Dr Tariq Mala
The normal body mass index (BMI) of a person ranges from 18.5 to 24.9 kg per meter square, values below or above this are considered abnormal. Obesity is increasing at an alarming rate throughout the world. Today it is estimated that there are more than 300 million obese people.
The prevalence of obesity is increasing in most parts of the world, affecting men, women and children. Furthermore, obesity is no longer just a concern for developed countries, but it is becoming an increasing problem in many developing countries also. It has a large number of negative health, social and economic consequences. Mortality and morbidity rates are higher among overweight and obese individuals than lean people.
As of 2008, the World Health Organization claimed that 1.5 billion adults, 20years and older, were overweight and of these over 200 million men and nearly 300 million women were obese throughout the world. China is currently facing challenges of ‘over-nutrition’. This is believed to be primarily due to the rapid declines in physical activity and changing dietary habits which has occurred between the 1980s and the 2000s. The decline in physical activity is attributed to increasing technology in the workplace and changing leisure activities. In India urbanization and modernization has been associated with obesity. In Northern India obesity was most prevalent in urban populations more in females followed by the urban slums and were the lowest in rural populations. With people moving into urban centers and with increasing wealth, concerns about an obesity epidemic in India are growing. The United States has the highest obesity rates in the developed world It is said, to lose one kilogram of body fat person should walk at least 70 miles with a normal speed which is very difficult for a human being.
The exact cause of obesity is still debatable but there is a clear cut familial predisposition. Certain hormones like cholecystokinin, ghrelin, leptin have a close relation with the satiety of a person, increased levels of ghrelin are associated with increased appetite while leptin decreases the intake of food. Obesity is a complex of diseases icluding genetic, behavioral and environmental factors among which the nucleus is metabolic syndrome which is a constellation of central obesity with other co-morbid conditions like type2 diabetes mellitus, dyslipidemias, hypertension and impaired sugar levels. There is inappropriate hepatic uptake of insulin, hyper insulinemia and followed by unresponsiveness of tissue to insulin. Epidemiological data and national institute of health (NIH) has given importance to waist-hip circumference and if it more than 98cm in males, more than 87cm in females is being always considered significant with more chances of grave cardiovascular events. Obesity has drastic effects on a normal body like degenerative changes in weight bearing joint especially in elderly females, sleep apnea and pulmonary hypertension (Pickwickian syndrome), cancers of colon, uterus, rectum, gallbladder, pancreas some lymphomas and menstrual irregularities.
To manage this upcoming challenge, it is important for us to modify our lifestyle, adopting primordial and primary preventions, by changing our dietary habits and daily exercise. The NIH has recommended many drugs of which some have been approved by FDA like sibutramine and orlistat. These drugs block norepinephrine, serotonin receptors and inhibiting pancreatic lipase which decreases absorption of fat in gut respectively, but these drugs have their own adverse effects and regaining of weight after their discontinuation. To overcome this surgical management (bariatric surgery) came into existence for those having BMI more than 40 kilograms per metre square (morbid obese). In the era of minimally invasive surgeries laproscopic surgeries with less complications are preferred especially adjustable gastric banding, gastric bypass and biliopancreatic diversions and sleeve gastrectomy. Research is now going on to find out the exact cause of obesity because in spite of taking high calorie diet only some regain weight and others do not, which needs further discussion to know the exact cause of obesity.
