Obesity: |a lifestyle issue

 Obesity, defined as having an excess proportion of total body fat, has reached endemic proportions in the western world and has already become a serious and increasing public health concern in developing countries. In the USA, 150 million people are overweight and of these, 75 million are considered clinically obese. Children are affected too, with the proportion of youngsters aged 5 to 17 years five times higher in 2008-09 than in 1973-74.

Doctors often use the Body Mass Index (BMI) to determine weight status. This ranges from low (less than 19), normal (20-24.9), overweight (25-29.9) and obese (over 30) and extremely obese (over 40). Although BMI may not be appropriate for all individuals, it is still widely used to assess most patients’ weight. BMI is the weight in kilogrammes divided by the square of your height.

The long-term consequences of obesity include high blood pressure, hyperlipidemia, cardiovascular diseases and diabetes. The condition also affects the pulmonary function, the bone and joints, the liver functions and increases the risk for numerous cancers such as oesophagus, breast, uterus, bowel, kidney, pancreas and thyroid. Obesity may also increase the risk of Alzheimer disease. 

There are a few essential concerns to understand when it comes to treating excess body weight: 

1- Stable weight is arithmetical. If your body needs 2,000 calories a day to function and to perform your daily physical activity, then any excess of 2,000 calories ingested is automatically stored (mainly in the form of fats within the adipose tissue) and your weight increases. A deficit of calories has the opposite effect. The core issue with obesity is thus primarily related to daily food intake and secondly to lack of physical exercise. This is why some markedly overweight persons remain overweight despite being active. However, even with low physical activity, reduction of food intake translates into weight loss. 

2- Excess weight is a lifestyle issue essentially related to the quantity of food ingested – not “a diet” issue per se. Daily food intake is obviously linked to how much pleasure get from eating, meaning that food intake is a lifestyle choice. Most obese people know all about healthy foods and the right cooking styles. What they need to realise is that any weight loss endeavour must come from significant and sustained motivation for behavioural changes. The diets listed in the “quick and easy weight loss” fads give rise to the illusion that eating pleasures can be maintained through a few dietary tips. By keeping the focus on the food intake, the lifestyle issue is not effectively addressed, leading to repeated diet regimen failures. 

3 - Some people insist that they do not eat a lot, yet their body weight keeps increasing. But that “not eating a lot” is still too high for them. There is some kind of metabolic injustice in that some people have lower metabolic requirements and burns fewer calories than others. Prior to switching to a low calorie diet, there is a need for an honest assessment of all types of foods taken during the day. From this analysis, the quantity of calories needed to lose weight (in a gradual manner) can be determined. 

4- Reduction and then maintenance of an acceptable body weight is a lifetime commitment. The focus in term of life’s pleasures needs to be realigned to other worthwhile interests such as returning to a more active, physical or outgoing lifestyle.

As mentioned above, the treatment of obesity, whatever the chosen medical or surgical options, can only become effective if lifestyle modifications including regular exercise are sustained. The goal of weight loss needs to be realistic and achieved over a reasonable period of time. Interestingly, a 10 per cent weight loss already leads to significant health benefits so further weight reductions can only bring a more positive outcome. 

 

 

Dr Gerard Lalande is managing director of CEO-Health, |which provides medical referrals for expatriates and |customised executive medical check-ups in Thailand. |He can be contacted at [email protected].