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New Delhi - 110062 (INDIA)
Tel: 91-11-25280150 / 25267671
E-mail: drbmmakkar@yahoo.com |
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Frequently Asked Questions -
Obesity |
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View Diabetes Section |
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Q. |
WHAT IS OBESITY?
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WHAT ARE THE HEALTH RISKS ASSOCIATED WITH OBESITY? |
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HOW DO WE DIAGNOSE OBESITY? |
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WHAT CAUSES OBESITY? |
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OBESITY – IS IT A DISEASE or A SIGN OF PROSPERITY ? |
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Why lose weight? |
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How to lose weight? |
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How much to lose? |
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Can I achieve all the health benefits with only 5-10% weight
loss? |
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Can I achieve good looks & good physique with
this much weight reduction? |
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What is the best strategy to lose weight? |
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WHAT IS OBESITY? |
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A. |
Obesity is a disease process in which there is excess fat
accumulation in the body leading to adverse effects on health.
Obesity is a disease of modern times that is increasing in
prevalence worldwide. It is disease process which results from
complex interplay between the genetic factors and the
environmental influences, and is largely due to changing dietary
habits with shift towards refined, high calorie food, increasing
mechanization resulting in lack of physical activity, and
sedentary lifestyles. |
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WHAT ARE THE HEALTH RISKS ASSOCIATED
WITH OBESITY? |
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A. |
Obesity
is a disease process which increases the risk of developing a
number of other diseases of adult life like high blood pressure,
ischaemic heart disease (angina & heart attacks), stroke
(paralytic attacks), gall bladder disease, joint problems, sleep
apnoea, respiratory problems, cancers of uterus, breast, large
intestine and prostate, and even pancreatic malignancy. In fact
there is a list of more than 30 diseases which obesity
predisposes to. |
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HOW DO WE DIAGNOSE OBESITY? |
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“If a
person looks fat, the person is fat”. This is known as eyeball
test. Obesity is usually easy to diagnose at first sight
Historically weight for height tables have been used to define
normal weight range. A body weight 10-20% more than the
desirable weight for height is considered as overweight and more
than 20% above the desirable body weight is considered as
obesity. However, these tables have their own limitations.
Presently, there are three commonly used objective methods for
estimating obesity in clinical practice.
BMI ( Body Mass Index )
Body Mass Index (BMI) = weight in kg / (height in metres)2.
A BMI of 18.5 – 23 kg/m2 is considered a good weight for most
individuals. BMI is the most accepted unit for defining
overweight. For Indians, overweight is defined as a BMI of 23 to
25 and obesity as a BMI of 25 or greater .
WHR ( Waist – Hip ratio )
WHR provides information about distribution of body fat.
Central Obesity is defined as a WHR > 0.95 in males and > 0.8 in
females
Waist circumference (WC)
In men there is increased risk if the waist circumference is
more than 90 cms and the risk is substantially increased if it
is more than 102 cms. The corresponding figures for females are
80 cms and 88 cms. For Indians, WC values of more than 90cms for
males and more than 80 cms for females are considered abnormal.
Body Fat Distribution:
Based on the WHR, obesity may be described as android type
(central obesity or apple obesity) and the gynecoid type (Pear
shape or gluteofemoral). Android type of obesity is associated
with risk of serious complications such as heart disease, high
blood pressure, diabetes, lipid or cholesterol problems, and
cancers. On the other hand, gynecoid obesity renders a person
more prone to mechanical problems such as varicose veins and
joint disorders. For any level of overweight or obesity, the
individuals with greater collection of central fat or visceral
obesity (i.e. fat around stomach area/abdomen) are at a higher
risk of serious health problems associated with obesity.
Since MEN typically have excess weight in upper body and women
in lower body, MEN rather than women should be targeted for
weight reduction.
EXTENT OF THE PROBLEM
The prevalence of obesity is on the rise worldwide among both
sexes and all ages, across all races, ethnic groups and
education levels. Accordingly, both the World Health
Organization and the National Heart, Lung and Blood Institute (NHLBI)
of National Institute of Health(NIH),USA, have classified
Obesity as an EPIDEMIC. The prevalence of obesity is on the rise
in our country too, particularly in the urban population. There
are today more than 100 million overweight Indians, a rising
number of them children. Studies in India have shown that almost
half the men and one third of women from industrial & urban
populations suffer from overweight or obesity (BMI more than
25). Central or android obesity was also found to be prevalent
in large percentage of Indian population and an increased
waist-hip ratio (>0.85 for males and >0.95 for females) has been
noted in every third adult individual in urban population. |
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Q. |
WHAT CAUSES OBESITY? |
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A. |
A
number of genetic as well as environmental factors including
cultural, socio-economic, behavioral factors play an important
role in causation of obesity. Most obesity is primary, and no
obvious factor for its causation exists other than imbalance in
energy intake and expenditure.
