11/05/2024
Author: Rituparna Nandy, Senior Dietician, Vivekananda ENT Clinic & KPC Medical College
Obesity is a disorder involving accumulation of excessive body fat that results from more calorie intake than are burnt by excessive or normal daily activities. Obesity can lead to physical discomfort, diabetes mellitus II & heart disease, affect bone health & reproduction, is a high risk of certain cancers, & it may cause obstructive sleep apnea.
Obesity Gradation:
Obesity is frequently subdivided into categories:
Class 1 : BMI of 30 to ⥶35
Class 2 : BMI of 35 to ⥶ 40
Class 3 : BMI of 40 or higher
class 3 obesity is severe obesity.
BMI is a screening tool for obesity. A trained health care provider should perform appropriate assessments to evaluate an individuals health status & risk.
Measuring waist circumference helps to assess possible health risks that come with obesity.
If fat accumulates in the waist, there is a higher risk for type 2 diabetes.
Prevalence In India:
The prevalence of obesity in India varies due to an age, gender, geographical environment, socio-economic status etc. According to ICMR-INDIAB study 2015, prevalence rate of obesity & central obesity varies from 11.8% to 31.3% & 16.9% to 36.3% respectively.
Various studies have shown that the prevalence of obesity among women was significantly higher as compared to men. The world obesity federation estimates that by 2020 around 770 million adults globally will be affected by obesity, & that figure is anticipated to exceed one billion by 2030 unless we act soon.
Prevalence of obesity in India is 40.3%. Zonal variation were seen as follows:
South India has the highest rate of obesity at 46.5% & eastern India, lowest at 32.96% .
Obesity was higher among women than men (41.88% vs 38.67%).
Urban than rural (44.17% vs 36.08%).
& over 40 & under 40 (45.81% vs 34.58%).
The prevalence of abdominal obesity in India was followed to be 40% in women & 12% in men. The findings show that 5-6 out of 10 women between the ages of 30-49 are abdominally obese. The association of abdominal obesity in women is stronger with older groups, urban residents, & non-vegetarians. Abdominal obesity is also on the rise in rural areas & is penetrating lower & middle socioeconomic sections of society.
For women, a waist circumference ⥸ 80cm, & for men waist circumference ⥸94 cm are considered as abdominal obesity. Individuals with BMI ⥸ 25 were considered as overweight & those with BMI ⥸ 30 were considered as obese.
Based on the body fat accumulation, there are two types of body forms; Gynecoid or Pear shape (fat accumulation in lower body such as hips & thighs) & Android or Apple Shape (fat accumulation in the upper body such as the visceral or abdominal region).These two types are usually associated with Cardiovascular disease, DM II,& other Metabolic disorders.
Causes:
Many factors can contribute to excess weight gain including eating patterns, physical activity levels, & sleep routines. Social determinants of health, genetics & taking certain medications also play a role.
Food, Activity & Sleep :
Eating & physical activity patterns, insufficient sleep & several other factors influence excess weight gain.
Social Determinants of Health (SDOH):
The conditions in which we live, learn, work & play are called Social Determinants of Health (SDOH). It can be difficult to make healthy food choice & get enough physical activity if these conditions do not support health. Difference in SDOH affect chronic disease outcomes & risk, including obesity.
Genetics:
Genetics changes in human populations occur too slowly to be responsible for the obesity epidemic yet variant in several genes may contribute to obesity by increasing hunger & food intake. Rarely, a specific variant of a single gene (monogenic obesity) causes a clear pattern of inherited obesity within a family.
Research shows that genetics play a role in obesity. Genes can directly cause obesity in such disorders as Prader Willi Syndrome.
Illness & Medication:
Some illnesses, such as Cushing's Disease, may lead to obesity or weight gain. Drugs such as Cortico-steroids (central Obesity) & some Antidepressants, Seizure Medicines may also cause weight gain.
Some hormonal problems may cause obesity, such as hypothyroidism & PCOS.
Environment:
The World around us influence our ability to maintain a healthy weight, for example:
1. Not having parks, playgrounds, sidewalks & affordable gyms makes it hard for people to be physically active.
2. Large food portions increase calorie intake, making it even more difficult to maintain a healthy weight.
3. Food advertising encourages people to buy unhealthy foods, such as high fat snacks & sugary drinks.
Complications:
Women are slightly more likely (40%) than men (35%) to have obesity. Obesity specifically affects some different aspects of women's health.
- Infertility
- Lifetime hormonal changes
- Polycystic O***y Syndrome (PCOS)
- Physical discomfort
- High risk pregnancy
- Gestational Diabetes
- Preeclampsia
- Obstructive sleep apnea
- Fatty Liver
Management:-
The amount of calories people consume has a direct impact on body weight.
High protein & low carbohydrates are good for weight management.
There are few reasons for eating a higher percentage of calories from protein may help with weight control, give more satiety, greater thermic effect, and improve body composition.
Low carbohydrate, higher protein diets may have some weight loss advantage in the short term. When it comes to preventing weight gain & chronic disease, carbohydrate quality is much more important than carbohydrate quantity.
Fiber is good for weight management benefits, fiber slows digestion, helping reduce hunger.
Fruits & vegetables are also high in water, vitamins, and minerals, which may help people feel fuller on fewer calories.
Nuts are rich in protein, fiber & antioxidants which may help feel fuller.
Milk and milk products are good for weight loss. Milk products like curd are good for a healthy gut.
Sugar, carbonated beverages are strictly avoided.
Instead of having fruit juice, whole fruits are more beneficial for weight loss.
Choose minimally processed food, whole food, whole grains, vegetables & fruits.
Limit sugary beverages, refined grains, potatoes,red & processed meats & other highly processed foods, such as fast food.
Exercise & deep breathing can help control weight.
Sedentary lifestyle can increase diabetes, high blood pressure, weight gain & bone related problems.
Conclusion:-
Diet Control with the help of a trained dietitian with the aim of limiting daily calorie intake.
Regular physical activity.
Medical disorders leading to obesity should be treated.
Medicines causing obesity should be avoided if possible.
Sometimes medicines may be needed to cause weight loss.
If all the above mentioned measures fail to control obesity then Bariatric Surgery / Intra Gastric Balloon Surgery may be offered.
Bibliography:-
World Health Organization - obesity & overweight.(1.03.2024)
Hypertension treatment cascade among men & women of reproductive age group in India :analysis of National Family Health Survey-5(2019-2021).
National institute of health (NIH) - overweight & obesity statistics-NIDDK.
World Obesity Federation - Prevalence of obesity.
Mayo Clinic-Obesity symptoms & cause.
Centers for disease control & prevention - Health effects of overweight & obesity, nutrition.
Centers for disease control & prevention.
Obesity prevention source-Harvard T.H.CHAN school of public health.
National Library Of Medicine-Exercise & Fitness Effect on Obesity.
