05 Dec 23

Understanding the link between obesity and breathing difficulties

Is there a relationship between obesity and breathing difficulties? Apparently there is, and it is not necessarily related to a lack of physical activity.

Together with an increased risk for conditions like diabetes or cardiovascular diseases, excessive accumulation of fat in your body may also lead to shortness of breath or dyspnea, which may be an indicator for underlying inflammation or changes in lung function.

  1. How are obesity and breathing difficulties linked

There are two way obesity can affect your lung function: by direct restriction or because of indirect processes.

Shortness of breath due to excessive body weight is usually associated with central obesity. In this case, fat tends to deposit especially around the chest and abdomen, creating a so-called apple-shaped body type (unlike peripheral obesity, where most of the fat can be found around the hips, thighs and limbs, creating a pear-shaped body). Fat deposits in your neck, chest and abdomen can act as obstacles for your lungs, restricting their ability to expand and causing alterations in breathing patterns.

Besides, central obesity can also impact hormone production, creating mild inflammations that can play a role in the development of metabolic syndrome and sleep-disordered breathing or sleep apnea.

Severe obesity-related shortness of breath can also be due to a condition known as obesity hypoventilation syndrome (OHS).

  1. What is OHS, obesity hypoventilation syndrome

OHS, obesity hypoventilation syndrome, also known as Pickwickian syndrome, is usually diagnosed in excessively overweight patients whose blood gas levels reach a specific threshold.

From a functional standpoint, healthy patients normally exhale carbon dioxide during the breathing process. In case of OHS, the levels of carbon dioxide in the blood are too high and the oxygen levels too low in comparison, which could lead to severe health problems.

  1. How is obesity hypoventilation syndrome diagnosed

Although the risk for OHS increases in obese patients, not all overweight people develop it. There are a number of factors that must be taken into consideration before issuing a diagnosis of obesity hypoventilation syndrome.

First of all, your physician will have to rule out other respiratory, neuromuscular, or metabolic conditions that could explain the following symptoms:

  • Breathlessness and wheezing
  • Dizziness or headaches
  • Fatigue, daytime sleepiness or lethargy
  • Difficulty breathing at night, often accompanied with loud snoring, chocking or gasping

In order to ensure a correct diagnosis, your doctor will first discuss your personal history and take measurements of your weight, height, waist and BMI.

At that point, they may ask you to run a lung test – such as lung diffusion capacity test, lung volume test or spirometry – as well as pulse oximetry and arterial blood gas test.

Diagnostic imaging can also be helpful: radiography, CT scan, MRI or bronchoscopy may be required in order to correctly evaluate your case. Further testing, such as sleep or cardiac studies, may also be considered.

Anyway, even though breathing difficulties may actually be due to excessive body weight or the accumulation of body fat, a patient may still not meet OHS diagnostic criteria.

  1. Treatments for obesity-related dyspnea

Since there are currently no medications for the treatment of OHS, most plans focus on healthy lifestyle changes as well as normalizing ventilation.

Following a diet plan and an exercise routine is still the preferable way, though weight loss must occur at a healthy rate and still it’s not always sustainable for all kinds of patients. Bariatric surgery is also an option for severe cases.

In case the oxygen levels are severely depleted, treatments to normalize ventilation may include positive airway pressure (CPAP or PAP), which involves the use of a respiratory mask to deliver air in your lungs at a consistent pressure, in order to get your body to properly expel toxins and gas. CPAP and PAP can also be used as a support during a long-term weight loss plan.

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