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How Obesity and Overweight Affects Wound Healing
Obesity and excessive weight are conditions that continue to disproportionately affect Black and African American people in the United States. With nearly 48% of African Americans being clinically obese, you can tell why more African Americans are grappling with heart disease, hypertension, and diabetes. An even more serious and concerning scourge in African American communities is lower-limb amputation, which is mainly caused by poor wound care among patients. Below, we lay bare the effects of obesity and overweight on wound healing.
What is Obesity and Overweight?
The World Health Organization (WHO) defines obesity as the abnormal or excessive accumulation of fats that poses a risk to one’s health. The body mass index (BMI) helps differentiate the two: one is considered overweight if their BMI is over 25, and obese for a BMI over 30. Overweight and obesity have grown into pandemic proportions, with over 4 million mortalities each year resulting from these conditions.
In African American communities, obesity and overweight are associated with systemic conditions such as heart disease, hypertension, and diabetes, which are risk factors for amputation. With Black and African Americans stuck on diets consisting of fried and highly processed foods, it feels like there is no end in sight when it comes to curbing obesity. What’s even more worrying is that African Americans have among the lowest rates of physical activity among all ethnic groups in the United States.
Overweight, Obesity, and Wound Healing
Obesity has long been linked to a reduced life expectancy. And it is important to note that it is detrimental to wound healing. When overweight and obese people develop pressure ulcers due to advanced age and limited mobility, the former conditions may impede wound healing. This is also the case when diabetic people develop diabetic foot ulcers – overweight and obesity could hinder the optimal healing of such chronic wounds.
When overweight and obese individuals undergo surgery, conditions like cardiovascular disease, hypertension, and diabetes could complicate postsurgical wound healing and increase the odds of developing wound complications. To better understand the relationship between obesity and wound healing, we must highlight two body systems: the cardiovascular and respiratory systems.
The Anatomy of Adipose Tissue
It is important to point out the properties of adipose tissue to help understand how obesity impacts wound healing. Adipose tissue is divided into lobules – small lobes that receive their blood supply from the surrounding capillary network. Obesity means that there is an excess of adipose tissue, and this increases the risk of venous insufficiency – the condition where blood doesn’t flow properly to the heart.
In body areas with high adipose tissue density, venous insufficiency stiffens the fat tissue even more. This results in decreased capillary proliferation and angiogenesis. Simply put, fat tissue restricts blood supply and hinders the development of blood vessels that supply the surrounding tissue with oxygen and tissue.
Cardiovascular System
Excessive weight and obesity affect the cardiovascular system by increasing the heart’s workload – the heart is frequently forced to work harder to supply oxygenated blood to all tissues and remove waste materials as well. Optimal blood circulation is vital for wound healing as body tissue receives much-needed oxygen and nutrients. Long-standing obesity decreases the heart’s efficiency due to overwork, which in turn reduces the cardiac output and blood volume.
Ischemia – the lack of blood to tissue – often leads to tissue necrosis. This condition can result from vessel constriction or obstruction, or the inability of the heart to pump adequately.
Respiratory System
Obesity often results in chronic hypoxia – the condition where the oxygen reaching body tissues is deficient. Typically, the respiratory pattern in obese people is hypoventilation – a condition where one breathes too shallowly or too slowly. This results from the thicker chest wall and the diaphragm’s inability to fully descend due to the abdominal adipose tissue.
The pulmonary function in obese individuals is altered by hypoventilation. In turn, such people experience a reduced vital capacity and tidal volume. Significant oxygen pressure is essential for adequate collagen formation. In obese people, the partial pressure of arterial oxygen is lower than in non-obese individuals due to the avascularity of adipose tissue.
Like moisture, oxygen requires a balancing act to aid optimal wound healing without significant clinical interventions. Collagen synthesis is oxygen-dependent, and a lack of it at the tissue level impedes leukocytic and phagocytic activities. The proliferation and migration of cells, which lead to the epithelialization of a wound from the edges inwards, also depends on oxygen.
Macro and Micronutrient Deficiencies
The orderly progression of wound healing also requires an adequate supply of protein, minerals, and vitamins. Unlike the common assumption, obese people suffer from malnutrition due to a high-calorie and high-fat diet that lacks minerals and vitamins. This, in turn, negatively impacts wound healing.
Obesity impacts wound healing in several ways. Understanding the effect of obesity and overweight on wound healing can help wound care specialists and caregivers understand the measures that can be taken to help obese patients to heal, including improving nutrition and administering supplementary oxygen.
Leveraging Technology in Amputation Prevention
The Wound Docs is a nationwide network of healthcare professionals such as podiatrists, vascular surgeons, and wound care specialists. By bringing together these healthcare professionals and leveraging the power of AI and advanced biologics, The Wound Docs seeks to achieve better results in wound care among Black and African American patients.
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