Special Report

October 17, 2010

Obesity: An underestimated ‘silent killer’

By Sola Ogundipe and Chioma Obinna

There is a new “silent killer” in town. It joins the ranks of malnutrition, malaria, hypertension, diabetes, HIV/AIDS, etc. It is obesity. “We are eating our way to the grave’’ and “obesity is rising in rural areas.’’ Adults are overweight or obese, while children are malnourished – a paradox. In the men still look at a potbelly as a badge of pride and success.”

This does not come as a surprise. Globally, the epidemic is growing. It is a substantial public-health crisis in the developed world, but the prevalence is increasing rapidly in numerous developing nations worldwide.

In Nigeria, obesity is visible. In 1996, the Associated Press cited the World Health Organization that more than one-third of African women and a quarter of African men are estimated to be overweight, and predicted that it will rise to 41 percent and 30 percent respectively in by 2016. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings.

Although data from Nigeria on obesity are scant, a clear and distinct secular trend of profoundly increased weight is clearly observed. This growing rate represents a concern that needs urgent attention if its potential morbidity, mortality, and economic tolls are to be avoided.Conservative estimates suggest that as many as 250 million people are obese.

Two- to three-times more people than this are probably overweight. Although socioeconomic class and the prevalence of obesity are negatively correlated in most developed countries, including the United States, this correlation is distinctly reversed in many relatively undeveloped areas, including sub-Saharan Africa.

The science of obesity is far more complex than the simple definition of an imbalance between energy intake and energy output. Although this concept allows easy conceptualisation of the various mechanisms involved in the development of obesity, obesity is far more than the mere result of too much eating and/or too little exercise. Obesity is defined as having an excessive amount of body fat. Obesity is more than just a cosmetic concern, though. It increases risk of diseases and health problems such as diabetes and high blood pressure. Obesity is also becoming an increasing health problem globally.

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres).

A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.Obesity represents a state of excess storage of body fat. Although similar, the term overweight is defined as an excess body weight for height. Although men have a body fat percentage of 15-20 percent, women have approximately 25-30 percent.1 Due to differences in weight among individuals are only partly due to variations in body fat, body weight is a limited, though easily obtained, index of obesity. The body mass index (BMI) is used far more commonly than body fat percentage to define obesity.

BMI is closely correlated with the degree of body fat in most settings. BMI = weight/height2, where weight is in kilograms and height is in meters.The good news is that even modest weight loss can improve or prevent the health problems associated with obesity.

Doctors often use a formula based on your height and weight — called the body mass index (BMI) — to determine obesity. Adults with a BMI of 30 or higher are considered obese. Extreme obesity, also called severe obesity or morbid obesity, occurs when you have a BMI of 40 or more. With morbid obesity, you are especially likely to have serious health problems.

Difficulty sleeping, Snoring, Sleep apnea, pain in your back or joints, excessive sweating, always feeling hot, rashes or infection in folds of your skin, feeling out of breath with minor exertion, daytime sleepiness or fatigue and depression

Although there are genetic and hormonal influences on body weight, the bottom line is that obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat. Obesity usually results from a combination of causes and contributing factors, including:

* Inactivity. If you are 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 off through exercise or normal daily activities. Watching too much television is one of the biggest contributors to a sedentary lifestyle and weight gain.

* Unhealthy diet and eating habits. Having a diet that’s high in calories, eating fast food, skipping breakfast, eating most of your calories at night, consuming high-calorie drinks and eating oversized portions all contribute to weight gain.

* Pregnancy. During pregnancy a woman’s weight necessarily increases. Some women find this weight difficult to lose after the baby is born.

* Lack of sleep. Getting less than seven hours of sleep a night can cause changes in hormones that increase your appetite..

* Certain medications. Some medications can lead to weight gain if you don’t compensate through diet or activity.

*Medical problems: Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing’s syndrome, polycystic ovary syndrome, and other diseases and conditions. Some medical problems, such as arthritis, can lead to decreased activity, which may result in weight gain.

Risk factors
* Genetics. Your genes may affect the amount of body fat you store and where that fat is distributed.
* Family history. Obesity tends to run in families. That’s not just because of genetics.
* 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.
* Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to a weight gain of as much as several pounds a week for several months, which can sometimes lead to obesity.
* Social and economic issues. Certain social and economic issues may be linked to obesity.

Complications & Causes
If you are obese, you are more likely to develop a number of potentially serious health problems, including: * Blood (fat) lipid abnormalities,

* Cancer, including cancer of the uterus, cervix, ovaries, breast, colon, rectum and prostate, depression, gallbladder disease, gynecological problems, such as infertility and irregular periods, heart disease, high blood pressure, metabolic syndrome, nonalcoholic fatty liver disease, osteoarthritis
* Skin problems, such as intertrigo and impaired wound healing, sleep apnea, stroke, type 2 diabetes
Other issues that may affect your quality of life include: depression, disability, physical discomfort, sexual problems, shame and social isolation.

