When do you say one is obese? How do you define obesity? Weight is not just a concern of health related issues but is an icon of beauty as well. The wide spectrum of health related disorders associated with obesity has led the medical field focus on obesity.
We consider a person to be overweight either by the way how he seems to our eye or by considering his weight. But this is not the situation.
Obesity is a state of increased adipose tissue (body fat). But it doesn’t mean that a person who is thin has to be underweight. A person with increased muscle tone could add up to his weight without any increase in his fat cells. So when do you say a person is obese?
The explanation follows
Obesity can be determined by considering the body mass index of an individual. Body mass index (BMI) usually takes into account the height and weight. This might be lead to confusion in person with increased muscle mass but decreased adipose tissue e.g. sports individual but this situation is very rare.
The results from calculating the body mass index can be grouped accordingly.
Low weight when an individual’s BMI is less than 18.5 it is considered to be low.
Healthy Weight When an individual’s BMI is between 18.5 and 24.9 it is considered to be healthy.
Overweight When an individual’s BMI is between 25 and 29.9 it is considered to be overweight.
It is when your health starts to deteriorate and even a small contribution to reduce
Weight will have a positive impact on your health.
One can also measure his waist to identify if one is carrying too much weight. It must be measured between the top of hip bone and midway between the lowest ribs.
Healthy waist
Women up to 35’’ (88cm)
Men up to 40’’ (102cm)
Health risk ensues when there is increase in the waist circumference, more than 35’’ (88cm) in women and more than 40’’ (102cm) in men. Other ways to measure adiposity are by measuring the skin fold thickness, CT and MRI.
The following is the international WHO classification for obesity.
Under weight <18.50
Severe thinness 16.0
Moderate thinness 16.0-16.99
Mild Thinness 17.0-18.49
Normal Range 18.50-24.9
Overweight ≥25.00
Pre Obese 25.00-29.99
Obese >30.00
Obese Class I 30.00-34.99
Obese Class II 35.00-39.99
Obese Class III ≥40.00
There are many reasons that influences weight gain. Weight gain is mainly distributed between two important facts input and output. Input is energy we take in through food and the disbursement of the energy we take in. Any small imbalance in this could result in weight gain. Weight gain is a result of interplay between hormonal and neuronal signals. Usually with weight loss, appetite increases and energy expenditure is decreased whereas with overfeeding, decreased appetite and energy expenditure is increased.
But ultimately in many cases the latter mechanism fails resulting in obesity when there is increased intake of food.
All the above mechanism is stimulated by leptin which is derived from adipocytes (fat cells).
What controls our appetite?
It is a hormone called Leptin which is produced by the fat cells. Leptin is produced after we have our meal and this decreases our appetite. Leptin as it is produced from fat cells it is proportional to the amount of fat cells in the body. In case of excess adipose tissue there is increased leptin production which decreases appetite. In contrast in obese individual, the person becomes resistant to leptin, which results in no change in the appetite after meal. There are also other signals orexins and ghrelin which plays a role in appetite regulation.
Adipocyte is not just storage of fat cells but it secretes numerous endocrine hormones such as
tumor necrosis factor alpha and Interleukin-6, adipsin, prothrombotic agents such as plasminogen activator inhibitor 1 and a part of blood pressure regulating system, angiotensiongen.
Adiponectin is a substance derived from adipocytes and these enhances insulin sensitivity. Unfortunately these levels are decreased in obesity.
Why obesity is a health hazard?
We are not aware that adipocyte has a great impact on insulin sensitivity, blood pressure control, coagulation and vascular related pathology. The wide variety of role played by adipocyte is the reason of all the obesity related disorders. This is the main reason why we are so concerned about obesity.
Energy consumed for doing an activity is higher for obese person when compared to lean. But the significant part is many obese people limit their activities.
Diseases causing obesity
There are many genetic associated syndromes like prader-willi, Laurence-Moon-biedl syndrome and disorders associated with mutation of leptin.
