In previous articles, we have learned that health is an investment and maintaining proper weight is an important tool for health investment.(Read ‘Health is Investment: Do you know’). We have also learnt that centenarians all over the world are lean and thin. (Read ‘Centenarian secrets). Obesity is number one enemy of health. For good health and long life, this enemy has to be kept at bay. Knowing about enemy (also called intelligence gathering in military parlance) is the first step to defeat an enemy. In this post we will try to gain insight into the destructive power of our enemy.
Why Obesity is Increasing
Obesity is akin to a bank balance with energy/Kcal as currency/money. If we put more money than what we withdraw, the bank balance will increase and vice versa. With economic growth, the income has increased leading to increase in purchasing power, availability of more food, consumption of energy dense foods, all resulting in increased energy intake. On the contrary, mechanization and remotely controlled devices have reduced the energy expenditure. This excess un-utilized energy is stored in the body as fat and results in overweight or obesity.
The prevalence of obesity is increasing globally. Global Burden of Disease Study 2013 Report highlights that nearly one-third of the world’s population is obese or overweight. The number has increased from 857 million in 1980 to 2.1 billion in 2013. In US about 68% population is overweight or obese. India with 41 million obese people, ranks third after US and China.
Dr, Am I Obese?
This is a common question. One can find the answer by calculating Body Mass Index (BMI). BMI is calculated by the formula ‘Weight (Kg) divided by square of height (in meters)’. If your height is 170 cm or 1.7 meters and weight is 70 kg, your BMI will be 70/1.7×1.7=24.22. For people who do not like to exercise their brain, ready made BMI calculators are available at many sites.
Interpretation of BMI Values
The interpretation of BMI values are as under
|BMI||TYPE OF OBESITY|
|< 18.5||Under Weight|
|>40||Obese Class-III, Extreme or Morbid Obesity|
Ideal weight can also be calculated by subtracting 100 from the height (cm). For eg if the height is 170 cm, the ideal weight is 170-100=70. A 10% variation on either side is acceptable as normal weight.
Types Of Fat Deposition in Body
Fat deposition in the body has two distinctive patterns leading to two morphological types of obesity.
- Central or Male type of obesity. Here the fat deposition is primarily in the abdomen. This type of obesity has been linked with metabolic syndrome (a combination of hypertension, diabetes, lipid abnormalities).
- Peripheral or Female type obesity. The fat deposition is around hips.
Waist circumference should not be more than 90 cm in males and 85 cm in females (applicable for Asian Indians). Waist to hip ratio should be maintained at less than 0.9 for men and 0.8 for women.
Obesity is not just a cosmetic consideration. It is harmful to health. In the United States, roughly 3,00,000 deaths per year are directly related to obesity. BMI value more than 40 reduces life expectancy significantly (as much as 20 years for men and 5 years for women). Obesity is a risk factor for Hypertension, Type 2 diabetes, Osteoarthritis, Sleep apnea, Respiratory problems, Endometrial, Breast, Prostate and Colon cancers. Higher body weights are also associated with increase in all-cause mortality. Obese individuals may also suffer from social stigmatization and discrimination. We will now discuss few of these diseases in more details.
Obesity increases risk of hypertension. The heart has to work more to carry extra body weight. The percentage of population suffering from hypertension increases with the rise of BMI values. At BMI <25, approximately 18.2% men and 16.5% women suffer from hypertension. At value of >30, the percentage increases to 38.2% for males and 32.2 % for females. In an International study (INTERSALT STUDY), it was found that a 10 Kg increase in weight causes 3 mm Hg rise in systolic BP (SBP) and 2.3 mm Hg rise in diastolic BP (DBP). This value corresponds to 12% increase in CHD (Coronary Heart Disease like Angina & Myocardial Infarction or heart attack) & 24% increase in Stroke in the population. Increase in one unit of BMI after 22 increases the risk of CHD by almost 10%. A weight gain of 5-8 Kg increases risk of CHD by 25%. Higher value of BMI will require higher dose of anti-hypertensive drugs. Higher the dose, higher the side effects of medicines.
Risk of Diabetes Mellitus (DM) increases with increase in value of BMI. After the BMI value of 22, additional increase in one unit increases the risk of DM by 25%. An increase in weight by 5 Kg results in 25% increase in diabetic population.
