Dr. Rakesh Periwal
Obesity is a disproportionate increase in body fat compared to other constituents in the body.This occurs due to an imbalance in the energy intake and expenditure. If the energy provided byfood (called calories) is in excess of what the body can spend, then that extra energy getsconverted to fat and contributes to obesity.
Accurate body fat quantitation requires sophisticated tools like MRI, CT Scan and Bio Electric Impedance Analyser. In clinical practice, anthropometric measurements are an easy tool todefine obesity in general.
BMI (Body Mass Index) is a simple tool.
BMI = Wt. in Kg / Ht. in (meter2)
BMI above 25 is considered abnormal and is considered a cut off mark for obesity.
It is not only total body fat, but also its distribution as well which better defines the risks associated with obesity. Fat around the abdomen and inside the abdomen (Visceral Fat) is themost dangerous, whereas lower body fat is not so.
An abdominal circumference of more than 90cms in males and 80cms in females is considered ahealth hazard, and can be used as an independent tool to define obesity related health hazard. Tobetter quantitate the disproportion between upper and lower body fat, the waist to hip ratio isused. A ratio of more than 1 in males and 0.9 in females is considered unhealthy.
A lower BMI cut off has been suggested for the Indian population, since it has been seen thatobesity related disorders are seen in the Indian population at values below that of their westerncounterparts.
Thus the best way to define obesity as a health hazard is to look for the presence of medical
disorders related to obesity. These are:
3) Cardiac disease
4) Abnormalities of Cholesterol
5) Polycystic Ovarian Syndrome (PCOS) and Infertility
6) Sleep Apnea
7) Mechanical Joint Disorders
Any health conscious individual with an elevated BMI and an increased abdominalcircumference should make every effort to normalize their weight, esp. if they have obesityrelated disorders.
Also, it has been seen that there is a clustering of diseases in obese people, whereby they usually have more than one problem, increasing morbidity and mortality, cost of care and impairingquality of life. Thus reversing obesity helps to combat multiple diseases simultaneously.
To identify obesity related health hazard at an early stage, a Metabolic Syndrome has been defined, where the following 5 parameters are included.
1) Waist circumference more than 90cms in males and 80cms in females.
2) Serum Triglyceride > 150 mg%
3) HDL Cholesterol < 40 mg% in males and < 50 mg% in females. 4) Blood Pressure > 130 / 85 mmHg
5) Fasting Blood Glucose more than 100 mg%
Presence of any of these three defines the metabolic syndrome in which obesity is the centralculprit. Patients with this syndrome have a much higher risk for the development of cardiacdiseases and diabetes.
Obesity has major adverse effects on health. Obesity is associated with an increase in mortality, with a 50-100% increased risk of death from all causes compared to normal-weight individuals, mostly due to cardiovascular causes. Obesity and overweight together are the second leadingcause of preventable death in the United States, accounting for 300,000 deaths per year.
Mortality rates rise as obesity increases, particularly when obesity is associated with increasedintra-abdominal fat. Life expectancy of a moderately obese individual could be shortened by 2-5years, but even more important is the constellation of diseases and the quality of life affected. A20- to 30-year-old male with a BMI > 45 may lose 13 years of life.
As weight increases, the morbidity associated with it also increases, and every Kg of weight lostis a health benefit. So even though you may fail to reach the target weight, every Kg of extraweight lost is a health benefit.
It is important on part of the patient to view obesity as a disordered physical state and seek helpjust as they do for other chronic diseases like diabetes. When you are not able to manage yourbody weight, seek the advice of an expert. This is the first important step in weight management.There is a lot contemporary medical science can provide for management of obesity. The nextimportant thing is to be patient. Weight loss usually occurs slowly and that is perhaps the safestway as well. It may take months of concerted effort to lose those extra kilos. But considering thatweight gain usually occurs over years, the process of weight loss is much faster than that!
Weight loss requires a small but definite behavioral change, a change in life style, to produce weight loss in a meaningful time frame.
Dr. Rakesh Periwal