Cushing syndrome
Hypothyroidism
Insulinoma
Carniopharyngioma and other hypothalamus related disorders
Poly cystic ovarian disease
Obesity as a risk factor
Obesity and overweight are the main preventable health related disorders.
Insulin resistance and Diabetes mellitus type II
Obesity primarily central obesity leads to production of increased fatty acids which results in increase insulin resistance in liver, skeletal muscle and adipose tissue. This results in hyperglycaemia leading to development of type II diabetes mellitus. Obesity plays a main role in the development of type II diabetes mellitus and 80% of type II diabetes mellitus patients are obese.
Cardiovascular disease
Abdominal obesity is a major risk factor for cardiovascular disease. When obesity combines with diabetes mellitus and hypertension, the effect is much worse than anticipated. It increases the probability of deposition of cholesterol in blood vessels. There will be increased low density lipoprotein cholesterol, very low density lipoprotein, triglyceride, decreased high density lipoprotein and decreased vascular protective adipokine adiponectin. This increases the risk of heart disease and deposition of atherosclerotic plaques in the blood vessel. Reducing weight will have a very good impact in the disease.
Respiratory problems
Obesity reduces the compliances of the chest wall and increase ventilation rate. Obesity can lead to obstructive sleep apnea which means that there is pause during breathing which can lead to hypoxia(decreased oxygen). This occurs due to increased soft tissue mass around the airway.
Obesity also plays a main role in formation of gall stones and has a main part played in many cancers. Obesity is a risk factor in the development of osteoarthritis and gout. Acanthosis nigricans which is thickening and darkening of skin folds is also found in obese people.
Management
Obesity is a big concern not just because it is a reason of mortality but obesity holds back one from the society. One has to learn from childhood the importance of leading a healthy life style. Education of obesity must start from home. Parents must teach children not by making them read books on healthy life style but must lead a healthy life and be an example to them.
It is essential that parents keep a record of the child’s weight. If you suspect your kid to be overweight, do not hesitate to take them to your general practitioner straight away and check his body mass index.
There are four important factors that I would like to mention here
Regular physical activity
Food habit
Regular habits and Stress control
Maintaining good relationships
Physical Activity
Take kids to the nearest park which will help you shape your body as well. Encourage them to play with the kids in the neighbourhood instead of using computers or playing video games.
It is necessary that you spare some time to move your body as well. Do not park yourself in front of the television or computer. Burn your calories in the ways you can.
Are you a busy bee? Do not have time to exercise? Then roll all your daily activities to burn your calories. Walk when you are on the phone, stretch your arms and legs at work, use stairs instead of lift, use your body for every possible activity you need to burn your energy, do not use car to the nearest railway station instead walk, even if you have to take your car, park your car at the far end and walk. Even hovering, cleaning the house, ironing, mowing the lawn could help you burn your calories.
If you are at home go for a walk, use bucket to water your plants instead of using a hose pipe, and take your grandparents for a walk.
Join the nearest gym. Never say ‘I do not have enough time’. We can make it but it’s just we don’t want to.
It is not the matter of losing weight but to keep it in control. Do not let it increase again. Be health conscious. If you are an example to your family, your children will be an example to the society.
Hold to positive thoughts. Stress could be an additional risk factor in the development of obesity. So try to avoid it. Discuss about the changes and the steps you have taken to lead a healthy life style. This could encourage them to follow you and will have a positive impact on you as well. Form a committee in your street and organize badminton match or some regular gardening works in your street.
Food habits
If you want to lose weight, then you must decrease your energy intake as well. Now you must learn what you must eat and what not to. Spare some time to read the calorie content of a food product. Eat not to fill your stomach. Be aware of what the food you consume means to your body. As I always say you do not have to take a mile change but small steps will be appreciable.
It is important to identify when to eat, how to eat and what to eat.
