|
Obesity is a disease - a lifestyle disease which has assumed epidemic proportions today. Obesity refers to a spectrum of problems of excess weight ranging from mild overweight to the morbidly obese. Patients with morbid obesity do not respond to medical means of weight loss. Efforts to treat morbid obesity through controlled diets, behavior modification and exercise programs are only temporarily successful with the patient invariably regaining even more weight than the amount lost. Obesity surgery is the only method by which long-term weight loss can be achieved in these patients. Seven to nine percent (7-9%) people in India are overweight, of which 20 - 25% are morbidly obese which amounts to a staggering 2 - 2.5 million people. Incidence of child hood obesity is on the rise due to changing lifestyles. These people are more likely to develop obesity related complications at an earlier age. There is an old adage repeated in many Indian homes " health is wealth". Well, the Indian middle class has got the wealth but is fast loosing its health. Paradoxically, a nation with 20% of the poor of the world is facing an obesity crisis. If not addressed today this problem is likely to compound imposing heavily on medical resources.
What is Obesity?
Obesity is defined as an excess accumulation of body fat that leads to pathology (a diseased state).
How do we quantify obesity?
 |
Being described as overweight does not indicate whether a person is suffering from obesity To determine the level at which excess weight becomes harmful it is necessary to quantify obesity. This is done by calculating the person’s total body mass known as Body Mass Index (BMI). BMI is calculated by dividing the persons weight in kilograms with the square of the height in metres i.e.:
Weight (in kgs)
BMI = ---------------------
Height x Height (in mtr.)
|
For example, if the weight is 125 Kg and Height is 1.6 mt, the BMI will be calculated as 125 / (1.6 x 1.6) = 48.8
The value thus obtained is analyzed against the standard Asian BMI guidelines for defining excess weight, which are as follows:
| BMI (Kg/m2) |
Obesity |
| Less than 18.5 |
Underweight |
| 18.5 – 22.9 |
Normal |
| 23.0 – 27.4 |
Overweight |
| 27.5 – 32.4 |
Pre-obese |
| 32.5 – 37.5 |
Obese |
| More than 37.5 |
Morbidly obese |
 |
Yet another method of determining the degree of obesity is by calculating the waist to hip ratio. The ideal ratio for Indian men should be 0.88 and for Indian women should be 0.8 If these values rise above the mentioned limits the deleterious effects of obesity come into force.
|
Adverse effects of obesity
Obesity is a major health problem and has been found to be associated with the 3Ds (disease, disability and death).
Nearly thirty diseases have been linked to obesity. Some important ones are:
- Hypertension
- T2DM (diabetes)
- CAD(heart disease)
- Hypercholesterolemia
- Sleep apnoea
- Osteo-arthritis
- Hypoventilation Syndrome
- COPD(lung disease)
- Stroke
- Gallstones
- Increased risk of Cancer of breast, Colon
- Prostate, Uterus and Ovary
- Deep Venous Thrombosis
- Infertility
- Skin infections
- Endocrine disorders e
Apart from the above medical diseases, an obese person is also likely to suffer psychological, social, physical and economic harm. Obese persons are often victims of prejudice and public ridicule due to their size. This often results in psychological illness like depression. Medical costs for treating associated co-morbidities adds to the financial burden and all these factors get multiplied manifold with advancing age. Obesity is the second leading cause of preventable death after smoking.
Why should obesity be treated?
Obesity is a disease like any other disease. It has medical, physical, social and psychological ramifications. The implied medical costs for treating obesity and related co-morbidities add significant burden on the country’s health budget. It is important that this disease be treated early and preventive measures be taken to check its escalating numbers. The disease has been labeled the worst pandemic of the 21st century and if the current trends continue unhindered, obesity is likely to emerge the single most important public health problem in India a decade from now.
Obesity in India - A rising trend
Various studies have been performed on the urban and rural population of India to document the incidence of obesity, 35% or approximately 120 million urban Indians are seriously obese, as are one in ten urban Indian children. In Delhi itself, 45% of males and 55% of females are suffering from obesity. The single most important causative factor, which has emerged, is the changing lifestyle. The increasing affluence has resulted in a change in eating habits, decrease in dietary fibre, an increasing ratio of fats and sugars in the diet resulting in an unbalanced diet, to this can be added an increasingly sedentary lifestyle. Certain Indian practices like a high fatty diet with near total immobility post partum (following child birth) results in rapid weight gain.
Obesity is known to run in families. This implies a genetic predisposition. These genes cause increased fat storage and obesity when food is plenty and energy expenditure reduced. Certain hormonal disorders like hypogonadism, hyperthyroidism and cushing's syndrome are also associated with obesity.
Yet another major problem requiring urgent preventive measures is the increasing prevalance of obesity in children. Although obese children have fewer associated comorbidities, they are likely to grow up into obese adults. They also suffer prejudice and ridicule and are likely to have psychosocial problems. The sufferers are frequently held responsible for their condition.
Another alarming picture which has emerged from these studies is the onset of obesity related medical diseases (which occur at much lower BMI in the Asian population) i.e. the onset of diseases like HT, T2 Diabetes Mellitus and CAD. All these diseases have been found to occur at lower BMI values compared to patients of obesity in the West.
Goals of the treatment
Treatment for morbid obesity is to reduce the excess body weight with maximum of safety and minimum of side effects and complications, control or prevention of obesity related comorbidity and long term weight control.
How should obesity be treated?
Obesity is a multifactorial disease. Simply put it is the result of energy imbalance when the energy intake is higher than the energy output. The treatment therefore is directed at decreasing the energy intake and increasing the energy output. The treatment protocol for treating obesity is as follows:-
Lifestyle modification
- Diet
- Exercise when BMI < 23
- Drugs (when BMI >23, when lifestyle changes fail)
- Surgery (when BMI >32.5 with comorbidity / BMI >37.5)
Diet
Dietary restrictions follow a pattern of altering the quality and decreasing the quantity of intake. Lowering the carbohydrate and/ or fat content of the diet along with decrease in the size of each meal restricts caloric intake and decreases energy intake resulting in weight loss. A majority of patients regain weight (some even more than their previous weight) on stopping their dietary regime.
Exercise:
Exercise works by increasing the energy output. However no amount of exercise however strenuous and prolonged can alone induce weight loss. Exercise tones the body and augments the weight loss effects of dietary restriction, however it alone cannot cause weight loss.
Drugs:
Certain drugs cause loss of appetite and thus act by decreasing the energy intake. Some of the drugs commonly used are Sibutramine, Orlistat, Phentermine, Bupropion, Metformin, etc. However all drugs are associated with side effects such as nausea, bloating, oily stools, flatulence, etc. and a certain amount of tolerance may also develop. Only the first three of the above mentioned drugs are approved for long-term use. Drugs however induce a weight loss of only about 10% of excess weight and may not therefore be the answer for patients requiring large amount of weight loss.
|