Dr Anbarasu Mohanraj"s Dairy

An Epidemic Called Obesity:

At no point of time in the history of man-kind, has there been excessive food on the table, as the last few decades. Science and technology has helped in mass scale of food production in the last 50-75 years. That’s helped in eliminating famines and improvement in the overall health of the society.

Scientific advancement has had it’s own perils as well. Man has been cuffed to his chair in the last few decades. Throughout history, our ancestors have been either wandering or been physically active right from our ape’s days. The average life expectancy of humans is at it’s peak and the boomer’s generation are living into their eighties quite easily.

Excessive food on table and lack of mobility is taking it’s toll on the humans throughout the world. The age of communicable diseases is gone but for a few nations which tend to be still poor. It’s the age of non-communicable diseases (NCSs) like Diabetes, Hypertension, Dyslipidemia and Obesity. 

What worries me as a doctor dealing with heart patients day in and out, is the marked change in the physique of my patients whom I see day to day. I see patients in their seventies coming up for heart surgery. Most of the patients are not over weight. But their kids who accompany the parents for surgery are grossly obese.

It is also alarming to see the number of young patients coming up with heart attacks. Heart attacks are no longer the disease of elderly any more. It’s quite peculiar to see patients coming with heart issues at either age spectrum. With increasing age expectancy, we see lot of very elderly patients. With increasing Non Communicable Diseases (NCSs) we see a lot of young and middle aged patients coming with heart issues.

 

Obesity is a chronic complex diseases defined by excessive fat deposits that can impair health. Obesity increases the risk of Diabetes, Hypertension, Heart disease, bone health and even reproduction. It also increases the risk of certain cancers and greatly influences quality of living, such as sleeping and moving.

The current incidence of obesity as per WHO across the globe is as huge as:

1 in 8 in the world live with obesity.

1 in 3 live over weight.

Worldwide, adult obesity has doubled since 1990.

Worldwide, adolescent obesity has quadrupled.

37 million children under the age of 5 are overweight.

Over 390 million children and adolescents aged 5-19 years are overweight.

160 million children and adolescents are living with obesity.

The diagnosis of overweight and obesity is based on Body Mass Index(BMI) - weight(kg)/height² (m²) . You could easily calculate it based on any online calculation. 

For adults, overweight is a BMI greater than 25 kg/m² and obesity as a BMI greater than 30 kg/m².

For children, overweight and obesity is based on age and it’s a child’s play to calculate it online.

In 2000, a WHO expert group proposed the BMI criteria for overweight as 23-24.9kg/m² and obesity as >25kg/m² for individuals of Asia-Pacific region as against the International criteria. So we need to take these values to define our level of obesity in India.

Childhood Obesity:

Childhood obesity is a serious health hazard increasingly rampant in our society. Childhood obesity can lead to poor self-esteem and depression. Childhood obesity kids are prone to develop adulthood obesity and makes these kids prone to develop Diabetes, Hypertension and other complications early in life. India ranks second in the World in having the highest number of obese kids.

Causes of childhood obesity include too little activity and too many calories from food and drinks, but genetic and hormonal factors need to be evaluated. Regular intake of high calorie food such as fast foods, baked foods and fizzy drinks are the common causes of childhood obesity. Although candies and desserts can also cause obesity, more and more evidence is pointing towards sugary drinks and sports drinks as culprits for obesity.

Like any other Nation, India is affected by the epidemic of obesity. The Indian incidence of obesity is around 13%, which is much higher than that in other middle income countries. As per a recent government information, the incidence of over-weight, ie BMI of >22.9 kg/m² is 44.02% in males and 41.16% in females. This obviously means that close to 50% of the population in our Nation are over-weight.

In addition to this issue, one other worrying aspect of our population is normal weight obesity, meaning our population have a higher body fat despite a normal body mass index (BMI). Another variation of obesity in our population is sarcopenia obesity. These people have increased BMI or waist circumference along with sarcopenia (gross loss of muscle mass).

Waist circumference is a very important indicator of obesity which is quite commonly ignored in our country. The incidence of increased waist circumference with normal weight is as high as 65% in men and women. These individuals are called TOFI (Thin Outside and Fat Inside). TOFI individuals have a high fat deposition around their waist and have a high incidence of Diabetes, Hypertension and Heart diseases as obese individuals. An ideal waist circumference is 90cms for men and 80 cms for women in our subset.

Overweight and obesity cause 3.4 million deaths annually world-wide. India ranks third after China and USA, in the problem leading to economic burden attributed to overweight and obesity. Apart from the direct medical costs incurred by the country, the issue of overweight and obesity is also linked with indirect costs associated with process of seeking medical healthcare, economic loss from premature mortality, absence from workdays and negative influence on work productivity. 

Obesity has deleterious impact on an individual, family, society and the Nation through multifactorial paths. Obesity may increase the risk of poor sexual health. The big challenge with obesity is the psychological impact. Obesity can trigger mental health issues like low self-esteem, mood disorders, motivational disorder, eating problems, issues with body image and negative impact on inter personal communication.

Obesity is a severe global problem. Weight loss results in reduction in blood pressure, improved cholesterol levels and reduced diabetes incidence, all at one shot without pills.

Treating obesity with newer medicines is quite effective, but is expensive and is not without any adverse effects. Metabolic surgery or Bariatric surgery is effective, but the cost involved and the long term nutritional aspects and protein supplements needed, have to be taken into account.

4A’s of Obesity:

Awareness, Attention, Advocacy and Addressal are the pillars in the prevention and treatment of Obesity.

Adhering to healthy food, cautiously avoiding carb rich and junk food are the need of the hour. While regular physical activities and simple change in life style are the must need. Achieving 6000-8000 steps each and every day, which is kept track easily on our smart watches or mobiles with mild weight training. Simple remedies like totally avoiding lifts, walking short distances to shops instead of bikes and intentionally avoiding sitting with the mobiles and TVs for prolonged duration helps.

Organizations and companies can give target based walking distances and incentives or appreciations will help in spreading awareness. Checking weight and waist circumference on regular basis itself will create a sense of motivation to address the issue of overweight and obesity in an individual.