A common misconception is that obesity is caused by overeating
and reducing food intake is the key to weight loss. A more
realistic concept is that weight control is a matter of energy
balance. When energy expenditure is less than the energy intake,
the result will be weight gain.
Based on this concept, the goal in weight loss should be to work
out a comfortable level of exercise and adjust the energy intake
to be less than energy expenditure. |
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Q. |
OBESITY – IS IT A DISEASE or A SIGN OF
PROSPERITY ? |
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A. |
Obesity is a chronic disease which increases the risk of a
number of diseases of adult life. The risks associated with
overweight were well recognized even during the time of
Hippocrates. Omar Khayyam, noted Persian physician & philosopher
mentioned in his writings “fat people may die happy,
nevertheless they die younger”.
Despite the established association between obesity and a number
of chronic conditions, little recognition has been given to
obesity itself as chronic disease. On the contrary, obesity was
traditionally believed to be associated with affluent lifestyles
in the west. In India, overweight has long been considered as a
sign of prosperity. Hence, most of the overweight persons do not
care to consult their physicians unless they develop some
co-morbid problem or they are told about their obesity by a
physician during a visit at his clinic for an unrelated illness.
The physicians consider obesity more like a subacute or
insignificant illness which generally results from overeating
and lack of physical activity on the part of an individual, only
causes some disfigurement of physique of an individual and will
respond to a time limited course of treatment and eventually be
cured. Also, even after weight loss the patients tend to gain
weight, and like diabetes and hypertension, obesity also worsens
after the active therapy is stopped. Reversal of high BP or
hyperglycemia after stopping the treatment is not considered to
be treatment failure, but regaining weight in similar situation
is considered as a therapeutic failure in cases of obesity.
Also, patients are not blamed for their diabetes or hypertension
(High blood pressure), they are blamed for their obesity.
Hence, obesity should be recognized as a chronic disease of
multifactorial origin. Considering obesity as a chronic disease
has multiple benefits. It removes the stigma associated by
obesity, recognizes it as a heterogenous disorder which like
hypertension needs to be treated for life, and encourages the
physicians and their patients to set realistic goals for weight
loss. |
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Q. |
Why lose weight? |
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A. |
Obesity
or overweight increases the risk of developing a number of other
diseases of adult life like high blood pressure, ischaemic heart
disease (angina & heart attacks), stroke (paralytic attacks),
gall bladder disease, joint problems, sleep apnoea, respiratory
problems, cancers of uterus, breast, large intestine and
prostate, and even pancreatic malignancy. In fact there is a
list of more than 30 diseases which obesity predisposes to. Even
in children with overweight, there is increased risk of
developing high blood pressure, high cholesterol levels, early
onset of adult type diabetes (Type 2), and of course the
psychosocial probems associated with overweight. And losing
weight is associated with positive effects on all these
illnesses. |
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How to lose weight? |
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Since
obesity results from the interaction between a number of risk
factors, ideal treatment of an obese patient is based on a
multidisciplinary team approach. The team includes a physician,
a nurse, nutritionist, psychologist, and exercise physiologist,
and a surgeon may be required if nothing works. Various
treatment modalities applied for weight reduction include diet
regulation, behaviour modification, prescribed exercises,
medication, management of complications, and surgery as the last
resort.
The management of obesity consists of reduction in calorie
intake and dietary modifications, increasing the physical
activity, behavior therapy, medically approved drug therapy, and
if nothing works surgical management. |
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Q. |
How much to lose? |
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A. |
It is
one of the most important questions which props up in one’s mind
before planning for weight loss. And the very thought of trying
to achieve ideal body weight appears to be a herculian task
leading to demotivation even before starting the weight loss
attmpt. But the important thing to remember is that you do not
need to achieve or even target the ideal body weight. Losing
only 5-10% of your current body weight is sufficient to give you
all the health benefits you are looking for. |
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Can I achieve all the health benefits
with only 5-10% weight loss? |
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Well,
the answer is a big yes. Losing only 5-10% of your current body
weight is not only sufficient to achieve health benefits but is
also a realistic and practical target for weight reduction. A
modest reduction in body weight of 5-10% is associated with
reduction in the risk of diabetes, high blood pressure, angina &
heart attacks, improvement in good cholesterol & reduction in
bad cholesterol levels, improvement in exercise capacity, better
cardio respiratory fitness, and improvement in self confidence. |
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Q. |
Can I achieve good looks & good physique with
this much weight reduction? |
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A. |
A
weight reduction of 5-10% may not be sufficient to get back a
perfect body figure and looks, but it certainly improves your
cosmetic appeal to a great extent. And for sure, a healthier
individual always looks better than an unhealthy one. |
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Q. |
What is the best strategy to lose
weight? |
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A. |
The
best strategy to lose weight is to look at multiple factors
related to energy balance and correct them. Some of the salient
tips
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