Obesity

Obesity - A Global Health Challenge

Obesity is no more a sign a good health or prosperity. It is a chronic and a serious disease, which requires life long treatment like diabetes. It results from an interaction between ones genes and environment. It is on the rise worldwide and more so in India due to westernization or modernization. WHO consider obesity to be a global epidemic? As per WHO, there are nearly 300 million obese people all over the world, and many more are over weight. Obesity poses more burden than you can weigh. It is the mother of all diseases and shortens your life. It is major risk factor for a number of medical diseases e.g. diabetes, hypertension, coronary artery disease, dyslipidemia, osteoporosis, arthritis, cholecystitis, and psychosocial problems. We have to manage obesity well and more aggressively. Loosing weight is one aspect; the more challenging part is maintaining the reduced weight. “Quick-Fix-Diets” and “Yo-Yo” dieting have only a short term effect on weight loss. We should always go for long-term and a more realistic weight management programme.

Thus India is faced with a dual epidemic of Diabosity (i.e. Diabetes & Obesity) and is facing a major economical burden. Obesity is central in causation of diabetes and is a major modifiable risk factor. Obesity has a negative impact on all the parameters of diabetes and a modest weight loss should be an important goal in the management of diabetes. Obesity should be treated as aggressively as diabetes, hypertension and dyslipidemia. As Indians have higher fat content and central obesity for same weight and BMI as compared to Caucasians, intervention for weight management should start at an early stage.

What are the Causes of Obesity :

The main cause overweight or obesity is a positive energy balance i.e. you are consuming more calories (over eating) and using less calories (not being active enough/sedentary lifestyle).  The other causes are genetic/hereditary, certain medications (steroids, insulin and anti-depressants) and hormonal disorders (hypothyroidism, POCD and Cushing’s disease). In a recent international conference Dr. Francesco Branca (Europian advisor to WHO) made a number of observations regarding prevalence of obesity in Europe. In India esp. in metros the incidence of obesity of has tripled in last two decades, nearly 40-50% of adults and 20% of children are overweight or obese. Indian environment is very conducive to unhealthy life style i.e. increase intake of high calorie fast foods and sedentary life style. Indians have more incidence of central obesity for the same weight and higher fat content for the same BMI as compared to Caucasians. Thus for Indians cut off values to diagnose obesity are lower than those for Caucasians.

Diagnosis of Obesity for Indians ( Indian Consensus Conference at Delhi, 2008):

 

BMI:	<=23 is Normal
	23-25 is Overweight
	>= 25 is Obesity

Class 1 (moderate to severe) obesity if BMI 25-30
Class 2 (morbid obesity) if BMI >30

CENTRAL OBESITY :

Waist circumference should be >80 cm for women and >90 cm for men

"Shorter the Waist Line, Longer the Life Line"

What is the health problems associated with obesity?

Obesity is associated with following health problems: 

1. Diabetes: Obese people are 2X as likely to develop type2 diabetes as those with normal weight.
2. High Blood pressure: Obese adults are 2X as likely to have high blood pressure as those with normal weight. 
3. Heart disease: Angina,Heart attack & heart failure are common in diabetics
4. Paralysis (Brain Stroke): This is due to clot in an artery of the brain, thus stopping blood flow.
5. High blood cholesterol: Generally “Bad Cholesterol” ( Total cholesterol, LDL & Triglycerides) is High & “Good cholesterol”  (HDL) is Low in Obese individuals
6. GERD (Gastro-esophageal Reflux): Heart Burn, Belching
7. Osteoarthritis: Pain & Inflammation of joints is more common in Obese individuals esp. Knee, Hip, and Spine. 
8. Cancer: Cancer of Gall bladder, Breast, Uterus, Cervix and Ovaries  (in women); while cancer of the colon, rectum and prostate (in men) are common obese people.
9. Obstructive Sleep Apnoea (OSA):Snoring with intermittent spells of apnoea during sleep followed by sleepiness during day time is very common. This results in High BP &  Heart Failre
10. Gallbladder stones: common in obese people esp.women. 
11. Polycystic Ovarian Syndrome (PCOS):Irregular menstrual cycles and infertility due to PCOS are common in obese women.
12. Psycho-social effects: Low self-esteem, Low confidence, Social Isolation & Depression are very common. Life becomes miserable and very frustrating.
13. Short Life span: Obese people have a shorter life span than people with normal weight
14. Poor Quality of life: Excessive Sweating & Shortness of breath even on slightest exertion.
15. Less Job Prospects

All these health problems can improve by loosing weight.
"LOOSE WEIGHT & GAIN LIFE"
"CHANGE YOUR LIFESTYLE FOR A BETTER LIFE"

What are the BENEFITS of loosing weight?

1. You can prevent all health problems associated with obesity
2. Your blood pressure, blood glucose & cholesterol will become normal if already high.
3. You will have a Smart Look, high self-esteem & confidence
4. You will live longer, healthier and happier.

What are the Important Steps for a Successful “Weight Management Programme”

You need to have a strong will power, motivation & determination to achieve success. The following steps would definitely help you in loosing weight:

1. Set Realistic Goals: Always set a goal which can be achieved i.e. a loss of 5-10% in initial weight over 6 months. It has been proved by a number of studies that this much weight loss is both healthy as well as medically beneficial. You must reduce your calorie (food) intake by 500cals/day and also increase your physical activity. Current scientific opinion is that one should loose weight gradually and steadily i.e. 1-2 kg every month.
2. Have a Positive Attitude: Don't be afraid of failures. The most important step is to have a positive attitude and persistence of sincere efforts to succeed in any sphere of life.
3. Identify Triggering Factors: Try to identify triggering factors and avoid them if possible e.g. Loneliness, anxiety, depression, eating while watching TV etc.
4. Put Sincere Efforts : Put your heart and soul in achieving your target and do not ever try to show off as it is for your benefit only.
5. Believe in your self : Nobody is perfect, so avoid negative thoughts like... I can't perform well... I am ugly looking... I am very lazy... etc. Always believe in you self and have a positive approach. I can assure you that you would always succeed.
6. Eating Behaviour Modifications (EBM): This is the most important step for a successful weight management programme. Make simple & small changes in your eating behaviour, and follow them strictly e.g. remove fried food, cold drinks, cookies etc. from your side table or refrigerator.
7. Be Patient: Success would never come over night. Always be happy even if success is very small; reward your self and move to the next goal
8. Life Style Modifications: Always make changes which are simple and easy to follow. Never tax your body by making a complicated schedule, as it would only bring frustration and nothing else.

What is the drug treatment for obesity?

Lifestyle modifications in the form of Healthy Diet, Eating Behaviour Modifications & Regular Exercise are the main pillars for weight loss management. It is not easy to change ones habit of over eating or eating unhealthy (high caloric, high fat & high carbohydrate) diet. You have to have a strong will power, motivation and determination to succeed in achieving your goal.
A good obesity consultant can help you by guiding you to choose right kind of foods, exercise programme and even may prescribe certain medications. You should always remember that these medications are effective only if you have a good control on diet and do regular exercise and not as a substitute. There is only one anti-obesity drug approved by FDA at present i.e. Orlistat (pancreatic lipase inhibitor), which does not let fat/oil (present in the food) gets digested and thus undigested fat passes in the stool. Always consult your doctor before starting this medication.