Obesity means an excess fat collection in the body. There is always an optimal weight for every age and sex. In obesity, this weight exceeds the upper limit of normal by 30%.
Morbid obesity is a condition wherein people are overweight by 45 kilos to what is normal for their age and sex.
The prevalence of obesity has increased sharply since the mid-seventies especially in the developed countries. In fact, obesity has become so rampant that more children and teenagers are obese nowadays than ever before. 70 % of the adult population in the U.S.A is considered obese.
Obesity is not just a cosmetic consideration. It is a medical condition associated with illness and disability. It can lead to: –
- High blood pressures
- Heart diseases like coronary heart diseases (CHD)
- Diseases of gallbladder
- Sleep apnea plus other respiratory problems
- Increased risks for many cancerous conditions in both men and women.
In the developed countries, obesity is more prevalent among people in the lower socio-economic strata whereas, in developing countries, obesity is a problem more seen within the higher socio-economic strata.
- Psychotic Drugs
- There are four major groups of drugs which can cause obesity: Benzodiazepines, Lithium, Antidepressants, Antipsychotic drugs
- Sulphonylurea agents (used in treatments of diabetes)
The increased demand for energy and the heightened metabolic activity of the body on account of the drastic hormonal changes, predispose pregnant women to weight gain and obesity. Women are known to gain as much as 12 to 16 kilos during pregnancy.
Tumors arising in the brain like craniopharyngiomas -> which is a non-malignant tumor, most commonly occurring in children (5-15 age group) and presenting with obesity, lethargy, poor memory and recurrent headaches.
- Endocrine disorders
Disorders affecting the hormone-producing plus secreting glands of the body are called endocrine disorders.
- Poly Cystic Ovarian Syndrome
a condition where a woman’s sex hormones get out of balance. There is an abnormal increase in the production of the male hormones (androgens) causing obesity, irregular periods, acne, hair loss from the scalp but increased body hair etc.
- Underactive thyroid disorder
can cause obesity in spite of a loss of appetite.
- Cushing’s syndrome
a disorder in which the body produces excess cortisol resulting in obesity along with other symptoms of fatigue, weakness, facial flushing, round (moon) face, etc.
So how is OBESITY measured?
The most widely used calculator for obesity is the Body Mass Index (BMI). This number is a ratio of a person’s weight (in kilograms) to his height (in meter square). BMI from 30 up to 35 indicate obesity. For adults above 35, a BMI greater than 27 is considered obese. According to the American Obesity Association (AOA), BMI also indicates the potential health risks that accompany obesity.
BMI less than 19 indicates mal-nutrition, while people with BMIs 25 up to 30 are considered overweight for their age and sex. BMI over 40 suggests morbid obesity. The BMI is a very sensitive indicator of obesity for people between the ages of 19 and 70 years.
Still, BMI is unsuitable in:
- Elderly people with general debility.
- Deformities of the spine like scoliosis (lateral deviation of the backbones) or kyphosis (forward deviation of the backbone)
- Children growing up very fast.
- Pregnant or lactating women.
- Body builders and athletes
Scientists use other, more sensitive methods to assess obesity.
CT & MRI Scans
- These are non-invasive methods which can assess the collection of fat cells. They are very reliable and identify the precise points of fat collection in the body.
Abdomino-Gluteal Ratio/Waist Hip Ratio (WHR)
- This measures the proportion of fat distribution around the torso. These measurements have a strong correlation with general health and fertility. It is optimal for men to have a ratio of 0.9. A ratio of 0.7 in women is considered very healthy. Ratios in women exceeding 0.9 and in men exceeding 1.0 imply obesity. WHR is a better tool for assessing a person’s risk for heart attack than the BMI.
- The BMI is of limited use in certain occasions. Many conditions render the BMI an unsuitable tool for health assessment. As a person accumulates fat in his body, fats are first deposited under the skin before being deposited around internal organs. Instruments that measure the fat deposited under the skin are called “skin calipers”.
Lesser used methods that scientists employ to study obesity are:
- Densitometry -> where weight is measured under water
- Water dilution methods
Symptoms and Diagnosis of Overweight
The world health organization (WHO) has categorized obesity as a metabolic disorder. Often obese people approach their doctors when other health conditions worsen due to obesity.
Signs and symptoms that suggest its time to tackle obesity are:
- Your diabetes does not improve inspite of medications and you are overweight. Remember that all obese persons do not develop diabetes, but 80% of diabetics are obese.
- You have trouble conceiving. Impotence and infertility are conditions worsened by obesity.
