UNDERSTANDING OBESITY PARADOX

Individual can be said to have excess weight if his weight is more than ideal weight for his/her height and person can be classified according degree of excess weight. For this categorization, we use Body Mass Index that adjusts your weight for your height and is calculated as:

BMI = Weight/Height² ( kg/m² )

Category	BMI (kg/m2)
Underweight	<18
Normal	18-23
Overweight	23-30
Obese	>30
Super-obese	>40

Why do we gain weight at all?

Our ancestors were hunters and gatherers. They had no guarantee of future availability of food. This made ability to store fat i.e. gaining weight an evolutionary advantage. This trait has persisted till date and human body perceives gaining fat as survival instinct. But, when exploited beyond a limit everything becomes harmful and same is true for fat also.

What is the extent of obesity in world today?

Two third of people living in USA are either obese or overweight. Situation is little better in India, but people from middle and higher socioeconomic strata are almost as obese as our western counterparts. More disturbing fact is increased prevalence of obesity in childhood. Obese children are common sight in schools now days.

What are the treatment options for tackling obesity?

Lifestyle changes are cornerstones of obesity treatment. Doing enough physical activity and restricting calories can not be replaced by any other means including medications and surgery.

Now, we also have some reliable medications which can make you lose weight when used judiciously with lifestyle changes. But, selecting right people for these medications is crucial to avoid side-effects.

Bariatric surgery is now a matter of fashion in our society. Bariatric surgery is definitely a good option in selected patients especially in super-obese people. But, being an irreversible in nature in most cases, long term complications and implications need to be looked into. Moreover, people opting for bariatric surgery should realize that lifestyle changes would still be required after surgery. In short, there is no short-cut to lose weight.

Persistent hard work along with ethical medical guidance would be needed for long term care.

What are recent trends in management of obesity?

There has always been a paradox while understanding obesity: If obesity is so harmful then does human body still perceives it as survival advantage?   Well there are two aspects this statement.

Firstly, that evolutionary cycle is actually longer than our lifespans and harmful obesity is relatively recent phenomenon.

Secondly, it now seems that actual harmful effects of weight are due also to inactivity associated with obesity along with per se increased fat mass.

So, we as doctors, now place more emphasis on overall fitness of person irrespective of their actual weight!!

Dr RAJIV SINGLA

Consultant Endocrinology & Metabolism.

HOD, Endocrinology Department, Saket City Hospital & Kalpavriksh Clinic.

9968277369

Childhood Obesity: An emerging epidemic

Is deficiency of the growth the only worrisome problem in the childhood?

Every parent has got a similar refrain that my child is not eating well or growing well. But in the real time scenario, where we follow one or two child policy in most households, parents in their attempts to feed the child will agree to unreasonable demands of children and would give child anything to eat when the child does not eat the good home-made food. And that is leading to another problem - Obesity. Obesity is the root cause of majority of the lifestyle diseases like diabetes, cardio-vascular problems, hypertension and even stroke. And in the present scenario with our junk food friendly diets, obesity is gaining epidemic proportions.

Obesity in children and adolescents is a common phenomenon now-a-days. Childhood obesity can lead to a variety of diseases. Because of obesity,  type 2 diabetes (usually associated with older adults) accounts for 30% of newly diagnosed cases of diabetes in teenagers now. Also associated with obesity are sleep apnea (temporary interruptions of breathing during sleep), raised blood pressure, high cholesterol, bone and joint problems, and depression.

When to say that the child is obese?

Defining childhood overweight and obesity is difficult. Body mass index used to define obesity in adults varies with age and hence should be used only after correction for age. 

A BMI-for-age higher than that of 85% of children of similar age indicates overweight; a BMI-for-age higher than that of 95% indicates obesity. 

Childhood obesity is a serious matter. Having excess fat should not be dismissed as a condition the child will grow out of, something “in the genes,” or a merely cosmetic concern. Obese children become obese adults.

It is good to follow up with your endocrinologist to rule out any hormonal disturbance. Doctor would assess your child for overall health and may some test might be required to rule out incident diabetes or thyroid disorder.

What can I do to manage obesity in my child?

Lifestyle changes, in form of diet and physical activity, form the cornerstone of therapy for childhood obesity. Healthy eating habits would include:

1.     Controlling caloric intake through portion control

2.     Avoiding the consumption of calorie-dense, nutrient-poor foods (e.g., sweetened drinks (such as soda, juice and sports drinks ), most “fast food,” and high-calorie snacks such as chips and candy)

3.      Increasing dietary fiber, fruits, and vegetables

4.     Eating regular meals, particularly breakfast, and avoiding “grazing” after school.

What is the role of exercise in controlling obesity?

Energy intake (calories) is only half of the equation governing weight gain; the other half is energy output (physical activity). 

• Children should engage daily in 60 minutes of vigorous physical activity, and should not spend more than 1 to 2 hours daily watching television, playing video games, talking or texting on cell phones, or using the computer for fun.
• Family as a unit should be part of lifestyle change. For example, it is important for parent to be an example of these healthy lifestyles, avoid overly strict dieting, avoid use of food as a reward or punishment, and try to build children's self-esteem. 

A positive approach works best. Parents should encourage healthy eating and regular exercise without developing a fear of food. This is the first step in establishing the behaviours essential to long-term success.

Contributed by:

Dr Rajiv Singla

Consultant Endocrinology & Metabolism

MD,DM Endocrinology.