Obesity

Obesity is a complex disorder involving an excessive amount of body fat. Obesity isn’t just a cosmetic concern. It increases your risk of diseases and health problems, such as heart disease, diabetes and high blood pressure. Being extremely obese means you are especially likely to have health problems related to your weight. Dietary changes, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss surgery are additional options for treating obesity. Obesity is diagnosed when your body mass index (BMI) is 30 or higher. Your body mass index is calculated by dividing your weight in kilograms (kg) by your height in meters (m) squared.

BMI

Weight status

Below 18.5 Underweight 18.5-24 Normal 24.1-26.9 Overweight 27.0-32.5 Obese (Class I) 32.5-37.9 Obese (Class II) 38.0 and higher Extreme obesity (Class III) ( Govt. of India Guidelines 2012)

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn’t directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obese category even though they don’t have excess body fat. Ask your doctor if your BMI is a problem.

When to see a doctor

If you think you may be obese, and especially if you’re concerned about weight-related health problems, see your doctor or health care provider.

The principal causes of obesity are:

• Inactivity. If you’re not very active, you don’t burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you use through exercise and normal daily activities.
• Unhealthy diet and eating habits. Weight gain is inevitable if you regularly eat more calories than you burn. And most Americans’ diets are too high in calories and are full of fast food and high-calorie beverages.

Risk factors

Obesity usually results from a combination of causes and contributing factors, including:

• Genetics. Your genes may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise.
• Family lifestyle. Obesity tends to run in families. If one or both of your parents are obese, your risk of being obese is increased. That’s not just because of genetics. Family members tend to share similar eating and activity habits.
• Inactivity. If you’re not very active, you don’t burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Having medical problems, such as arthritis, can lead to decreased activity, which contributes to weight gain.
• Unhealthy diet. A diet that’s high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
• Medical problems. In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing’s syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.
• Certain medications. Some medications can lead to weight gain if you don’t compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.
• Social and economic issues. Research has linked social and economic factors to obesity. Avoiding obesity is difficult if you don’t have safe areas to exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have money to buy healthier foods. In addition, the people you spend time with may influence your weight — you’re more likely to become obese if you have obese friends or relatives.
• Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs, and can make it harder to keep off excess weight. If you don’t consciously control what you eat and become more physically active as you age, you’ll likely gain weight.
• Pregnancy. During pregnancy, a woman’s weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
• Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain that the person becomes obese. In the long run, however, quitting smoking is still a greater benefit to your health than continuing to smoke.
• Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain. Even if you have one or more of these risk factors, it doesn’t mean that you’re destined to become obese. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

If you’re obese, you’re more likely to develop a number of potentially serious health problems, including:

• High triglycerides and low high-density lipoprotein (HDL) cholesterol
• Type 2 diabetes
• High blood pressure
• Metabolic syndrome — a combination of high blood sugar, high blood pressure, high triglycerides and low HDL cholesterol
• Heart disease
• Stroke
• Cancer, including cancer of the uterus, cervix, endometrium, ovaries, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate
• Breathing disorders, including sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts
• Gallbladder disease
• Gynecological problems, such as infertility and irregular periods
• Erectile dysfunction and sexual health issues
• Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver and can cause inflammation or scarring
• Osteoarthritis

Quality of life

When you’re obese, your overall quality of life may be diminished. You may not be able to do things you used to do, such as participating in enjoyable activities. You may avoid public places. Obese people may even encounter discrimination. Other weight-related issues that may affect your quality of life include:

• Depression
• Disability
• Sexual problems
• Shame and guilt
• Social isolation
• Lower work achievement

All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan. Other treatment tools include:

• Dietary changes
• Exercise and activity
• Behavior change
• Prescription weight-loss medications
• Weight-loss surgery

Dietary changes

Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they’re unlikely to help you keep excess weight off for the long term. Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight-loss success. There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:

• Cutting calories. The key to weight loss is reducing how many calories you take in. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.
• Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods — such as desserts, candies, fats and processed foods — are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have lower energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
• Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein — such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils.
• Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended, and limiting these drinks or eliminating them altogether is a good place to start cutting calories.
• Meal replacements. These plans suggest that you replace one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that’s low in fat and calories. In the short term, this type of diet can help you lose weight. Keep in mind that these diets likely won’t teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off.

Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don’t appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you’re likely to regain it when you stop the diet. To lose weight — and keep it off — you have to adopt healthy-eating habits that you can maintain over time.

Exercise and activity

Increased physical activity or exercise is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking.

To boost your activity level:

• Exercise. People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To achieve more-significant weight loss, you may need to exercise 300 minutes or more a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve.
• Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day.

Behavior changes

A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating. Tailor your behavior changes to address your individual concerns.

Behavior modification, sometimes called behavior therapy, can include:

• Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Therapy can take place on both an individual and group basis. More-intensive programs — those that include 12 to 26 sessions a year — may be more helpful in achieving your weight-loss goals.
• Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers.

Prescription weight-loss medication

Nearly all the prescreption drugs against obesity are not approved in India except Orlistat. Ayurveda does provide with some alternatives but are usually unproven and there are no long term data to support their efficacy or their safety.