Know about Obesity

Obesity is defined as a disease in which fat has accumulated to the extent that health is impaired. WHO defines Overweight & obesity as abnormal or excessive fat accumulation that presents a risk to health. Obesity occurs when an individual’s body weight is in excess of the healthy range for their height leading to a high percentage of body fat.

Obesity isn't just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.

Obesity is commonly measured by body mass index (BMI), which calculates the relationship of weight to height. An adult with a BMI of 30 or more is considered obese. Click here to know more about BMI

 

Facts about Obesity

Worldwide more than 1.9 billion adults are overweight and 650 million are obese. Approximately 2.8 million deaths are reported as a result of being overweight or obese. In India, more than 135 million individuals were affected by obesity. Prevalence rate of obesity and central obesity are varies from 11.8% to 31.3% and 16.9%-36.3% respectively.

  • A dramatic increase in the prevalence of overweight and obesity among all the age groups has occurred in last 2-3 decades.
  • About 30-50% of adult Indians are either overweight or obese.
  • 1 in 5 adults overweight in India.
  • Urban population is more prone to obesity as compared to their rural.
  • Middle class more at risk of obesity.
  • In India, abdominal obesity is one of the major risk factors for cardiovascular disease.

 

How Does Obesity Affect You?

Obesity substantially contributes to

  • Preventable Non-Communicable Diseases
  • Shortened life-expectancy
  • Impaired quality of life

Obesity is a major risk factor for many physiological and psychological consequences such as

Physiological consequences of obesity are:

  • Type 2 Diabetes
  • High blood pressure
  • Heart disease
  • Gallbladder disease
  • Cancer (breast, uterine and colon cancer)
  • Digestive disorders (gastroesophageal reflux disease or GERD)
  • Breathing problems (asthma)
  • Problems with fertility and pregnancy
  • PCOD (Poly Cystic Ovarian Disease)
  • Urinary incontinence
  • Joint problems (arthritis)
  • Shorter life expectancy

Psychological and social consequences of obesity are:

  • Negative self-image
  • Social discrimination and isolation
  • Depression
  • Anxiety

Other consequences include:

  • Difficulty in performing normal tasks, as movement becomes more difficult
  • Feeling tired more quickly
  • Experiencing shortness of breath
  • Difficulty in using public transport seats and driving cars
  • Difficulty in maintaining personal hygiene

Obesity is now challenging smoking as the major cause of potentially preventable death in India

 

Changing Perceptions

Before

In the past, obesity was seen as a weakness or failure of the individual. Diet and exercise were prescribed treatments and weight loss surgery viewed as dangerous and extreme.

Today

Now, obesity is considered a disease and the cause of many serious health conditions. Obesity is no longer considered a cosmetic issue due to eating too much. The World Health Organisation (W.H.O) from 2013 recognizes obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.

 

What are the Causes of Obesity?

Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise. Obesity tends to run in families. That's not just because of the genes they share. Family members also tend to share similar eating and activity habits.

Lifestyle choices

  • Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
  • Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to significant weight gain.
  • Inactivity. If you have a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is a sedentary activity. The number of hours you spend in front of a screen is highly associated with weight gain.

Certain diseases and medications

In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.

Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.

Social and economic issues

Social and economic factors are linked to obesity. Avoiding obesity is difficult if you don't have safe areas to walk or exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have access to healthier foods. In addition, the people you spend time with may influence your weight — you're more likely to develop obesity if you have friends or relatives with obesity.

Age

Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. Generally, lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs, and can make it harder to keep off excess weight. If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight.

Other factors

  • Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women. Breast-feeding may be the best option to lose the weight gained during pregnancy.
  • Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. In the long run, however, quitting smoking is still a greater benefit to your health than is continuing to smoke. Your doctor can help you prevent weight gain after quitting smoking.
  • Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
  • Stress. Many external factors that affect your mood and well-being may contribute to obesity. People often seek more high-calorie food when experiencing stressful situations.
  • Microbiome. Your gut bacteria are affected by what you eat and may contribute to weight gain or difficulty losing weight.
  • Previous attempts to lose weight. Previous attempts of weight loss followed by rapid weight regain may contribute to further weight gain. This phenomenon, sometimes called yo-yo dieting, can slow your metabolism.

