seek assessment if weight keeps rising, activities become harder or you already have one of these conditions. As appropriate, glycemia, HbA1c, the lipid profile, liver enzymes and other markers are checked; symptoms of eating disorders also need attention, and strict diets are not a suitable solution for everyone.

How it is treated

The plan includes lasting changes in nutrition, physical activity according to ability, adequate sleep and follow-up. The aim is to improve health and maintain the result; even a loss of 5–10% of weight considerably improves glycemia, blood pressure and lipids. In selected cases, weight-management medicines may be recommended (for example GLP-1 receptor agonists such as semaglutide, tirzepatide and liraglutide, or orlistat) or assessment for metabolic (bariatric) surgery at a specialized center, usually considered when BMI is 40 or above, or 35 or above with coexisting conditions. The choice requires weighing benefits, limitations and contraindications, and these medicines require follow-up.

Do not use slimming drugs or products bought online without medical supervision. Check-ups take place every 6 months to a year, or sooner when the doctor considers it reasonable. Care at Tirana Polyclinic: we offer endocrinology consultation and assessment of metabolic factors. Care may be coordinated with other specialties according to coexisting problems.