Select one chronic or complex condition and explore this relationship by addressing the following questions. Chronic condition: Obesity * Discuss the factors surrounding gastrointestinal health that...

Introduction
Obesity is a complex, multifactorial, chronic noncommunicable condition and is considered as a global epidemic.[1] Obesity can be simply defined as the accumulation of excess abnormally high proportion of fat that may impair the health of an individual. The human body, for its normal functioning, requires energy. The energy intake of an individual must be adequate to meet the energy needs of his/her body for metabolism and physical activity. Obesity is mainly caused due to energy imbalance which results when the calorie intake exceeds the measure of calories expended by an individual. The recurring imbalance leads to weight gain over time, and it is most commonly caused as a result of overeating, inactivity, or both.[2]
Obesity is one of the commonest and highly prevalent metabolic disorder which is associated with several comorbidities. The prevalence and incidence of obesity are increasing worldwide which is mostly due to lifestyle habits. Obesity is associated with a significant risk of mortality and development of other disorders, such as metabolic and cardiovascular disorders. It is one of the significant public health concerns which is associated with a detrimental effect on health and enormous economic burden. The adverse health complications that result from obesity include stroke, cardiovascular diseases, type 2 diabetes, dyslipidemia, hypertension, breast cancer, endometrial cancer, prostate cancer, gallbladder disease, osteoarthritis, respiratory diseases such as asthma and sleep apnea, and depression.[3] Of late, the relationship between obesity and functional gastrointestinal (GI) disorders is much debated.[4]
Obesity and gut health
Obesity is related to several gastrointestinal conditions. Though most of the obesity-related gut diseases are linked with altered humoral and mechanical factors, some conditions are associated with insulin resistance and altered circulating levels of adipocytokines. The common conditions that are associated with gut health include Barrett's esophagus, gastroesophageal reflux disease (GERD), nonalcoholic fatty liver disease, colon polyp and cancer, hepatitis-C associated disease, gallstones, cholangiocarcinoma, pancreatic cancer, and hepatocellular carcinoma.[4]  
Adiposity and excessive weight lead to elevation of leptin, free fatty acids, plasminogen activator-inhibitor, resistin, and tumor necrosis factor-alpha and reduction in adiponectin. The increase in bioavailability of insulin-like growth factor 1 (IGF 1) and elevation of cell proliferation on target cells and inhibition of apoptosis.[5]
The factors surrounding the effect of obesity on gastrointestinal health include insulin and IGFs, adipokines such as leptin, resistin, adiponectin, visfatin, apetin, omentin, vaspin, chemerin, and retinol binding protein 4 and immunomodulation.[5]
Obesity is linked with low-grade, chronic inflammation which plays an important role in the modulation of immune cell function. Other risk factors of obesity include age, gender, endocrine disorders such as hypothyroidism and diabetes mellitus, improper dietary habits, lack of physical activity and certain behavioral issues. Recent studies have shown that the GI microbiome plays a vital role in weight gain.[4]
Obesity management involves a multidisciplinary approach which involves physicians, nurses, dietitians, physical activity instructors, bariatric surgeons, and behavioural therapists. Physicians and nurses are involved in assessment of the severity of obesity, dietitians help in planning dietary requirements, physical activity instructors recommend necessary exercises, and behavioural therapists help in increasing the adherence to treatment. Practice nurses play an important role in assessing such issues and addressing them. Nurses can identify the GIT diseases associated with obesity based on the symptoms and signs patients exhibit. Gastrointestinal hormonal changes and inhibition of certain digestive pathways can lead to caloric imbalance, which in turn can lead to obesity. Nurses must be vigilant in assessing non-alcoholic steatohepatitis, cholelithiasis, and gastrointestinal reflux disease which are directly associated with abdominal obesity and weight. Also, nurses should be cautious in observing the gastrointestinal functions, especially the sensations of postprandial fullness and satiation in the patient. Changes in the function of the gastric system such as increased gastric accommodation and rapid gastric emptying should also be observed, as they may lead to excess calorie intake and weight gain.[6]
Dietary and gastrointestinal considerations
The amount of food taken by an individual can influence body weight. It is more common that the increase in energy intake over a period causes weight gain and obesity. Increased consumption of energy-dense food, fast-food meals, and food rich in fats and carbohydrates causes an excess intake of calories and results in weight gain. Also, lack of adequate nutrition for microbiota is an essential factor that impacts dysbiosis, dysfunctional microbiota, chronically raised inflammation and the production and seepage of endotoxins via different tissue barriers.[5]
Communication between the central nervous system and gastrointestinal tract forms a vital part of appetite regulation. The gut-brain-axis involves both humoral and neural components which include brainstem-vagus nerve complex in the feeding mechanism. Any alteration on the release of neuropeptides such as neuropeptide Y can affect the feeding behavior and also the energy expenditure. The gut hormones in the GI tract play an...