It is considerable to eat on a regular time. When your meal is irregular, these results in decrease consumption of the calories you eat. There are studies that shows the increase in insulin resistance and blood cholesterol when a person eat on irregular hours. Make sure you do not go to bed straight after your dinner. Time your meal.
It is very important that you eat very slow, chew your food and especially sit and relax while you eat be it with the family or in an office environment. We usually think to grab a bite on the run makes us eat less which means you opt for fast food or snacks which are often higher in fat and calories. Turn off you television when you eat. Make it a habit to sit with your family and have your dinner. This reduces your stress. You get time to discuss about many things. Especially you will know what your children like and you can make sure that your child eats right proportion of food.
The most important thing is what you eat. Addition of vegetables and fruits in each meal is very essential. Read the caloric content of each food product. It does not mean that to eat healthy is just to eat green vegetables. All depends is the amount you eat. We must have carbohydrate, protein and fat in equal proportion. Include starchy food like potato, rice, wholemeal bread, fish, decrease salt intake, cutting out fizzy and sugary drinks and drink less alcohol can help. Try different recipes so that it would not be difficult for you to feed your kid. It is important that the food is healthy and tasty as well. Learn about saturated and unsaturated fat. Unsaturated fat (omega 3 fatty acid) helps to lower blood cholesterol. Read the label in the food product. Make sure you choose the right food. You are what you eat. Balance your diet.
Regular habits and stress control
Join a gym or a swimming club. Be it a meditation centre or be it even at home, make sure you do something regularly. But that must satisfy your body and your mind. This will keep your stress under control. Visit your parents if they live far from you, have a get together once in a while, visit your neighbours, organise a picnic with your friends and make it a custom to take your wife out on a small romantic outing on a weekend.
Relationships
Maintaining good relationship with your family, friends and neighbour will not reduce your body weight but will help you reduce your stress level. A good morning to your neighbour, a smile to the cleaner on the road, hug to your kid before to school and a kiss to your wife before to work will have a very good positive impact on both the receiver and the giver. Reciprocation of love is very important in every step of your life.
When all this fails, then it’s time for doctors to treat you for obesity.
It is very fundamental that you meet up with your family doctor once you feel you are gaining weight. He will check your body mass index and let you know what has to be done.
Anti- obesity medication:
Centrally acting
These are drugs which suppresses appetite by acting on the brain. E.g. sibutramine
Peripherally acting
These are drugs that decrease the absorption of dietary fat. E.g. orlistat.
The above mentioned drugs are not to be taken without the advice of your family doctor.
Rimonabant
It is an anti-obesity medication which acts by suppressing appetite and it also increases thermogenesis thereby increasing energy expenditures. It does not cause weight loss but it reverses the metabolic effect of obesity.
Metformin In patient with type II diabetes mellitus, metformin can reduce weight.
Exenatide It is analogue of GLP-1 secreted from intestine. It delays gastric emptying and promotes early satiety. There are many unresearched anti-obesity medications being advertised in the society. When all your effort to reduce weight fails, it is advisable to contact your family doctor to advice you. Do not buy any anti-obese medication without a prescription because they do have many side effects.
Surgical aid
It is done only in the case when the body mass index is >40kg/m2 or BMI > 35 with obesity related medical conditions. Bariatric surgery is a procedure which reduces the size of stomach through gastric banding, through removal of portion of stomach or gastric bypass surgery. It has few post operative complications but when compared to the risk put forth by obesity, these complications seems to be of worth undergoing.
Leading a healthy life is not about you but it is about the society, about the government, about the medical profession, our future generation and about us. It is not too late. Please educate yourself, your family and friends about what it means to lead a healthy life.
Reference
Fauci As, Kasper DL, Braunwald E, HauserSL, Longo DL, Jameson JL, Loscalzo : Biology of obesity in Harrison’s principles of Internal medicine, 17th edition
Praveen Kumar, Michael Clark: Obesity in Clinical Medicine, Fifth edition.
NHS: YOUR WEIGHT, YOUR HEALTH How to take control of your weight 2006.