Effect on Blood Lipids
Blood lipids are risk factors for atherosclerosis. Obesity increases total cholesterol, LDL (Bad cholesterol) and decreases HDL (good cholesterol). One unit increase in BMI reduces HDL by 1.1 mg in males & 0.69 in females. LDL is considered to be most potent atherogenic agent. If BMI increases from 20 to 30 level, LDL increases by 20 mg.
Effect on Gall Bladder
Obesity increases risk of gall stones (stones in gall bladder) by almost ten times. Gall stones can cause acute abdominal pain, obstructive jaundice and pancreatitis (inflammation of pancreas)
Effect on Joints
Increased weight means extra pressure on the complete skeletal system and joints. It can precipitate as well as aggravate osteoarthritis in Knee joints and Hip joints.
Obesity and Cancers
Obesity has been linked to several cancers. Studies have indicated a positive association between BMI and cancers of the following:-
- Malignant melanoma (men only)
- Non-Hodgkin lymphoma
- Multiple myeloma
- Ovary & Uterus (endometrium)
- Gastric cardia.
As per estimates, 2.7% of cancers in men and 4.9% cancers in women were related to overweight/obesity during 1983–6. For further reading readers may visit http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252060/
Effect on Pregnancy
Pregnancy is a journey to joy of motherhood and ultimate desire of women (exceptions are always there). Obesity can turn pregnancy into a nightmare for the pregnant mother and treating doctor equally. Obesity can lead to following complications:-
- Increased foetal deaths.
- The risk of gestational diabetes mellitus and pregnancy induced hypertension increases by 10 times.
- The complications of labour & delivery are increased. More Cesarean Sections are required to be performed. The anaesthesia becomes high risk.
- Incidence of neural tube defects also increases in obese women.
A Word About Childhood Obesity
All mothers, irrespective of nationality derive pleasure in feeding their child. A plumpy child (we call them “golu-molu” in hindi language) gives a comfortable feeling that my child is healthy. However, it must be understood that an obese baby is not a healthy baby. Obese babies are likely to remain obese even in adulthood and suffer from complications discussed earlier. School going obese children become a point of bullying & teasing by peers. I remember, during our school days we use to address them as Motu (a hindi term for fat person). Unexplained pain in hip, knee and ankle is often related to obesity. Various problems faced by obese children are summarized as under:-
- They are more likely to be teased and bullied
- They are more likely to bully others
- They may have poor self-esteem and may feel socially isolated
- They may be at increased risk for depression
- They may have poorer social skills
- They may have high stress and anxiety
- They may have behaviour and/or learning problems as a result of psychological difficulties related to childhood obesity
BMI can be used to assess obesity in children also. Interested readers may refer to http://www.who.int/dietphysicalactivity/childhood/en/
Weight Loss Helps
Losing weight helps to reduce the risks associated with obesity. A weight loss of 0.5 kg reduces CHD risk by 50%, risk of death by 54% and diabetes risk by 30-40%. One kg of weight loss reduces systolic BP by 0.4 mm and diastolic BP by 0.3 mm of Hg. Reduction of 4.5 Kg will reduce systolic BP by 2.8 mm and diastolic BP by 2.5 mm, equal to drug therapy. I have personally seen the beneficial effects of weight reduction. One of my colleague was detected to have abnormal Glucose Tolerance Test (GTT) also termed as impaired GTT. He was found to be 4 kg overweight. His doctor advised him to reduce weight. He took it seriously and reduced 4 kg by diet and exercise. After one month of weight reduction, the test was repeated and the result was found to be normal. This incident amply describes the positive influence of weight reduction on progression of diabetes mellitus (DM). Had he ignored the findings, I am sure, he would have developed full fledged DM after some time. So message is very clear for the overweight and obese individuals. Reduce, reduce and reduce your weight.
For long and healthy disease free life, weight control is essential. Weight reduction will also help to improve ones personality, self-esteem, figure and look (especially for ladies). Overweight/obese individuals must loose weight.
Obesity is your enemy. Defeat your enemy. Be a winner.
Is the article informative? Does it give you some message? Do you feel motivated to spread the message to your friends. One open question for all. Why childhood obesity is increasing? Comments are welcome. You can visit our Facebook or Twitter page to share your views. You can CONTACT US at firstname.lastname@example.org or email@example.com. In the next post we will discuss various methods available to loose weight.