Obesity

OBESITY

What is obesity?

Obesity is defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health may be impaired. It is a consequence of an energy imbalance where energy intake through the foods we consume is more than the energy utilized through physical activity over a considerable period of time.

Why do people become obese?

The various factors leading to overweight and obesity are:

Dietary Habits: Diet, particularly the level of fat and energy intake is strongly associated with excess body weight. Excess dietary fat is readily stored in fat depots of the body. Excess carbohydrates can also be converted to fat. Overeating, irregular eating habits, nibbling in between meals, eating a night due to insomnia, contribute to high-energy intake and thus obesity. Alcohol intake provides empty calories and contributes to increase in central obesity. Consumption of fast foods that are high in fats and refined carbohydrates and low in fiber often used as regular additions to the diet also contribute to increased energy intake.

Level of physical activity: There is a high co-relation between obesity in parents and their children. If both parents are of a normal weight only 7% of children will be obese. If one parent is obese, the incidence of obesity in children is 40% and it rises to 80% if both parents are obese.

Heredity: There is a high co-relation between obesity in parents and their children. If one parent is obese, the incidence of obesity in children is 40% and it rises to 80% if both parents are obese.

Psychological factors: There may be a physical connection between depression and obesity. For an individual who is lonely, discontented or depressed, eating can be a solace. Obese people seem to be affected more by taste and appearance of food rather than hunger and satiety . Tension, anxiety, fear may further make a person resort to food for emotional satisfaction.

Environmental and societal influences: Social pressure and official commitments of eating out and attending parties is a common cause of excessive intake of food and energy.

Endocrinal factors: Certain genetic disorders as well as some hormonal problems such as hypothyroidism, insulin resistance, Cushing’s syndrome can cause weight gain. The female sex hormones also play a role, as obesity may occur after pregnancy, after removal of ovaries or uterus or at menopause.

Medications: Drugs such as steroids, most oral hypoglycemic, anti-epileptics, non-steroidal anti-inflammatory drugs, oral contraceptive pills and some antidepressants may also cause weight gain.

How is obesity measured?

Certain health indicators are used as yardsticks to assess the level of overweight and obesity. Body mass index (BMI) is a simple index of weight for height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m square) eg an adult who weighs 70 kgs and whose height is 1.75 m will have a BMI of 22.9.

WHO Classification of adult according to BMI
Classification	Popular Description	BMI (kg/m2)	Risk of Co-morbidities
Underweight	Thin	<>	Low
Normal range	Normal	18.5 – 24.9	Average
Overweight		>= 25.0
Pre-obese	Overweight	25 – 29.9	Increased
Obese Class I	Obese	30.0 – 34.9	Moderate
Obese Class II	Obese	35.0 – 29.9	Severe
Obese Class III	Morbidly obese	>= 40.0	Very severe

Waist circumference:

The distribution of fat induced by weight gain affects the risks associated with obesity and the kinds of disease that result. In central obesity, fat is concentrated in the abdominal area instead of being distributed evenly all over the body. The fat that collects in this area is most dangerous because it is metabolically active and causes medical complications like diabetes, heart problems and stroke. Waist circumference is an index of intra-abdominal fat distribution and associated risks. The sex specific waist circumference cut offs along with associated relative risk defined by WHO are given below:

Risk of metabolic complications	Waist Circumference (cm)
	Men	Women
Increased	>= 94	>= 80

Since Asian/Indians have a characteristic obesity phenotype, with relatively lower BMI but with central obesity the waist circumference values suggested for Indians are 80cm for females and 90 cm for males.

What are the health consequences of obesity?

Obesity is more than a cosmetic problem. It is a major health hazard. Many diseases are more common in obese and overweight people and you are less likely to develop them if you lose some weight. They include: diabetes, high blood pressure, stroke, heart problems, some types of cancer, arthritis, gout, sciatica, gallstones, menstrual problems, infertility, breathing problems, some complications of pregnancy, skin disorders, sleep disorders like obstructive sleep apnea, poor psycho-social functioning and depression.

What are the benefits of losing weight?

Even modest decrease in weight will substantially decrease the chances of getting the above and reversing the disease process. If you are taking medication for these problems, you may need a reduced dose.

· As obesity declines

· Cholesterol decreases

· Blood pressure decreases

· Diabetes is controlled

· Joint pain reduces

· Lung function & OSA improves

· Functioning of digestive system improves

· Hormonal functions improve

· Fertility improves

How can we manage obesity?

Losing weight and getting fitter means that you have to find a balance between calorie intake and energy input. The right knowledge about diet and lifestyle is necessary for achieving this goal. Modifications in the diet need to be made to reduce the total calories by lowering the intake of highly refined carbohydrates and replacing these with complex carbohydrates and reducing fat intake. Specific behaviors conducive to overeating and or under-activity need to be identified and corrected. Since each individual’s constitution is different, for a successful weight loss program, modifications in diet, physical activity and behavior need to be done on an individual basis.

How ALC can help you lose weight?