A Family Doctor's Tale - OBESITY

DOC I AM TOO FAT

Obesity is defined as having a weight 20% above the desirable weight which is having a BMI (Body Mass Index) of 22 or less.
It is a chronic medical condition where fat accumulates in the body due to excess calories.
Obesity is harmful to the person's health and well being.


Many factors contributes to obesity:


Genetic factors

Obesity runs in the family and is hereditary.
Family members who share the same diet and lifestyle may have the same overweight condition.


Environmental factors

The environment is an important factor in determining obesity.
1.Overeating -
many people have an increased craving for food. It has found that these people lack a hormone called serotonin in the brain which acts to decreased appetite.


2.low metabolism -
some people has a lower metabolic rate tends to accumulate the excess energy from food as fats in the body. Classic example is hypothyroidism where the low thyroid hormone reduce the capacity of the body to burn off energy so they become lethargic and fat.


3.lack of exercise -
Exercise helps to burn up calories. People who tend to have a sedentary life without exercise tends to be overweight


4.Certain medication:
some medications like corticosteroids, female hormones aand antidepressants tends to cause increased appetite and water retention and contributes to weight gain.


Psychological factors

Psychological factors may be the cause of tendency to overindulge in food.
Some people eats more out of boredom, sadness, or anger. Others overeat as a way of dealing with stress or depression.


Rare illnesses:

Some rare illnesses like hypothyroidism, Cushing's syndrome, depression, and certain neurological problems  can lead to overeating. These conditions are believed to be responsible for only about one percent of all obesity cases.


The most widely used method is the body mass index (BMI).
BMI is the gauge of the amount of body fat in adults.


BMI      =                    Your Weight (kg)            
                            ---------------------
                        Height (metres) x Height (metres)


The risk of developing heart disease and diabetes begins at BMI values of 23 kg/m2 and above.


BMI (kg/m2) (for adults)
 Risk of Heart Disease and Diabetes


27.5 and above
 High Risk


23.0 - 27.4
 Moderate Risk


18.5 - 22.9
 Low Risk (healthy range)
  
Less than 18.5
 Risk of nutritional deficiency diseases and osteoporosis


Knowing your BMI will motivate you to lower your weight.


Health hazards

Obesity is not just a cosmetic problem.
Many serious medical conditions are associated with it:

1.High blood pressure
2.High blood cholesterol
3.Diabetes
4.Coronary heart disease
5.Stroke
6.Gallbladder disease
7.Liver disease
8.Degenerative joint disease
9.Cancer (colon, uterine, breast and other cancers).
10.Gout,caused by high levels of uric acid in the blood from the high purine proteins consumed.
11.Sleep apnoea


Emotional effects:

1.Feelings of rejection, shame, or depression 
2.Feeling undesirable compared with a slim person.
3.Some face prejudice or discrimination.
4.Some may be seen as lazy or lacking in self-control.



Motivation:

Motivation is the key to weight control.
Knowing the dangers of obesity will help to motivate a person to lose weight.
Set realistic goals for losing weight eg. reduce 10% in 6 months
Gradually reduce weight and maintain it at a healthy weight.
Even if you fail to reach your targeted healthy weight, any reduction helps your health and prevents diseases associated with obesity.


Exercise:

Regular exercise daily, or at least three times a week is good for the body.
It helps to improve blood circulation and breathing.
Start with a regime of walking or cycling or swimming.
Slowly increase the level of activity to more intense physical exercise like jogging.
Lead an active lifestyle.


Diet:

Choose a  healthy diet with with reduce calories and which is nutritionally balanced
Take plenty of vegetables and fruits.
Eat less food which is high in fat and sugar
Low Fat and high carbohydrate diets may reduce the weight but may have long term bad effect on your health.


A combination of diet and exercise is more effective in reducing than either one alone.


Medication:

Two main types of medications are available to help control weight:
1.Appetite suppressants:
help promote weight loss by reducing appetite or increase the sensation of being full.
They increase serotonin or catecholamine - brain chemicals that affect mood and appetite.
They also help by increasing metabolism thus burning away the fat.
They may have limited effect on weight loss as the patient's weight loss level off after 4 to 6 months.
They have the side effects of irritability, insomnia, palpitations and tachycardia.
They should be avoided in heart disease, anxiety, insomnia.
They should be used for short term (6-12 months) as there is also a danger of dependency.


2.Fat absorption suppressant:
prevents the absorption of fats by interfering with the enzymes which dissolves the fat and absorbs the fat into the body.
Instead the fat is not absorbed into the body and passes out in the stools undigested.
The fat in the body is then used up to provide energy and production of hormones.  
Less fat is available for putting on weight.
They should be avoided in malabsorption syndrome, liver disease or pregnancy.
The side effects of these medicines are usually diarrhea due to the fat passed out in the stools.
They can be taken for a longer peroid of 2 years.


Surgery:

Surgical treatment may be required for the severely obese (those with a BMI of 40 or greater) or with other health problems).
Surgery should be used only drug therapy, diet, exercise have failed.
Minor surgery may involve liposuction (sucking out the fats in the abdominal wall,under the chin, buttocks and other obvious parts of the body.
Lapband surgery is done for the very obese when other methods have failed and there is a risk of obesity related disease. A band is placed over the middle of the stomach making it narrow and not capable of taking much food. Surgery has some complications such as infections.


Many studies showed that most people will regain weight within 5 years.
You can maintain your weight by
1.eating a low calorie diet, low in fats
2.maintaining a healthy exercise regime
3.maintaining motivation and self esteem
4.monitoring your weight food intake and exercise