Understanding obesity: Dr Anshuman Kaushal, Consultant, Minimally Invasive Bariatric Surgeon, Columbia Asia Hospital, Gurgaon

obesityOf the people diagnosed with type II diabetes or adult onset diabetes, almost 80 per cent are overweight. An overwhelming majority of people who develop cardiovascular disease have excessive weight. Besides multiplying the risk of heart disease, diabetes and stroke, obesity is also a major cause of sleep apnea, gall bladder stones and early osteoarthritis. The risk of certain types of cancer is found to increase in overweight people. Excessive weight also raises blood cholesterol and triglyceride levels, lowers “good” HDL cholesterol, and increases blood pressure.

In brief, if we maintain a healthy body weight, we can dramatically lower our risk of a range of potentially fatal diseases and lead a healthier, longer and more productive life. Yet, India is falling prey to the lifestyle disorder called overweight or obesity.

According to Obesity Foundation of India, 30 million Indians are obese, and the number is predicted to double over the next few years. According to WHO statistics, India ranks second to China in Asia with regard to the number of people with obesity. A National Health & Family Survey put Punjab, Kerala and Goa among the top 3 states with the most number of people overweight in India, with 30 % of Punjab’s, 24 % of Kerala’s and 21 % of Goa’s population in the overweight bracket.

The American Medical Association has classified Obesity as a disease in 2013. During the initial phase of human evolution, human beings lived in an age of food scarcity. So there is an inherent tendency in our bodies to accumulate calories. Added to this are our static, low exercise lifestyles and improper eating habits today that have resulted in a large number of Indian population turning overweight. For people in the Indian subcontinent, a BMI (Body Mass Index) of 18-23 is considered adequate; while the same is 19-25 for people of other races. A BMI of above 30 means you are obese. We are also more prone to metabolic syndrome. We tend to gain fat around the abdomen. Yet, we in the Indian subcontinent have not handled obesity as our western counterparts have. As compared to 10 years back, people today are certainly more aware about the threat of obesity, but even if they are aware, they do not take any action to control it.

Easy accessibility of packaged junk food which is high in calorie, low on fibre and rich in salt, accompanied by increasingly sedentary lifestyles due to a preference for the virtual world over outdoor exercise, the urban young is now facing the effects of lifestyle disorders like obesity. Walking to the office or the nearby market, or cycling to school is no more the norm. People travel by vehicles even for short distances, they take elevators even for two floors and children prefer to play video games rather than spend time running and playing. All these have contributed to a major spurt in overweight people and a consequent rise in associated disorders like diabetes, hypertension, heart disease, osteoarthritis etc.

A serious concern is a rise in childhood obesity. School cafeterias today also serve high calorie foods like cakes, pizzas, burgers etc which are easily available to children. More and more children today are also relinquishing active playing and turning to video game culture. This is very harmful.

Stress is another factor that sometimes leads to weight gain. When in stress, people tend to overeat. When we heat a certain hormone is released in the brain that relaxes our stressed out nerves. Nut, the same hormone is release when we exercise, essentially having the same relaxing effect. So, we need to become more exercise centric, rather than being food-centric.

We need to make people more conscious and more responsible for their own health. We need to develop a culture of exercise, right from childhood.

Excess weight puts us in the line of threat of Type 2 Diabetes Mellitus, Sleep apnoea, Hypertension, Hypercholesterolemia, increased risk of heart attacks,  increased severity of symptoms of asthma, gastro esophageal reflux disease, stress incontinence (loss of bladder control), low back ache and joint pains, polycystic disease of the ovary as well as decreased fertility.

Morbid obesity is a complex multi factorial, chronic disease, where weight and symptoms build up slowly over time. Obesity becomes “Morbid” when it reaches the point where it has an adverse effect on health. Class II and class III obesity are considered morbid obesity. For patients of morbid obesity who are under a serious health risk, we recommend bariatric surgery. Bariatric surgery is a weight loss procedure in which accumulated fat from the body melts away uniformly over 4 to 6 months’ time after surgery and it has crucial health benefits.

However, it is extremely important to emphasis the need for prevention by radically changing our lifestyles, improving our food habits and making exercise a regular feature of our lives.