Tests & diagnosis
* Taking your healthy history. Your doctor reviews your weight history, weight-loss efforts, exercise habits, eating patterns, what other conditions you’ve had, medications, stress levels and other issues about your health.
* Assessing other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure or binge eating disorder.
* Calculating your BMI. Your doctor will check your body mass index (BMI) to determine your level of obesity. Your BMI also helps determine what other health problems you may face and what treatment may be appropriate.
* Measuring your waist circumference. Fat stored around your waist, sometimes called visceral fat or abdominal fat, may further increase your risk of diseases such as diabetes and heart disease. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches may have more health risks than people with smaller waist measurements.
* A general physical exam. This includes measuring your height, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
* Laboratory tests. What tests you have depend on your health and risk factors. They may include a complete blood count (CBC), a check of cholesterol and other blood fats, liver function tests, fasting glucose, a thyroid test, and others depending on your health situation. Your doctor also may recommend certain heart tests, such as an electrocardiogram.

Treatment and drugs
The goal of obesity treatment is to achieve and maintain a healthier weight to reduce your risk of serious health problems and enhance your quality of life. You may need to work with a team of health professionals, including a nutritionist, dietitian, therapist or an obesity specialist, to help you understand and make changes in your eating and activity habits. Together, you can determine a healthy goal weight and how to achieve it. Your initial goal may be to lose 5 to 10 percent of your body weight within six months.

You can start feeling better and seeing improvements in your health with just minor weight loss, though — 5 to 15 percent of your total weight. That means that if you weigh 200 pounds (91 kilograms) and are obese by BMI standards, you would need to lose only about 10 to 30 pounds (4.5 to 13.6 kilograms) to start seeing benefits.

Specific treatment methods
There are many ways to treat obesity and reach a healthier weight.

Treatment methods include: Dietary changes
* Exercise and activity, behavior change, prescription weight-loss medications and weight-loss surgery
Dietary ways to overcome obesity include:
* Reducing your calorie intake. The key to weight loss is reducing how many calories you consume. You and your doctor can decide how many calories you need to take in each day to achieve weight loss, but a typical amount is 1,000 to 1,600 calories.
* 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 and processed foods, are high in energy density. This means that a small volume of that food has a large number of calories.
* Adopting a healthy eating plan. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole grains.
* Following a very low calorie liquid diet if medically recommended. These mainly liquid diets are meant to provide rapid weight loss over the short term. They provide only about 600 to 800 calories a day. Your doctor may recommend a very low calorie diet if you need to lose weight quickly before a medical procedure or if you have serious health problems.

* 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.

Increased activity: Increased physical activity or exercise is also 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. One of the best ways to lose body fat is through regular aerobic exercise, such as walking, cycling, stair climbing or swimming.
* Increase your daily activity. 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.
Behaviour changes: To lose weight and keep it off, you need to make changes in your behaviour and attitudes toward food and exercise.

There are a number of ways to help you change unhealthy behaviour and thoughts.

Behaviour 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.

* Support groups: You can find camaraderie and understanding in support groups where others share similar challenges with obesity.

Weight-loss surgery
In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery offers the best chance of losing the most weight, but it can pose serious risks. Weight-loss surgery limits the amount of food you’re able to comfortably eat or inhibits the absorption of food and calories, or both.

Weight-loss surgery for obesity may be considered if: You have extreme obesity, with a body mass index (BMI) of 40 or higher
* Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure
* You are committed to making the lifestyle changes that are necessary for surgery to work
* Gastric bypass surgery. This is the favored weight-loss surgery in the United States because it has shown relatively good long-term results.
* Laparoscopic adjustable gastric banding (LAGB). In this restrictive-type procedure, your stomach is separated into two pouches with an inflatable band.
* Biliopancreatic diversion with duodenal switch. In this malabsorption-type procedure, most of your stomach is surgically removed. This weight-loss surgery offers sustained weight loss, but it poses a greater risk of malnutrition and vitamin deficiencies, and you require close monitoring for health problems.

Whether you are at risk of becoming obese, currently overweight or at a healthy weight, you can take steps to prevent unhealthy weight gain and related health problems. Not surprisingly, the steps to prevent weight gain are the same as the steps to lose weight: daily exercise, a healthy diet, a long-term commitment to watch what you eat and drink.

* Exercise regularly: One of the most important things you can do to prevent weight gain is to exercise regularly. According to the American College of Sports Medicine, you need to get 150 to 250 minutes of moderate-intensity activity per week to prevent weight gain. Moderately intense physical activities include fast walking and swimming.

* Eat healthy meals and snacks. Focus on low-calorie, nutrient-dense foods, such as fruits, vegetables and whole grains. Avoid saturated fat and limit sweets and alcohol. Remember that no one food offers all the nutrients you need. Choose a variety of foods throughout the day. You can still enjoy small amounts of high-fat, high-calorie foods as an infrequent treat. Just be sure to choose foods that promote a healthy weight and good health more often than you choose foods that don’t.

* Know and avoid the food traps that cause you to eat. Identify situations that trigger out-of-control eating. Try keeping a journal and write down what you eat, how much you eat, when you eat, how you’re feeling and how hungry you are. After a while, you should see patterns emerge. You can plan ahead and develop strategies for handling these types of situations and stay in control of your eating behaviours.

* Monitor your weight regularly. People who weigh themselves at least once a week are more successful in keeping off excess pounds. Monitoring your weight can tell you whether your efforts are working and can help you detect small weight gains before they become big problems.

* Be consistent. Sticking to your healthy-weight plan during the week, on the weekends, and amidst vacation and holidays as much as possible increases your chances of long-term success.