Even if you have one or more of these risk factors, it doesn't mean that you're destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

 

Symptoms of Obesity

Clinical obesity and weight gain can have a negative impact on your physical and mental health. Some symptoms or side effects of obesity include:

  • Low back pain or Backaches
  • Feeling tired all the time
  • Heavy sweating
  • Joint pain (especially weight-bearing knee and hip joints)
  • Low confidence or self-esteem
  • Shortness of breath
  • Snoring or Sleep Apnoea

Frequently Asked Questions

 Once you are home with your new baby, stick to your healthy eating and exercise habits to reach a normal weight. Breastfeeding is recommended for the first year of a baby’s life. Not only is breastfeeding the best way to feed your baby, it also may help with postpartum weight loss. Overall, women who breastfeed their babies for at least a few months tend to lose pregnancy weight faster than women who do not breastfeed.

 Overweight and obese women have longer labors than women of normal weight. It can be harder to monitor the baby during labor. For these reasons, obesity during pregnancy increases the likelihood of having a cesarean delivery. If a cesarean delivery is needed, the risks of infection, bleeding, and other complications are greater for an obese woman than for a woman of normal weight.

 Your weight will be tracked at each prenatal visit. The growth of your baby also will be checked. If you are gaining less than the recommended guidelines, and if your baby is growing well, you do not have to increase your weight gain to catch up to the guidelines. If your baby is not growing well, changes may need to be made to your diet and exercise plan.

 If you have never exercised before, pregnancy is a great time to start. Discuss your exercise plan with your obstetrician to make sure it is safe. Begin with as little as 5 minutes of exercise a day and add 5 minutes each week. Your goal is to stay active for 30 minutes on most—preferably all—days of the week. Walking is a good choice if you are new to exercise. Swimming is another good exercise for pregnant women. The water supports your weight so you can avoid injury and muscle strain. It also helps you stay cool.

 Finding a balance between eating healthy foods and staying at a healthy weight is important for your health as well as your baby’s health. In the second and third trimesters, a pregnant woman needs an average of 300 extra calories a day—about the amount of calories in a glass of skim milk and half of a sandwich. You can get help with planning a healthy diet by talking to our nutritionist.

 Despite the risks, you can have a healthy pregnancy if you are obese. It takes careful management of your weight, attention to diet and exercise, regular prenatal care to monitor for complications, and special considerations for your labor and delivery.

 Bariatric surgery may be an option for people who are very obese or who have major health problems caused by obesity. If you have weight loss surgery, you should delay getting pregnant for 12–18 months after surgery, when you will have the most rapid weight loss. If you have had fertility problems, they may resolve on their own as you rapidly lose the excess weight. It is important to be aware of this because the increase in fertility can lead to an unplanned pregnancy. Some types of bariatric surgery may affect how the body absorbs medications taken by mouth, including birth control pills. You may need to switch to another form of birth control.

 If you have tried to lose weight through diet changes and exercise and you still have a BMI of 35 or greater or a BMI of at least 30 with certain medical conditions, such as diabetes or heart disease, weight-loss medications may be suggested. These medications should not be taken if you are trying to become pregnant or are already pregnant.

 To lose weight, you need to use up more calories than you take in. You can do this by getting regular exercise and eating healthy foods. Your obstetrician may refer you to a nutritionist to help you plan a healthy diet. You also can use the Choose My Plate web site at www.choosemyplate.gov. Increasing your physical activity is important if you want to lose weight. Aim to be moderately active (for example, biking, brisk walking, and general gardening) for 60 minutes or vigorously active (jogging, swimming laps, or doing heavy yard work) for 30 minutes on most days of the week. You do not have to do this amount all at once. For instance, you can exercise for 20 minutes three times a day.

