Obesity: Wounded and Hurting!

Obesity brings with it too many health woes! Obesity is not good…it is highly troublesome, an omnipresent and a significant health issue in today’s society! Not only does it have an adverse effect on your health directly, leading to blood pressure, cholesterol, heart diseases, diabetes, cancer, respiratory problem, dyslipidemia, malfunctioning of organs, etc., but indirectly impacts other ailments and delays cure or healing. An example of this is wounds.

How does being overweight affect wound healing

Wounds need the right environment for healing which depends largely on the person’s overall health and well being. If there are health issues, then wound healing is delayed. Morbidly obese people usually tend to have several health problems which have a direct impact on wound healing. The process of wound healing can get delayed because of this.

Complications of wound healing

Wounds can be a big bother if they do not heal quickly. Handling serious wound conditions can be tricky and a worrisome matter. Wound healing process requires observation and complete care because there can be several complications of wound healing. It is crucial that a wound is given the right environment to heal.

Factors affecting wound healing

Let us take a look at the factors that have an impact on wound healing - both local and systemic.Local factors include oxygenation and infections.

Oxygenation and wound healing

Oxygenation is crucial for wound healing because the initial environment of the site is oxygen-derived due to the high consumption of the gas by metabolically active cells. Hence, if a boost in oxygen levels to the wound tissues is not given then healing will not take place. Right amount of oxygenation protects the wound from infection, encourages angiogenesis, boosts keratinocyte differentiation, migration and re-epithelialization and promotes contraction. Therefore, proper oxygen level is crucial for optimum wound healing.

Infection and wound healing

Infection can be a big hindrance to wound healing and good care has to be taken to ensure that the wound site is protected from any type of infection.
The systemic factors that affect wound healing are age, stress, chronic diseases, diabetes, nutrition, medications, age, body type, etc.

Environment for wound healing

Wounds need the right environment to heal. By the right environment we mean good vitals, proper nutrition, strong immune system, etc. If any of these are compromised then wounds will take a long time to heal, get infected and be the cause of much pain and difficulty.
Wound healing is a complex biological process that consists of hemostasis, inflammation, proliferation and remodeling and involves a large numbers of cell types, including neutrophils, macrophages, lymphocytes, keratinocytes, fibroblasts and endothelial cells. If the body is afflicted with some health problem, then this will slow down the wound healing process.

How does obesity affect wound healing

Obesity plays a major role in obstructing wound recovery primarily because it brings with it so many health issues. This metabolic disorder can lead to a lot of health problems, chief among them being diabetes which makes it difficult for obese people to recover from wounds easily. Plus, there are several other problems like very poor nutrition habits and vascular/venous insufficiency.
As a result, obese people are often faced with various wound complications like infection, impairment of cutaneous wound healing, total wound failure, dehiscence, hematoma and seroma formation, pressure ulcers and venous ulcers. And it is reported that a higher rate of surgical site infection is found to occur in morbidly overweight patients, after both bariatric and non-bariatric procedures.
For a doctor, it becomes imperative to keep an extra look out for infections in obese people because obesity and wound infections are closely related.

How does diabetes affect wound healing

Obese individuals are at a high risk of developing Type 2 diabetes which also weakens their immunity. There is a tendency for fat people to get diabetes. So those with diabetes and a wound have to be extra careful with it and closely monitor it because in such an environment, it is likely to heal slowly and can worsen rapidly. Elevated blood sugar levels stiffen the arteries and narrows the blood vessels. This does not allow normal blood flow and oxygen to the wound and prevents rapid recovery of a wound.
The diabetic person’s poor immune system puts him or her at a high risk for developing an infection. This will slow the healing process of the wound and will require more medication. And if not treated properly, there is the risk of the wound developing gangrene, sepsis or a bone infection.

Impact of obesity on the immune response to infection

Obesity weakens the immune condition to such an extent that it becomes harder for even a minor wound to heal leading to infection and delayed recovery. Stress, anxiety and depression are all situations which are related to obesity and this can cause an impaired immune response.

Obesity and nutrition

Effect of nutrition on wound healing is quite defined. For a wound to heal, proper nutrition is required like Vitamins A and C, zinc and sufficient proteins. A well-balanced diet of fruits, vegetables, dairy products, whole grains and low-fat proteins is essential. However, obese people tend to eat very poorly. They will binge on high cholesterol and high calorie foods which are extremely detrimental to their overall well being. Their diet often is high in sugar and they keep very poor nutrition routine and discipline. It is recognized that deficiencies of specific nutrients can have a negative effect on wound healing and that a composite nutrition support is necessary for recovery.

Vitamin A is seen to be very important for wound healing process. Its deficiency may lead to prolonging of the inflammatory stage because low Vitamin A serum levels are associated with increased oxidative stress and Th1 response. This is likely to increase the inflammatory processes already involved in the chronic inflammation and fat deposition intrinsic in obesity. Again Vitamin A is important for wound closure, collagenes is and epithelialization as well for decreasing the severity of infections.
For the wound’s defense system to be strong, iron is very important while protein is required for fibroblast proliferation, angiogenesis and collagen production.
Lack of macronutrient and micronutrient and the right cofactors and enzymes delays wound healing in obese individuals and complications arise. This may be sorted out by giving nutritional supplements to these patients before a surgery.

Obesity and vascular/venous insufficiency

Obesity is also associated with venous insufficiency which arises in obese people because there is a disproportionate increase in the density of the capillary in comparison with the adipose tissue. This has an impact on wounds because vascular insufficiencies and changed population of immune mediators present may increase the inflammatory status of the wound and leave the patient more vulnerable to infections.
Venous insufficiency creates a barrier around the capillaries thus preventing oxygen and nutrients from capillaries to reach the surrounding tissues. This leads to the development of chronic wounds and delayed wound healing.