Some forty years back you wouldn’t have seen many a fat people on the streets. On the silver screen, there was one and only Oliver Hardy. Now, you often come across obese people jostling for space in overcrowded pavements in a metropolis.
If you are not aware of its easy mathematics, unit of obesity is BMI (Body Mass Index) and is calculated as the ratio of one’s weight in kilograms divided by square of height in meters. Over 30 kg/m2 one is marked as obese. A range in between 25 to 30 is taken as overweight. Undoubtedly uncared overweight turns obese.
Obesity means excess fat and has a bag full of the curse for us like cardiovascular disease, type 2 diabetes, sleep apnoea and other sleep problems, dyslipidemia, depression, fatty liver, atherosclerosis, reproductive disease, chronic kidney disease, reducing life expectancy and certain types of cancer. Obesity also accelerates development of cancer. There is increased mortality and considerable morbidity associated with obesity. This list of afflictions, according to WHO, is inexhaustible as more research papers are published.
Childhood obesity, on the other hand, is devastating and needs urgent handling by public health people. Some medical and social intervention may have brought a relief but ‘severe childhood obesity’ is simply on the rise and is at greater risk for adult obesity. Bass and Eneli in 2015 have rung the bell for urgency regarding this.
The 2013 guideline from American College of Cardiology, American Heart Association, for management of overweight and obesity still stands good and is readable. Metabolic syndrome (fasting blood sugar 100 mg/ml or more, reduced fasting good cholesterol HDL, increasing triglycerides, increasing blood pressure values and rising waist circumference) which paves way for obesity is one term which the common people are still not aware of.
Body’s simple engineering lies in the input-output theory. If your food intake is excessive and physical activity and exercise does not counteract your intake, you are sure to gain weight turning overweight and later an obese. Only a handful in the crowd can blame their genes, metabolic disorders, medications and mental status for this. Rightfully obesity is classified as a lifestyle disorder confirming that it is mostly self- preventable through personal choice, change in diet and exercise. It is a leading preventable cause of death. In 2015 WHO data mentions 600 million adults and 1oo million children are obese worldwide.
It is a serious public health problem of this century, reaching pandemic proportions, forcing American Medical Association to call it a disease. And the number is on the rise without hindrance. The USA presently has the most number of obese in its population. We can appreciate our subcutaneous (below the skin) fat at the most, but what about the fat around our internal organs, the visceral fat, which we can’t see. Repple et al in 2018 confirms both grey and white matter atrophy in obesity irrespective of age and sex. Moreover, truncal obesity has a critical role to play.
So how powerful is this disease? It’s very powerful indeed, it is silent and it kills us softly. Owino and Cornelius in 2018 have made surprising discoveries, ‘Double Burden of Nutrition (DBM)’, a quick shift from plant-based nutrition to energy packed ones like milk, animal fats, meat and vegetable oils drive us to obesity. This drive becomes faster with urbanization, more media exposure, rising income, increased density of population and availability of cheap foods. When looked into holistically, all these work as Endocrine Disrupting Chemicals (EDC), in the malnutrition-causal schema.
In this age of information, it is still surprising to find people depriving themselves of food to treat obesity. It is foolish to reduce sugar intake drastically as memory, thinking and other cognitive functions of the brain are closely related to glucose levels in the body. Other way round, less sugar means less intelligence. Decade-old anti-obesity drugs are still not dependable. There is an obesogenic - environment all over the world and it needs to be cut short quickly. There is a connection between diet, obesity and cancer and one must appreciate it. Researchers from Case Western University, tells us how obesity is shifting cancers to young adults.
Research from University of Medicine from Seoul says breastfeeding reduces high birth weight infants from turning obese. University of Cambridge has found a link between expecting mother’s high blood pressure with an obese child. Childhood obesity has lasting damage to body says researchers from the University of Surrey. Plant-based food like fruits and vegetables cuts risk of obesity for sure.
As there is little medicine available till now to treat obesity, it is better to treat this disease by oneself. Exercise, regulated quality consumption of food is the mantra now. When there is no other way out or when everything fails, Bariatric surgery is the final word.
Kovesdy and others in 2017 mentions, that prevalence of obesity is projected to grow by 40% in ten years. Only education and awareness can save the human population from the silly hands of obesity, which none of us like but doesn’t gather enough strength to fight against it.
(The writer is a doctor working for a state-run hospital)
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