 Losing weight before you become pregnant is the best way to decrease the risk of problems caused by obesity. Losing even a small amount of weight (5–7% of your current weight, or about 10–20 pounds) can improve your overall health and pave the way for a healthier pregnancy.

Obesity increases the risk of the following problems during pregnancy:

  • Pregnancy loss—Obese women have an increased risk of pregnancy loss (miscarriage) compared with women of normal weight.
  • Birth defects—Babies born to obese women have an increased risk of having birth defects, such as heart defects and neural tube defects.
  • Problems with diagnostic tests—Having too much body fat can make it difficult to see certain problems with the baby’s anatomy on an ultrasound exam. Checking the baby’s heart rate during labor also may be more difficult if you are obese.
  • Macrosomia—In this condition, the baby is larger than normal. This can increase the risk of the baby being injured during birth. For example, the baby’s shoulder can become stuck during delivery. Macrosomia also increases the risk of cesarean delivery. Infants born with too much body fat have a greater chance of being obese later in life.
  • Preterm birth—Problems associated with a woman’s obesity, such as preeclampsia, may lead to a medically indicated preterm birth. This means that the baby is delivered early for a medical reason. Preterm babies are not as fully developed as babies who are born after 39 weeks of pregnancy. As a result, they have an increased risk of short-term and long-term health problems.
  • Stillbirth—The higher the woman’s BMI, the greater the risk of stillbirth.

Obesity during pregnancy puts you at risk of several serious health problems:

  • Gestational diabetes is diabetes that is first diagnosed during pregnancy. This condition can increase the risk of having a cesarean delivery. Women who have had gestational diabetes also have a higher risk of having diabetes in the future, as do their children. Obese women are screened for gestational diabetes early in pregnancy and also may be screened later in pregnancy as well.
  • Preeclampsia is a high blood pressure disorder that can occur during pregnancy or after pregnancy. It is a serious illness that affects a woman’s entire body. The kidneys and liver may fail. Preeclampsia can lead to seizures, a condition called eclampsia. In rare cases, stroke can occur. Severe cases need emergency treatment to avoid these complications. The baby may need to be delivered early.
  • Sleep apnea is a condition in which a person stops breathing for short periods during sleep. Sleep apnea is associated with obesity. During pregnancy, sleep apnea not only can cause fatigue but also increases the risk of high blood pressure, preeclampsia, eclampsia, and heart and lung disorders.
  • Encourage regular physical activity.
  • Eat small meals regularly at frequent intervals.
  • Cut down sugar, salt, fatty foods, refined foods, soft drinks and alcohol.
  • Eat complex carbohydrates, low glycemic foods and fibre rich diets.
  • Increase consumption of fruits and vegetables, legumes, whole grains and nuts.
  • Limit fat intake and shift from saturated to unsaturated fats.
  • Avoid trans-fatty rich foods (vanaspati, bakery products and sweets).
  • Use low- fat milk.

 There is no single regimen for weight reduction; it has to be individualized. Weight reduction should be gradual. Weight reduction diets should not be less than 1000 Kcal/day and provide all nutrients. A reduction of half a kilogram body weight per week is considered to be safe. Extreme approaches should be avoided and use of drugs may be dangerous. In children, obesity should be controlled by increasing physical activity rather than restricting food intake. Modifications in dietary habits have to be incorporated into one's lifestyle along with adequate exercise to keep the body weight within the normal limits. 

 

As fat contains more than twice the calories (9Kcal) per gram compared to protein (4Kcal) and carbohydrate (4Kcal), weight reducing diets should limit the fat intake. Refined sugars (4Kcal) and alcohol (7Kcal) provide empty calories and should be avoided. Refined carbohydrates which promote fast absorption of glucose (Glycemic carbohydrates) also need to be restricted. Plant foods that provide complex carbohydrates and fibre may be preferred as they reduce blood glucose, cholesterol and triglycerides. Weight- reducing diets must be rich in proteins and low in carbohydrates and fats. Consumption of plenty of fruits and vegetables would not only result in satiety but could also help to maintain adequate micronutrient intake. Frequent fasting/ semi-fasting (cyclic weight reduction) followed by adequate or excess food consumption will also aggravate the problem of weight gain. All reducing regimens should be monitored by a doctor and a dietitian.

