OBESITY

OBESITY

According to the World Health Organization (WHO), obesity is one of the most common, yet among the most neglected, public health problems in both developed and developing countries. According to the WHO World Health Statistics Report 2012, globally one in six adults is obese and nearly 2.8 million individuals die each year due to overweight or obesity. Due to the increased risk of morbidity and mortality, obesity is now being recognized as a disease in its own right.

Additionally, obesity is strongly associated with other metabolic disorders including diabetes, hypertension, dyslipidemia, cardiovascular disease and even some cancers. The risk for these disorders appears to start from a body mass index (BMI) of about 21 kg/m2. Obesity is generally classified as generalized obesity (GO) and abdominal obesity (AO). Individuals with obesity have higher rates of mortality and morbidity compared to non obese individuals

Prevalence in India

India, with 1.2 billion people is the second most populous country in the world and is currently experiencing rapid epidemiological transition. Under-nutrition due to poverty which dominated in the past is being rapidly replaced by obesity associated with affluence. Industrialization and urbanization also contribute to increased prevalence of obesity. Studies from different parts of India have provided evidence of the rising prevalence of obesity.

What is obesity?

Obesity can be defined as condition with accumulation of excess body fat. More than a general accumulation, the distribution of fat around the abdomen is considered to be more harmful than fat around the hips. Measurement of direct body fat is difficult, so an indirect method, called BMI is generally used. In general BMI ranging from 18.5 to 25 is considered to be normal. But for Asians it is recommended that the BMI should be between 18.5 and 23.

WHO classification according to weight status

Weight status

BMI range

Underweight

<18.5

Normal

18.5 to 24.9

Pre-obese

25 to 29.9

Obese (grade I)

30 to 34.9

Obese (grade II)

35 to 39.9

Obese (grade III)

40 and above

  • Overweight – a parson who is 10-20% above the normal ideal weight for his sex, age and height.

  • Obese – a person who is more than 20% above the normal ideal weight for his age, sex and height.

  • Underweight – a person who is 10 or more below the normal ideal weight, for his sex, age and height.

Consequences

Overweight individuals are also at risk for developing health problems, such as heart disease, stroke, diabetes, certain types of cancer, gout (joint pain caused by excess uric acid) and gallbladder disease. Being overweight can also cause problems such as sleep apnea (interrupted breathing during sleep) and osteoarthritis (wearing away of the joints).

Weight-loss can help improve the harmful effects of being overweight. However, many overweight people have difficulty reaching their healthy body weight.

Waist to hip ratio

It is a simple method of distinguishing between fatness in the lower trunk and upper trunk.

WHR of > 1 for men and > 0.85 for women is indicator of abdominal obesity. Lower trunk fatness is often called gynoid obesity. Upper trunk or central fatness is called android obesity.


 

TREATMENT

Behavior Modification
Behavior plays a significant role in obesity. Modifying behaviors that have contributed to developing obesity is one way to treat the disease either alone or in combination with other treatments. Some behavior modifications include:

  • Changing eating habits

  • Increasing physical activity

  • Having regular meal times

  • Do not read or watch television while eating

  • Eating healthy snacks

  • Eating slowly, chewing the food properly in smaller portions

  • Handling stress in a positive manner through exercise, yoga and medication.

Physical activity
Initiating or increasing a physical activity program is an important aspect in managing obesity. Today’s society has developed a very sedentary lifestyle and routine physical activity can greatly impact your health. Although, it is difficult to prescribe the optimum amount of physical activity, it is important that any exercise program has to be consistent for affecting some degree of weight loss. The type of exercise selected by an individual should be pleasant, enjoyable, affordable and easy to do. Daily at least 30 minutes or more of moderate exercise is best for maintaining ideal body weight.

 

Dietary modifications
Dietary modifications serve as a guide for the obese to make healthy food choices. The food plan should be well balanced and suited to particular needs of the individual, together with consistent exercise for consistent results. It should be done in such a way so as to bring about a gradual weight loss, to maintain the desirable weight and a good nutritional status, to correct faulty food habits.

Surgical Treatment
Surgical treatment of obesity is an option for those who are classified as morbidly obese. If an individual has a BMI of 35 or higher, he may benefit of surgical procedures. These may be: gastric restrictive surgery, jejunoileal bypass, jaw wiring,liposuction