Risks of obesity largely reversible

The prevalence of obesity is increasing rapidly in most parts of the world and is widely regarded as a pandemic with potentially disastrous consequences for human health.

The prevalence of obesity has increased threefold within the last 20 years and continues to rise.  Obesity reduces life expectancy by 7.1 years in men and 5.8 years in women amongst non-smokers, and by 13.7 and 13.3 years respectively amongst smokers.

Obesity is associated with an increased risk of multiple health problems, including hypertension, type 2 diabetes, dyslipidemia, stroke, coronary heart disease, reflux disease, infertility, degenerative joint disease, varicose veins and some malignancies.
Obesity is commonly seen in families, and the heritability of body weight is similar to that for height.A small daily excess consumption of only 0.2 - 0.8 MJ (50-200 kcal;   
 Obesity can be quantified conveniently using the body mass index (BMI). BMI is calculated as the person's weight in kilograms divided by the square of his or her height in metres (kg/m2). Normal BMI is 18 – 23. BMI of 23 – 25 Overweight; BMI >25 Obesity.  A simple measure which reflects the degree of abdominal obesity is the waist circumference, measured at the level of the umbilicus. A waist circumference of > 90 cm in men or > 80 cm in women in Indians indicates that the risk of metabolic and cardiovascular complications of obesity is high.

Management      

The health risks of obesity are largely reversible. Behavioural modification to avoid some of the effects of the 'obesogenic' environment is the cornerstone of long-term control of weight. To lose  one kg of weight requires about 7,000 calorie negative balance. Achieving this is difficult but not impossible. 

Reducing the intake of calories and performing about 20 – 30 minutes a day of additional moderate exercise will help in losing weight. Where possible, the physical activities should be incorporated in the daily routine (e.g. walking rather than driving to work) since this is more likely to be sustained.

Alternative exercise, e.g. swimming, may be necessary if musculoskeletal complications prevent walking. Changes in eating behaviour including food selection, portion size control, avoidance of snacking, regular meals to encourage satiety is desirable. Situations  leading to increased food intake should be identified and avoided.

Dr M Suresh Babu
JSS Medical College Hospital

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