Obesity

Obesity

Obesity is an epidemic of the 21st century, and is a major causative factor for many other metabolic disorders. According to a global estimate by the World Health Organization (WHO), in 2005 there were about 1.6 billion overweight persons aged 15 years and above and among them at least 400 million adults were obese. The revision of definition of obesity to adjust for the racial differences, by the WHO, has resulted in a higher prevalence of 1.7 billion people classified as overweight. The WHO further projects that by 2015, approximately 2-3 billion adults will be overweight and more than 700 million will be obese.Obesity has been identified as a major cause of disability and premature deaths in less developed countries. This has been attributed to shifts in diet and lifestyle changes. The risk of many diseases including cardiovascular diseases (CVDs), hypertension, hyperlipidemia, diabetes mellitus, and certain cancers increases many folds in association with obesity. It has been estimated that obesity accounts for 2% to 7% of total healthcare costs.

Obesity is thus a vexing problem in the developed economies, yet for developing countries like India, morbid obesity has not yet become a public health priority. Why is this so? Though the reasons are still far from clear probably, India is, in our own eyes, still a country of poverty, hunger and malnutrition.

Transport facilities, medical care and food habits, educational status, and family income have dramatically improved, which along with easy access to city and television watching, result in unwanted changes in lifestyle. These have eventually led to significant increase in body mass index (BMI) as well as abdominal obesity in both sexes as compared to a similar study conducted in the year 1989. The prevalence of overweight thus rose from 2 to 17.1%.The changing life style has been found to be a contributory factor for the rising rates of obesity and associated metabolic diseases such as diabetes and also clustering of cardiovascular risk factors like blood pressure, fasting plasma glucose, HDL-cholesterol and triglycerides. The comorbid conditions associated with obesity are, abnormal glucose tolerance including type 2 diabetes, hyperlipidaemia, hypertension, early menarche, polycystic ovarian syndrome, increased risk of obesity in adulthood, increased risk of other hormonal disorders and psychosocial issues.

Epidemic of chronic non-communicable diseases have been associated with increasing obesity or, more specifically, excess of fat at wrong places. Maternal malnutrition associated with low birth weight results in phenotypically “thin-fat baby”, which means that though the baby is weighing less than Western counterparts, it harbors more fat in the body. Current belief is that if fat is stored at right places, i.e. adipose tissue, individual is protected from diabetes; if it spills over and gets deposited at ectopic sites, it leads to its adverse effects on various organ systems including muscle, heart, and pancreas. It has been hypothesized that this programming occurs in fetal life, where good maternal nutrition programs the body to store fat at right places and vice versa. Traditionally, Indian mothers are fed well by parents and in-laws. With modernization and living as nuclear family, traditional care is giving way to maintaining body weight at the cost of nutrition to the baby. One may argue that improving maternal nutrition may help in preventing obesity and related epidemics.

Some specific traditional Indian customs can offer innovative solutions for obesity prevention at low cost – maternal nutrition, walking, yoga, meditation, and the traditional Indian folk dance systems. Not all aspects of traditional India are healthy. For instance, many traditional Indian foods are oil rich, carbohydrate overloaded, and just plain unhealthy. Also unhealthy are some traditional Indian customs like tobacco chewing and smoking. It is, therefore, suggested that one should choose the most health-friendly among our traditions and customs, and apply them to prevent obesity. This may help improve the implementation of an obesity prevention program.

Diet, exercise, and behavioral modification should be included in all obesity management approaches for body mass index (BMI) of 25 kg/m 2 or higher. Other tools, such as pharmacotherapy for BMI of 27 kg/m 2 or higher with comorbidity or BMI over 30 kg/m2 and bariatric surgery for BMI of 35 kg/m 2 with comorbidity or BMI over 40 kg/m 2, should be used as adjuncts to behavioral modification to reduce food intake and increase physical activity when this is possible. Commercial weight loss programs can also be considered, as many they are successful. Use the BMI calculator to find out whether one is obese or not.

As with all chronic medical conditions, effective management of obesity must be based on a partnership between a highly motivated patient and a committed team of health professionals.

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