The battle against obesity requires a solution that is most likely to work for the individual in the long run.

When Charles Darwin talked about “the survival of the fittest”, he may not have envisioned the context in which we would be using it today. Health problems created by sedentary lifestyles, unhealthy eating habits and a lack of physical exercise have added a whole new dimension to this phrase.

Obesity, an ailment characterised by an excessive accumulation of body fat, is fast emerging as India's single most preventable health problem. If we do not take strong measures to check it, we will be dealing with a national health catastrophe in a decade from now. Battling this threat begins with an awareness of risk factors. Most studies on the incidence of obesity in both rural and urban areas indicate that people in the middle income class are more prone to it. People are also more susceptible to the condition as they get older.

Interpreting the numbers

For a person to be classified as obese, their excess body weight needs to measure above certain predetermined levels.  Being overweight is not the same thing as being obese. To identify when excess weight becomes harmful, it is necessary to quantify obesity. The most reliable way to do this is through the Body Mass Index (BMI).

According to the table, a person with a BMI of 27, while overweight, is not obese and needs to reduce weight to get into the healthy range. However, a person with a BMI of more than 28 is obese and may face several health risks.

Obesity adversely impacts longevity. Studies have shown that morbidly obese individuals have a 200 per cent more risk of premature death as compared to individuals of normal weight.

Obesity has been associated with the 3D's: disease, disability and death. It is the underlying cause of several problems such as osteoarthritis, hypertension, diabetes, cardiac problems, obstructive sleep apnea, cancers, skin infections, and endocrine disorders. An obese person may also suffer from psychological and social problems arising from reduced self-esteem and the stigma attached to the condition.

Another worrying trend is that diseases historically linked to obesity - hypertension, diabetes and heart problems - occur at much lower BMI values among South Asians as compared to other ethnic groups.

Beat Obesity

Moderate weight loss is largely a result of physical activity. Exercise increases energy output and boosts the effects of dietary restriction. Regular exercise also helps control related ailments like hypertension and diabetes.

A dietary overhaul requires a change in both the quality and quantity of food consumed. If you go low on carbohydrates (cereals) and fat (dairy, oily food) and reduce the quantity eaten at each meal, you will manage to restrict caloric and energy intake, resulting in weight loss. Unfortunately, a majority of patients regain weight as soon as they go off their careful diets. This yo-yo effect is common in obese individuals.

Certain drugs such as Sibutramine, Orlistat, and some antidepressants help in weight loss. But these should only be taken after consulting a doctor and under strict medical supervision. They are also not meant for long-term use. On the surgical front, Bariatric surgery is a viable option for reversing the condition. Bariatric surgery alters the digestive system by decreasing stomach size and the length of the intestines. The procedure also makes it easier for patients to follow and adhere to dietary restrictions.

Obesity management requires a multi-disciplinary approach. When a patient has a BMI of 38 or more, they are at high risk for many life-threatening ailments.  Battling the problem requires identifying the weight reduction solution that is most likely to work for him or her in the long run.

The writer is a Chennai-based Surgical Gasteroenterologist and Obesity Surgeon.


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