An Overview Of The Chronic Disease Of Obesity!
Obesity is a complex, chronic disease involving accumulation of excessive amount of body fat.
It significantly increases the risk of various health problems and is a growing global health concern.
Causes of Obesity:
Obesity is caused by an imbalance between calorie intake and expenditure.
Our food provides us with the energy required to carry out our body functions and activities.
If we consume more calories than our body burns, the excess calories are stored in our body as fat and our weight increases.
But several contributing factors are involved in this process.
- Lifestyle Factors : Overeating (especially calorie-dense, nutrient-poor foods: fast food, processed snacks)
- Physical inactivity : Sedentary lifestyle (excessive screen time and desk jobs etc.)
- Genetic and Biological Factors : Genetics can influence how fat is stored, metabolism, and hunger cues
- Hormonal imbalances (e.g., leptin resistance) : Leptin is a hormone produced by the fat or adipose cells. Its job is to signal to the hypothalamus that the body has adequate levels of stored fat and to reduce appetite, increase metabolism and calorie expenditure.In Leptin resistance the brain ignores the Leptin signals and the appetite increases and the metabolism and calorie expenditure is reduced and fat storage is increased. Medical conditions like hypothyroidism, PCOS, Cushing’s syndrome cause weight gain.
- Psychological and Social Factor
- Emotional eating (stress, boredom, depression)
- Socioeconomic status (easy access to high sugar, high fat and high calorie food, alcohol and sedentary recreation options)
- Cultural norms (e.g., large portion sizes, food as reward)
Diagnosis Of Obesity:
- Checking weight against a standard height for weight chart
- Measuring waist circumference
- Calculating waist to hip circumference ratio
- Calculating Body Mass Index or the B.M.I.
Effects of Obesity:
- Obesity affects nearly every system in the body.
- Physical Health Effects
- Heart disease (high blood pressure, atherosclerosis)
- Type 2 diabetes
- Sleep apnea
- Fatty liver disease (NAFLD)
- Joint problems (especially knees and hips)
- Certain cancers (colon, breast, endometrial)
- Mental and Emotional Impact
- Depression and low self-esteem
- Social stigma and discrimination
- Anxiety and body image issues
Prevention of Obesity :
Healthy Eating
Emphasise whole foods: Focus on fruits, vegetables, whole grains cereals and pulses and legumes and low fat milk, curds and buttermilk and if possible fatty sea fish.
Limit added sugars, refined carbs, and trans fats
Practice portion control and mindful eating: Make sure you’re as light after a meal as before.
Regular Physical Activity: Minimally 150 to 300 minutes / week of moderate exercise (brisk walking, cycling, etc.) .
Include strength training 2–3 times per week.
Behavioural Strategies: Maintain consistent sleep schedule (poor sleep increases appetite)
Reduce screen time :Manage stress effectively, practice yoga, yoganidra, meditation, pranayama, deep breathing.
Cardiovascular exercise like walking, cycling, swimming reduces stress.
Treatment of Obesity
- Treatment depends on the severity and underlying causes.
- Lifestyle Modifications is the first line of treatment
- Personalised diet and exercise plan
- Behavioural therapy and coaching
- Writing a daily diary of food and exercise regularly and habit tracking
Medical Treatment
Medical treatment for obesity:
Newer prescription medications like GLP-1 agonists like semaglutide (Ozempic) and liraglutide (Saxenda) have been approved in the Western countries principally for type 2 diabetes but are also being used widely to treat obesity.
They help control appetite and cravings and are used as supplementary treatment to lifestyle modifications.
Some of these medicines are gradually becoming available in India.
These medicines have gastrointestinal side effects like nausea, vomiting, diarrhoea or constipation which may settle down after a while. More serious complications like pancreatitis, gall stones, hypoglycaemia have also been reported.
They cannot on their own help much unless accompanied by lifestyle changes.
Do not confer cardiovascular fitness.
Treatment of co-existing conditions like hypertension and diabetes.
Surgical Interventions (for severe obesity)
Bariatric surgery (gastric bypass, sleeve gastrectomy)
Usually recommended for BMI ≥40 or ≥35 with co-morbidities.
Patients are advised to eat protein dense low carbohydrate foods only after the surgery.
Most Indian people are primarily vegetarian and find it difficult to eat protein dense low carbohydrate foods as most of their protein sources are also carbohydrate dense
They also end up eating less than 300 – 400 calories a day for several months after the surgery and maximally just 500 – 700 calories a day several months later.
So gross nutritional deficiencies are as inevitable as in any very low calorie diet (VLCD).
Sustained nutritional supplements have to be taken after surgery as they can’t eat much food.
Maximum weight loss achievable post bariatric surgery is 50 to 70 per cent of the total excess weight, many lose much less.
Do not confer cardiovascular fitness.
Most people start regaining weight after two to three years.
Gastric pouch stretching and other anatomical changes occur in five or six years and many regain all the weight they lost post surgery, unless they adapt a healthy lifestyle including healthy food and exercise habits.
The Final Verdict
Lifestyle modification including healthy, balanced nutrition and regular exercise is the only sustainable treatment of obesity.
It confers cardiovascular fitness.
It is by far the healthiest treatment of obesity.
