Unveiling hidden dangers of obesity's impact on kidney health

Obesity is not just a matter of physical appearance; it is a complex health issue with far-reaching consequences. It is crucial to bring to attention 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 and posing serious health risks beyond the surface. According to National Family Health Survey 5, 22.9% men and 24% women are overweight in India. In an interview with HT Lifestyle, Dr Aparna Govil Bhasker, Consultant Bariatric and Laparoscopic Surgeon at MetaHeal - Laparoscopy and Bariatric Surgery Center in Mumbai and Saifee, Apollo and Namaha Hospitals in Mumbai, shared, “It's not just about weight gain but a cascade of health challenges associated with it, including metabolic (diabetes, hypertension, cholesterol issues), cardio-vascular (heart disease), orthopaedic (joint pains), lung and liver disease, risk of certain cancers, PCOD and mental health issues like depression and anxiety.”

Impact on Kidney Health:

Dr Aparna Govil Bhasker revealed, “One of the lesser-known but significant impacts of obesity is on kidney health. Obesity's role in diabetes and hypertension further compounds this risk, making kidney problems a looming threat for those battling weight issues.” She listed some of the ways in which obesity affect the kidneys adversely -

• Proteinuria: Proteinuria is often a sign of kidney damage. It has a significant association with central obesity. It often goes undiagnosed as it does not have any clinical symptoms.
• Sub-nephrotic syndrome: Patients with obesity may develop a sub-clinical nephrotic syndrome. Unlike the typical rapid onset of nephrotic syndrome, this condition progresses slowly over several years. Nevertheless, obesity increases the risk of kidney dysfunction in affected individuals.
• Progression to end stage kidney disease (ESKD): Individuals with obesity have a 3 times higher risk of developing ESKD as compared to those with normal weight.
• Kidney stones: Individuals with obesity have a higher risk of developing kidney stones.
• Problems during dialysis: Individuals with obesity face more challenges with iv line insertions due to higher levels of fatty tissue under the skin. Time taken for dialysis and its frequency may also be higher. It is also more difficult to achieve dry weight after dialysis.
• Kidney transplant: Transplant recipients with severe obesity have a higher rate of delayed graft function, wound infection and rejection. Though the BMI cut off limits for transplant have been increased, it is still one of the leading causes of being inactive on transplant list.
• Cancer: The risk of kidney cancers increases by 35% in overweight individuals and by 76% in individuals with obesity in comparison to normal weight people, irrespective of the gender.
• Fatty kidney: Fat accumulation around the kidney is said to play a role in kidney dysfunction in individuals with obesity. It can have toxic effects on kidneys and lead to an increase in kidney damage.
• Other effects: Obesity is associated with obstructive sleep apnoea and non-alcoholic fatty liver disease (NAFLD). Both of these conditions have been shown to add to the loss of kidney function.

Understanding the Mechanisms:

Dr Aparna Govil Bhasker informed, “Obesity harms kidneys in three ways: by causing inflammation that directly damages kidney tissues, by disrupting hormonal balance (like insulin and leptin), and by accumulating excess fat around the kidneys, which strains their function. Additionally, obesity is often linked to conditions like diabetes and high blood pressure, both of which can independently lead to kidney damage. These combined effects emphasize the critical importance of managing obesity to protect kidney health.”

Tackling Obesity for Kidney Wellness:

Emphasising a holistic approach for tackling obesity and focusing on sustainable lifestyle changes rather than quick fixes, Dr Aparna Govil Bhasker advised, “Small but consistent adjustments like increasing physical activity, opting for whole foods over processed ones, and addressing emotional eating patterns are key. individuals may 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 Bhasker explained, “Metabolic/bariatric surgery, encompasses surgical procedures aimed at reducing obesity and improving metabolic abnormalities. The most common surgeries in India include vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and mini gastric bypass. Choosing the most suitable procedure requires consultation with a bariatric surgery team along with a nephrologist. Surgical intervention for obesity has significantly enhanced the management of chronic kidney disease (CKD) in both diabetic and non-diabetic patients, leading to a reduced rate of decline of kidney function towards end-stage kidney disease (ESKD).”

She elaborated, “Even in established ESKD cases, bariatric surgery remains a generally safe intervention with low complication rates. Bariatric surgery can also be performed for a patient with obesity before kidney transplantation. It increases the possibility of getting a transplantation and having better outcomes later. Similarly, it may offer benefits as a treatment option for potential obese kidney donors. Obesity's impact on kidney health is a pressing concern that demands attention.”

With informed choices, support from healthcare professionals, and a commitment to lifestyle changes, individuals can pave the way towards a healthier, kidney-friendly future. For more information and guidance on managing obesity and kidney health, consult a qualified healthcare professional.