- The menstrual cycles have become irregular. You either have them too often or they seem to be diminishing in flow and appear later than usual.
- You have lately developed high blood pressure or your existing high pressures are not responding well to medications.
- Off-late you suffer from increased daytime sleepiness. Chances are you may suffer from sleep apnea.
- Obesity increases chances of skin infections. Fungal infections are common in skin folds of the abdomen, torso and lower limbs.
- Obesity can result in many chemical changes within the body. In some people, the Uric Acid content in blood rises sufficiently to cause gout-> a common condition causing joint inflammation.
- The weight bearing joints of the body -> back bones, knees, ankles etc. can suffer from joint inflammation (osteoarthritis). Pains in the back and knee are common complaints associated with obesity.
- Young Children who are obese are more prone to joint problems, especially of the knee joints and lower limbs.
- Obesity can cause hemodynamic changes that resulting in stasis of blood flow especially in the lower limbs which lead to varicose veins.
Treatment of Obesity:
Optimal treatment plans for obese people consist of the following:
Changing diet and behavior.
Introducing Exercise, Drugs and surgery (last option)
Dietary + Life style changes
Excess calories consumed end-up being stored as fat. A good diet plan must have foods high in nutritive value and low in empty calories.
Give up the idea of starving yourself. Crash diets rarely remedy the situation. You are likely to quit the regimen very soon either out of frustration or from progressive weakness.
Instead, try to eat more of the right kind of foods. The realistic approach is to achieve a “healthier weight” and not what is touted as the “ideal weight”.
- Don’t avoid carbohydrates -> have less of simple carbohydrates (sugars) and consume more of complex carbohydrates. Most naturally occurring complex carbohydrates also provide sufficient vitamins and minerals for energy production. Wheatgerm, bran, oats, cornmeal, maize, buckwheat and barley are all excellent sources of complex carbohydrates.
These foods are best consumed as they are that is in their natural states.
- Complex carbohydrates -> minimum 60% of your daily calories must come from carbohydrates. If you are uncomfortable using complex carbohydrates routinely, there are plenty of choices you may opt for
- pasta and its varieties
- whole grain cereals
- shredded wheat
- porridge oats
- oat cakes
- brown rice
- brown bread
- pitta bread
- Avoid food fads which promise dramatic weight lose in little time. Rapid weight loses generally mean you are losing a lot of proteins and body fluids. This eventually depletes your body’s muscle mass and leading to exhaustion. The ideal diet will enable the body to burn fat while conserving muscle proteins.
- Add more high fiber foods. Vegetables, fruits, beans and whole grains are high in fibers which prevent excess absorption of carbohydrates from the intestines.
Have plenty of red, yellow and orange fruits which are high in antioxidants.
- Avoid having animal fats. These are high in saturated fats which lead to conditions like high blood pressures and diabetes. Animal fats are very rich in cholesterols which can cause heart diseases along with obesity.
- Drink plenty of water. Recent studies have shown that simply having more water can increase your metabolic rates thus help in burning more calories in the form of fat.
- Maintain a balance between caloric intake and energy expenditure. It is true that obese people consume more calories than they require and burn lesser calories. So an ideal balance needs to be maintained.
- Start being more active.
- Walk more, use the car less often.
- Avoid using the car for short distances -> try cycling or walking instead.
- Climb stairs instead of always using the elevators.
- Pursue active recreational sports when home rather than watching television or surfing the net.
Increase your fitness levels by including activities that you enjoy. It takes about 3,500 excess calories to gain just 0.5kg (1lb). Few people gain more than 2lb to 5lb each year. Weight fluctuates from day to day, but you should aim to stay about the same weight from week to week.
- Have moderate sizing when at the restaurant. Try having starters instead of heavy desserts. Restaurants generally provide very large servings, try to split your dish with a friend and do not order for anything offered super sized.
- Eat a variety of foods. Try and get your vitamin and mineral nutrients from food and not through supplements.
- Have adequate amounts of calcium. Calcium is essential for strong bones and teeth.
Anti-obesity medications are prescribed mostly only to persons who suffer from morbid obesity. The most commonly used drugs are:
- Symlin 90
These drugs act by suppressing the appeties, increasing the body metabolism and preventing the absorption of fats from the digestive system.
Performed only where all other methods to lose weight fail. The procedures done commonly, aim to reduce the stomach size and bypass the stomach by connecting the food pipe to the small intestine. Common procedures include gastric bypass, vertical banding and gastroplasty.