World Obesity Day: A special feature

It’s the festive season and many of us are battling two things -- sweet temptations and weight gain. While gaining a few kilos occasionally is not frightening, drastic weight gain is matter for serious concern.

Fat nation: According to Dr shashank Shah, over 60 million people in India are obese and /or overweight. Pic/Thinkstock

Obesity today in India is growing at a disturbing rate. According to the WebMD website, being obese means having so much body fat that your health is in danger. A person is considered obese when his or her weight is 20 per cent or more above normal weight. Having too much body fat can lead to type 2 diabetes, heart disease, high blood pressure, arthritis, sleep apnoea, and stroke. The most common measure of obesity is the body mass index or BMI. In Asian countries, a person is considered overweight if his or her BMI is between 25 and 29.9; obese if his or her BMI is over 30.

Specialist: Cardiologist Dr B K Goyal

With obesity becoming a global threat the World Health Organization (WHO) in May 2012 announced, “Obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese. Once associated with high-income countries, obesity is now also prevalent in low- and middle-income countries.”

Crisis: Laparoscopic and bariatric surgeon Dr Shashank Shah feels obesity is not considered a serious disease in India

According to laparoscopic and bariatric surgeon Dr Shashank Shah, over 60 million people in India are obese. Marginally more women than men suffer from obesity. The total estimated number of children suffering from obesity is unavailable but it has been increasing since the last few years in India. With over 45 million diabetics in the country, India has become a global hub for diabeticity (people suffering from obesity and diabetics). He adds, “The rise of obesity in children and adolescents will add more type 2 diabetics to the current number. When it comes to obesity, there are definitely genetic elements. Today, there is a lack of awareness among parents. Parents often take their kids out for pizzas and junk food. With the intake of junk food, there is hardly any ground sport. Kids are always on the computer and playing video games. The open spaces are vanishing so fast, there is hardly any space for kids to play, these days. I have come across so many cases of young people, who are already suffering from obesity or are overweight, suffering from diabetes by the age of 25. Eventually by the age of 40, they have serious heart problems.”

Concerned: Gynaecologist Dr Deepali Prabhat. Pic/Sayed Sameer Abedi

Dr Shah continues, “With inflation on the rise, many people just can’t afford to be sick. Obesity is one of the most expensive diseases to treat. A person doesn’t just suffer from obesity. He suffers from diabetes and heart disease along with obesity. This makes it very expensive. Why do you think insurance companies do not cover obesity and diabetes in their plans? They don’t want to be burdened by it. Obesity-related diseases are on the rise with an increasing number of joint replacement surgeries and angioplasties taking place. Obesity has a negative impact on confidence, productivity and self-esteem, and health hazards related to the problem further worsen the overall health of the individual.”

Life style: Developmental pediatrician Dr Samir Dalwai blames eating habits and myths for weight gain among kids. Pic/Sayed Sameer AbediDI

According to gynaecologist Dr Deepali Prabhat, studies have revealed a direct connection between obesity and diabetes in women, with around 32 per cent increase in women with diabetes. She says, “The two major reasons for obesity among women are improper diet and lack of exercise. Women suffer from irregular cycles and hormonal imbalances, which is called polycystic ovary syndrome.  “It is quite common that a woman does not get her periods for months together. That is called anovulatory cycle. Usually in a normal cycle, in the first half estrogens, primary female sex hormones, are released, then the egg and then the progesterone hormone is released. This balances out the estrogen effects. But when there is an anovulatory cycle, only estrogens are released. This leads to hyperandrogenism where there is excessive production and/or secretion of androgens,which leads to weight gain. Since this condition remains fora longer time, there is also a higher risk of breast, ovary anduterus cancer. 

Inspiration: Nutritionist Naini Setalvad lost over 100 kilos in two years

Further talking about the relation between obesity and infertility, Dr Prabhat says, “Obesity is also one of the major causes of infertility. This is because stores of fat change the levels of sex hormones that the body produces, making it increasingly difficult to become pregnant. Not only can obesity interfere with fertility, it can also put a woman and her baby at risk for health complications.”

According to the chief of cardiology at Bombay Hospital, Dr B K Goyal, the number of obese patients are relatively decreasing as people are more aware. He says “People today are more conscious about their health and their lifestyle in general. But it is a known fact that obesity is one of the main reasons of coronary heart diseases (CHD). As your body mass index rises, so does your risk for CHD, in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque can narrow or block the coronary arteries and reduce blood flow to the heart muscle. “Obesity also can lead to heart failure, high blood pressure, stroke, high cholesterol and so on. The person’s metabolism is slow as there is no physical activity. Obese patients should maintain their blood pressure, reduce intake of carbs and fats, exercise more and avoid smoking if they want to avoid heart complications.” 

