Articles
Obesity Facts
Obesity has long been recognised as a major risk factor for cardiovascular disease. At times obesity is a cosmetic problem but more importantly, such as its association with Metabolic Syndrome, it can lead to complications such as Diabetes and Heart Disease. Other factors often associated with obesity are Osteoarthritis, Sleep Apnoea, Depression and Gout.
Here are some of the reasons obesity leads to further health issues
• Excessive weight gain can lead to decreased insulin action. Insulin requirements then increase and the body becomes insulin resistant leading to Type 2 Diabetes.
• There is a close link between hypertension and weight. As weight increases so does blood pressure. Hypertension is a risk factor for Heart Disease
• Diets high in saturated fat diet often lead to obesity, and increases in LDL cholesterol, bad cholesterol. High LDL is also a risk factor for Heart Disease.
• Increasing weight puts increasing stress on the joints making osteoarthritis more painful.
• Gaining excess weight can increase fatty tissue in the throat and surrounding tissues. This can affect breathing and increase problems of Sleep Apnoea.
• Depression can either be from being depressed as a result of being obese or as a consequence of overeating when depressed. This can hinder weight reduction. It is easier to lose weight when psychological factors are not present. Sometimes the help of a counsellor or psychologist will be very beneficial.
Body Mass Index and Abdominal Circumference
Obesity is best defined as “Increase in body fat resulting in impaired health or increasing the patient’s risk of disease”. Obesity is measured using the Body Mass Index (BMI) or by Abdominal Circumference.
BMI is calculated by dividing the weight in kilograms by height in metres squared. A BMI of 20-25 is a healthy ideal weight. A BMI of 25-30 is classified as overweight and greater than 30 is classified as obese. The abdominal circumference is the best measure of fat distribution. In men there is increased risk if the abdominal circumference is greater than 94 cm and a substantial increase so if it is greater than 102cm. For women there is increased risk greater than 80cms or substantial risk greater than 88cms.
Causes of Obesity
Physicians previously considered that obesity was caused by excess food intake. It is now recognised the problem lies between the imbalance of energy intake and energy expenditure. With the modern conveniences of today’s world, we are less active in everyday life. We may still expend energy whilst we perform planned exercise, but overall we expend less energy because we do less in terms of incidental physical activity such as chopping wood, washing clothes, cutting the lawn, cleaning house, and walking to the shop or up the stairs.
In 1994 a substance called Leptin was identified in the body. It plays a roll in regulating body stores of fat and shows close correlation with body mass index (BMI) and with percent body fat. The majority of obese patients have high Leptin concentration and appear to be Leptin resistant. It could be that forty to sixty percent of obesity is through an inherited predisposition, or genetics. The rest is life style. Even with a predisposition to obesity, greater care with nutrition and a higher level of physical activity can make all the difference.
Suggested Targets
It is not always possible or practical to reach an ideal weight, but any weight loss is beneficial. It has been proven that losing as little as 5-10% of body weight can decrease the risk of many morbidities. If health risks can be reduced and there is an improvement in fitness then this is a good outcome.
Reduction in body weight of five to ten percent sustained over a period of five years is a reasonable goal. Even sometimes weight maintenance in itself can be an achievement. Sometimes weight can stay the same but increasing muscle and decreasing fat will give an improvement in shape and a reduction in waist circumference. With improved diet there can be improved control of diabetes, hypertension, dyslipidemia and increasing ability to exercise.
A Place For Medication, Replacement Meals or Surgery
It is felt that drug therapy may be appropriate when reducing fat intake and increasing activity have failed to achieve improvement in the metabolic risk factors.
Orlistat, a lipase inhibitor known as Xenical can be recommended. It is the only one of its type available in Australia.Orlistat or Xenical will induce severe fat malabsorption. If a person has a high fat meal, then this will induce significant fatty diarrhoea and even faecal incontinence. This can be valuable retraining for the person.
Very low kilojoule or low energy diets are useful in special circumstances where sufficient weight loss cannot be achieved and exercise is limited. An example of this is Modifast. It is a complete replacement meal of 1800 KJ or 425 calories per day including 56 grams of protein. It is only prescribed through a doctor. Modifast works well under a Dietitian’s supervision but is considered a last resort. Low kilojoule vegetables and some fruit may be combined with the Modifast. It is low in fibre so the addition of pysllium husks or bran can be very helpful in preventing constipation and increasing satieity.
Sometimes assistance with weight loss through fat malabsorption or a low energy replacement meal will give sufficient weight loss to allow more physical movement. This could make it easier to maintain a lower weight. If someone is chronically obese then lifestyle advice, physical activity, possible medication and a very low kilojoule diet to give significant weight lost can be used. Surgery can then be used to remove excess fat folds and fat cells. This can give a better chance of long-term control.
Added to site on : Tuesday, 18 January 2011