As many as 135 million Indians are currently battling obesity and tackling related health issues. On the occasion of World Obesity Day (Oct 26), KAMALA THIAGARAJAN elaborates.

In a country where excess is usually frowned upon and an estimated 30 per cent of the population live below the poverty line, you might find it difficult to digest the fact that millions of Indians are now battling the bulge and opening the lid on a Pandora's box of health issues. But this, according to Dr R.M . Anjana, Joint Managing Director & Consultant Diabetologist at Dr.Mohan's Diabetes Specialities Centre and Obesity& weight management centre, Chennai, defines the greatest Indian paradox. "Those who do the most activity on a daily basis eat the least and those who eat the most food, perform the least activity! This is perfectly normal when you think about how economics plays a role in obesity; the coolie who doesn't have access to quality food as a result of poverty must compromise on nutrition, whereas the sedentary white collar worker who sits around most of the day has access to a variety of fare."

Not a genetic curse: One of the biggest myths related to obesity today is that it is a genetic issue and no matter what the individual does, it remains a life-long problem. Another myth is that you're born with genes that somehow make you obese and that you're helpless when it comes to reversing it. "While it's true that some people may tend to gain weight easily, they don't have to go through life being overweight," says Dr Anjana. "Obesity can certainly be prevented and even reversed. Clearly, we are over-estimating our nutritional needs and consuming far more calories than required." Even 50 extra calories a day (which is a very conservative estimate, considering how people tend to consume far more) can add up to around 18,000 calories a year, resulting in an annual weight gain of around 2 kilos. "Over a ten year period, that can make you over twenty kilos overweight," says Dr Anjana. "If you examine family photos from ten years ago, you'll find that you can hardly recognize your own family members!" Since this weight gain happens gradually over a period of a decade, seldom do people notice it. "For this reason, obesity can be a very stealthy disease," says Dr Anjana. "Rather than being born with the affliction, it quietly creeps up on you."

While a sensible diet and exercise remain the cornerstones of obesity treatment, here are some immediate, practical steps you can take (with revealing facts that may surprise you).

The need for extra-vigilance during childhood: Does obesity run in your family? Then you'll need to be very vigilant with your children. This doesn't mean exposing them to restrictive dieting, but you will need to increase their intake of fresh fruits and vegetables and avoid junk foods like the plague. This is a reason for this, experts say. "Where your body stores its fat is pre-determined by your genetic make-up (which explains why one person might have excess abdominal fat while another who weighs the same might pack on the kilos along their arms and thighs), but the number of fat cells that we have are determined during the pre-pubescent phase of childhood," says Dr Anjana. "Being careful at this stage is important, because afterwards, it is extremely difficult to the rid the body of fat cells. When you lose weight, your fat cells are likely to shrink, but their numbers remain the same." Children who pack on more fat cells at this phase find themselves inevitably battling the bulge later on in life. "If your child is overweight, take small steps to encourage an increase their activity, weed out empty calories from their diets and ensure they get a balanced diet. Overweight children can most certainly become obese adults," says Dr Anjana.

Matching your intake with activity levels: You don't need to eat fancy, exotic or organic food to lose weight.The latest strategies in obesity treatment involve ensuring that your diet is suited to the kind of physical activity that you perform every day. If you lead a sedentary life, you'll need less food and vice-versa. "The importance of controlling portion sizes cannot be stressed enough," says Dr Anjana. "Hard and fast rules about dieting just never work, because these are difficult if not impossible to sustain on a daily basis. The first advice we give patients who are obese is to cut their portion sizes by half. This is a simple step that most people can do immediately. By decreasing quantity, you can still get the nutrition you'll need." This method also ensures that you ease into a weight loss programme, (without the hassle of having to prepare special meals with hardly available ingredients), enhancing the likelihood that you'll stick to it in the long-term.

Learning to train your appetite: While it's natural to feel a little hungry when cutting your intake by half, your appetite too can be 'trained' until eating the correct quantity of food that you require becomes a second nature. Experts say that it is possible for the stomach to 'shrink' as it adopts to its changing quantities of food.

If you find counting calories for Indian foods challenging, the illustrated food atlas priced at Rs 850 and available at Dr Mohan's Diabetes centers (http://www.drmohansdiabetes.com/patient_care/images/food-atlas/food_atlas_rs.pdf?cc_ref=IND-101&cc_code=ind) has a pictorial representation of popular foods and desserts from across the country, detailing the calorific value of the portion sizes that you see in the pictures. Just as in dress sizes, you'll instantly be aware of whether your appetite rates a S, M, L or XL in portion sizes and this will in turn help create awareness of the quantities that are currently being consumed.

Daily dose of Exercise: How much exercise should an obese person need in order to lose weight? According to guidelines set by the American College of Sports Medicine, at least 150 minutes (30 minutes, five times a week) of moderate-intensity physical activity is essential in order to prevent further weight gain or to lose a small amount of weight. However, for significant weight loss, you'll need at least 250-300 minutes (an hour, 5 times a week). Taking small steps will help you progress faster in your fight against obesity and onwards in your journey towards healthy living.