Obesity is a state of excess fat being stored in the body. It is arguably the biggest health crisis the world is currently facing and is fast approaching the status of a pandemic. It takes a huge toll on morbidity, mortality and finance both at an individual, as well as at a community level.
Being overweight or obese are major risk factors for a number of chronic metabolic diseases, including but not limited to, diabetes, hypertension, metabolic syndrome and cancer. In urban settings, obesity is on a rise in low income communities as well now.
QUICK FACTS ABOUT OBESITY
Body mass index (BMI) – the weight in kilograms divided by the square of the height in meters (kg/m2) – is a commonly used index to classify overweight and obesity in adults. WHO defines overweight as a BMI equal to or more than 25, and obesity as a BMI equal to or more than 30.
In 2008, >1.4 billion of the world’s population was overweight or obese. At least 2.8 million people each year die as a result of complications of obesity. Major killers in this regard are stroke, heart attack and complications from diabetes.
Worldwide, 42 million pre school children were obese in 2013. The figures are steadily rising, making childhood obesity one of the foremost challenges to health care advances in the 21st century.
Regular physical activity helps maintain a healthy body. People should engage in adequate levels of physical activity throughout their lives. At least 30 minutes of regular, moderate-intensity physical activity on most days reduces the risk of cardiovascular disease, diabetes, colon cancer and breast cancer. Muscle strengthening and balance training can reduce falls and improve mobility among older adults. More activity may be required for weight control.
CAUSES OF OBESITY
The basic reason behind gaining excessive weight is an imbalance between caloric intake and caloric expenditure. As a global trend in recent years, there has generally been a rise in consumption of saturated, processed and high fat foods. At the same time, sedentary lifestyle and excessive workplace/general life stressors have contributed towards an unhealthy shift in paradigm towards physical inactivity.
In the developing world, the rise in obesity has led to a manifold increase in the health burden, as these countries are already fighting against communicable diseases and other low income stressors, such as undernutrition.
COMPLICATIONS OF OBESITY
While not every obese/overweight person will face complications of the disease, a good number of patients could have one or more of the following complications:
Heart disease and stroke
High blood pressure
Certain cancers, such as Colorectal, pancreatic and postmenopausal breast cancer
sleep apnea and asthma
A reasonable goal for weight loss in the setting of a medical treatment program is approximately 1-2 lb/wk. However, it is becoming increasingly apparent that the weight-loss goal for each patient must be individualized and cannot be unilaterally based on standard weight-for-height norms.In addition to the patient’s weight, factors to consider when setting individualized weight loss goals are the weight of other family members, as well as the patient’s cultural, ethnic, and racial background. A study of approximately 200 obese black women, the Obesity Reduction Black Intervention Trial (ORBIT), found evidence that greater weight loss can be achieved with a culturally adapted weight-loss program than with a more general health program.
Management of obesity starts with a comprehensive lifestyle overhaul, including behavioral modification, diet and increased physical activity. Behavioral modification includes monitoring self for caloric restriction, controlling the stimuli that may lead to excessive food intake, such as anxiety and stress, setting goals to meet healthy eating and weight loss milestones, and incorporating a healthy amount of physical activity in to the daily routine.
Weight loss medication should be introduced for patients with BMIs of 30 or more. The purpose of these drugs is mainly to improve adherence to behavior change, thus making it easier to modify lifestyle and make healthier choices. In patients with metabolic syndrome, which is a combination of multiple diseases including high blood pressure, high blood sugar due to insulin, and elevated cholesterol, certain medicines which target these conditions may also have a significant role in orchestrating weight loss as a side effect.
For patients with significantly high BMI of 35 or more, weight loss surgery (bariatric surgery) should be recommended after assessing any coexisting problems that might make surgery an invalid option.