Obesity management / weight loss  

Compiled & reviewed by Dr.Sanjana.V.B, BHMS,DBRM.CDN

       Obesity or excessive body mass and weight is a preventable health crisis,  which is a major cause  for many morbidities or illnesses affecting the population such as diabetes ,cardiovascular diseases, cancers ,hormonal diseases and metabolic syndrome.  Obesity is a major health problem affecting both children and adults alike in developed, developing and low income countries of the world.

  A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. According to world health organization [data of 2022] more than 1 billion people worldwide are obese – 650 million adults, 340 million adolescents and 39 million children. This number is still increasing in a rapid pace everywhere on the globe.

    Obesity affects the vital organs like heart, liver, kidneys, joints, and reproductive system. It may lead to a range of non-communicable diseases (NCDs), such as type 2 diabetes, cardiovascular disease, hypertension and stroke, various types of cancers, and mental health issues.

 Obesity linked to heredity or genes in some people. Certain rare genetic disorders may cause intractable obesity like Padre Willi syndrome. Genes have definite role in obesity and weight gain. However physical inactivity or sedentary life style has a significant role in developing obesity.    

  Nowadays people are leading sedentary lifestyles. Everything is available on fingertips in this era of internet and technology. Thus prolonged inactivity, induced by comforts may increase the weight gain as the carbohydrates and fats consumed through daily diet are not burned into energy and instead deposited as fat contributes to obesity.

      Eating large quantities of carbohydrates and high glycemic index [sugar level increasing] foods increase the risk of weight gain. The amount of calories people eat and drink has a direct impact on their weight. Consume the same amount of calories every day that the body burns them over time, and weight remains stable. As you eat more than the body could burn, weight goes up.

     The quality of food you eat is more important than their relative quantity in the diet. Foods and eating patterns may help to keep calories in check. Milled, refined grains and the foods made with them-white rice, white bread, white pasta, processed breakfast cereals, potatoes, sugary drinks are rich in easily digested carbohydrates.i.e. Foods having high glycemic index and glycemic load. Such foods cause rapid elevation in blood sugar and insulin levels that it can cause hunger to spike soon and may lead to overeating. In short these foods increase the risk of weight gain, obesity, diabetes, and heart disease.

        Clinical trials have found that merely following a low-fat diet does not help to lose weight than following a moderate- or high-fat diet. The problem of following with low-fat diet alone simply is that they are often high in carbohydrate, especially from rapidly digested sources, such as white bread and white rice. And diets high in carb foods increase the risk of weight gain. Another reason is the quality of fat in the food you consume. Increased consumption of unhealthy fats- especially trans- fat and saturated fats are linked to weight gain, but increased consumption of healthy fats-monounsaturated and polyunsaturated fat-in moderate amount do not cause weight gain.

   Hormonal disorders also cause obesity. An underactive thyroid gland (hypothyroidism) – where your thyroid gland does not produce enough hormones and eventually it may cause obesity as  hypothyroidism slows down the metabolism. Cushing's syndrome – a rare disorder that causes the over-production of steroid hormones and leads to obesity.

    Certain medicines, including some corticosteroids, medications for epilepsy and diabetes, and some medications used to treat mental illness – including antidepressants and medicines for schizophrenia – can contribute to weight gain.

   Health science classifies obesity into class types based on body mass index [BMI] and its intensity. If your BMI is between 25.0 and 29.9 kg/m², you are in the overweight category.  But here are three general classes of obesity that healthcare providers use to evaluate the grade of obesity to decide obesity management protocols and it is strictly individualized. They include:

Class I obesity: BMI 30 to <35 kg/m².

Class II obesity: BMI 35 to <40 kg/m².

Class III obesity: BMI 40+ kg/m².

BMI [Body mass index]:

Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.   Body Mass Index (BMI) is a person’s weight in kilograms (or pounds) divided by the square of height in meters (or feet). A high BMI can indicate high body fatness. BMI screens for weight categories that may lead to health problems, but it does not diagnose the body fatness or health of an individual.

Impact of obesity on health

Obesity has tremendous but progressive impact on cardiovascular, reproductive and general health in adults as well as children .It may lead to a range of non-communicable diseases (NCDs), such as type 2 diabetes, cardiovascular disease, hypertension and stroke, various forms of cancer, as well as mental health issues.

Fatty liver disease also may result from obesity.Excess fats circulating in the blood may get deposited in the liver, when the liver begins storing excess fat, it can lead to chronic liver inflammation (hepatitis) and long-term liver damage (cirrhosis].

Higher blood cholesterol levels can cause cholesterol to accumulate in your gallbladder, leading to cholesterol gallstones and potential gallbladder diseases like cholecystitis.

Other complications of obesity include:

Asthma

Obstructive sleep apnoea or difficulty in breathing while sleeping

Obesity hypoventilation syndrome

Osteoarthritis

Back pain

Gout

Memory and cognition is also affected gradually. There is a heightened risk of Alzheimer’s disease and dementia.

Female infertility, polycystic ovarian syndrome and pregnancy complications

Depression and mood disorders

Certain cancers, including esophageal, pancreatic, colorectal, breast, uterine and ovaries.

General tips to manage obesity
·        Reduce carbohydrate to moderate amount and the quantity as well as quality of food you take is important.

·        Include moderate amount of healthy mono and polyunsaturated fat into your diet.

·        Avoid sugary sweetened beverages.

·        Reduce alcohol intake. The scientific data available till date do not strictly restrict alcohol intake considering it as a major cause of obesity. Even though most alcoholic beverages have more calories per ounce than sugar-sweetened beverages, there’s no clear-cut evidence that moderate drinking contributes to weight gain. While the recent diet and lifestyle change study found that people who increased their alcohol intake gained more weight over time, the findings varied by type of alcohol.

·        Yogurt - A study from the Harvard School of Public Health, found that people who increased their yogurt intake gained less weight. Increases in milk and cheese intake, however, did not appear to promote weight loss or gain. More research is needed in this area.

·        Nuts are rich in protein and fiber, both of which may help people feel fuller and less hungry.

People who regularly eat nuts are less likely to have heart attacks or die from heart disease than those who rarely eat them. So include nuts in a healthy diet.

·        Whole grains-The weight control evidence is stronger for whole grains than it is for fruits and vegetables. So include whole grains as your carbohydrate portion of diet.

·        Proteins- some proteins are good for weight loss. Replacing red and processed meat with nuts, beans, fish, or poultry seems to lower obesity and the risk of heart disease and diabetes.

·        Fibers- since fibers slow down digestion, they help to curb hunger. Many fruits and vegetables are rich in fibers.

·        Lower carbohydrate, higher protein diets may have some weight loss advantages in the short term.

·        Reduce stress and stress related hormonal imbalances which may lead to obesity

·        Treat medical conditions like hypothyroidism and Cushing’s syndrome which are diseases contributing to obesity.

·        Promote physical activity through exercise programs and games.

References

https://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/diet-and-weight/   

https://www.who.int/health-topics/obesity#tab=tab_1  

https://www.nhs.uk/conditions/obesity/causes/#:~:text=Obesity%20is%20generally%20caused%20by,by%20the%20body%20as%20fat.

https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html