 Always speak to your doctor before taking any type of medication, including over-the-counter weight loss medications or supplements, since they can be harmful if used incorrectly and may interact with other medications and medical conditions.

You may be advised by your doctor to consider weight loss surgery if your body mass index (BMI) is 30 or higher and you have other risk factors, or is 35 or higher with no risk factors. Also taken into consideration is your medical history and your attempts to lose weight.

Liposuction, sometimes called body contouring, is a cosmetic procedure that re-shapes and smoothes the body. Though liposuction removes unwanted deposits of excess fat, it is not a substitute for diet and physical activity and is not a treatment for obesity.

Over-feeding during infancy, childhood and adolescence predisposes to overweight/ obesity during adulthood. The tendency of familial obesity seems to be inherited. Eating junk or unhealthy foods coupled with low physical activity is considered as a main contributor. Complex behavioral and psychological factors influence the eating patterns. In addition, metabolic errors in energy utilization may favor fat accumulation. Insulin is an important modifier of energy and fat metabolism favoring fat deposition. Low and high birth weight (<2500 g and >3500g), obesity during childhood and adolescence are likely to lead to obesity in adults. It is therefore, necessary to maintain a desirable body weight by consuming just enough calories or adjust physical activity to maintain energy balance (intake = output). Body weight must, therefore, be checked and monitored periodically. Several studies have suggested that hours spent in watching television is strongly associated with weight gain in childhood and adolescents, mostly due to the sedentary behavior, tendency to consume snack foods while watching television and influence of the advertisements of energy dense foods. Adults usually tend to gain weight between the ages of 25-50 years. In women, obesity develops just around pregnancy and after menopause.

There are several health consequences of obesity. Excessive body weight increases the risk of heart disease, hypertension, diabetes, gallstones, certain types of cancers and osteoarthritis. Obesity invariably predisposes to reduced levels of high-density lipoproteins ('good' cholesterol) and to increased levels of low density lipoproteins ('bad' cholesterol), and triglycerides, besides an abnormal increase in glucose and insulin levels in blood. Considering the increasing trend in the prevalence of coronary artery disease, hypertension and diabetes in India, it is important to maintain desirable body weight for height and avoid obesity.

The waist circumference and waist-to-hip ratios are useful for estimation of central and truncal obesity respectively. Several studies have shown that the central obesity was directly correlated with chronic degenerative diseases especially metabolic syndrome. Waist-to-hip ratio of more than 0.9 among men and 0.8 in women and waist circumference 90cm for men and 80cm for women are associated with increased risk of several chronic diseases especially in Asian Indians.

There is no clear definition of a desirable or ideal body weight. Body weight for a given height of person with good health and long lifespan is considered as Ideal body weight. A much simpler and more acceptable measure is the ratio of weight and height, which estimates total body mass and correlates highly with the % of body fat. The most commonly used ratio is the BMI. It is computed by dividing the weight in kilograms by the square of the height in meters [BMI = Weight (kg) ÷ (Height in m)2]. The ideal ranges of weights for a given height are provided by WHO which is useful for categorizing persons as normal (ideal), undernourished and overweight or obese.

 The definition of obesity is based on the degree of excess fat. More than a general accumulation, the distribution of fat around the abdomen is now considered to be more harmful than fat around the hips. Accumulation of fat around abdomen indicated by higher waist circumference is considered as risk factor. In general, BMI ranging from 18.5 to 25 is considered to be normal. However, for Asians it is recommended that the BMI should be between 18.5 and 23, since, they tend to have higher percentage body fat even at lower BMI compared to Caucasians and Europeans, which puts them at higher risk of chronic non-communicable diseases. The cut-off levels for categorizing overweight and obesity in children and adolescents are different. =5th and < 85th centiles are normal, and with =85th and < 95th centile are considered as overweight. More than 95th centile are considered as obese.