Health and food consultant Naini Setalvad suffered from obesity since adolescence. She says, “I was a skinny five-year-old. I used to give a hard time to my parents at mealtimes and hence they fed me fat-rich food, daily! My initial weight gain started during school. I preferred eating dal, instead of vegetables and salads, to cut down on the chewing time. In the canteen I would stuff myself with samosas, cola and puffs. In my 9th grade I was 90 kg, 12th 108 kg and during college I was 145 kg. By 1996, my weight was 160 kg, with a 76-inch hipline.”

From visiting dieticians and gastroenterologists, to spending summers in hospital and being on the verge of becoming anorexic, Setalvad has experienced it all. Explaining her struggle with weight loss, Setalvad says, “I lost my health, my ovaries revolted and menses ceased. Energy levels plunged and I looked tortured. Basic things like tying my shoelaces seemed like a task to me. I literally tried all the diets available! But even though I lost oodles of weight, I faced other problems like constipation and hanging skin. My family had to cremate nine kilos of my skin, after a surgery, as the hospitals didn’t have the facility to dispose of that much of loose skin. It emotionally drained my family.” Not surrendering to obesity, Setalvad studied sports and fitness science. She adds, “It is not about calorie-counting or cutting out any food. It is about understanding food combinations, and controlling your mind and listening to your body, to make good choices.”

Retired paediatrician Dr RD Potdar says, “The child’s growth is related to the child’s birth weight. If a child is small, he is going to small throughout his life. If a child is bigger his growth will be accordingly. But in India, people have a fascination for having chubby babies. So from early childhood itself, parents feed their baby with the aim of making them fat. Now, kids get used to street food and junk food from school itself. They put on weight easily. Who is to blame for that? The parents. Even kids in slums suffer from obesity. In stead of spending money on dal and fruits, which is very expensive today, we can feed our child with a biscuit packet for only R 5! Parents overfeed their child; this is why kids are obese.”

Developmental pediatrician Dr Samir Dalwai feels that childhood obesity can be blamed on lifestyle, myths and endorsements by celebrities, clever advertisement of food products and convenience of parents. He says, “If you look at kids today, they don’t carry dabbas. Their lunch is replaced with fried foods and wafers. Even their snack is replaced with ready-made food. When both the parents are working, it is easier to serve packed food. Also, with the café culture, kids are drinking a lot of coffee and tea, which have high sugar content. All this, plus lack of physical activity, is making the younger generation obese. The sedentary lifestyle is ruining children’s health. In India when we see a fat child, we usually call it a sign of prosperity. We call the child ‘healthy’, but the reality is that it is exactly the opposite! The flip side is that with a fear of gaining weight, kids and even adults become anorexic. This is a psychological issue that needs to be tackled carefully.”

Dr Dalwai adds, “Parents with younger kids should realize the problems their child may face due to obesity. They have to be more aware. People have a very relaxed approach towards obesity, like ‘khate peete ghar ka hai’. Second, parents should be aware of their child’s condition and avoid pushing them more into it. As both the parents are working, a child has nothing better to do than to watch TV. Parents should find an alternative method and turn children toward sports and recreational activities. Parents of older kids and teenagers have to realize that the child needs help, counselling and proper treatment, as kids with obesity lack self-confidence and need motivation. Complaining about their problems is not going to help the parents or the child.”  Dr Shah adds, “Obesity needs to be treated as a disease, and not a lifestyle disorder. It is an epidemic. It can be treated through diet regulation, including regular physical activity in your routine, lifestyle changes, and anti-obesity medications like appetite suppressants or medications which will minimize fat absorption from the intestine. Beyond this, severe obesity should be treated surgically through metabolic and bariatric surgery, which is the only scientifically proven long-term remedy for obesity and related diseases.” 

Fact file
According to the WHO:

1. Excess weight and obesity are defined as ‘abnormal or excessive fat accumulation that may impair health’
2. Worldwide obesity has nearly doubled since 1980.
3. In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.
4. 35 per cent of adults aged 20 and over were overweight in 2008, and 11 per cent were obese.
5. 65 per cent of the world’s population lives in countries where being overweight and obese kills more people than being underweight does.
6. Overweight and obesity are the fifth leading risk for global deaths.
7. More than 40 million children under the age of five were overweight in 2011.
8. Obesity is preventable
9. Obesity is usually due to imbalance between calories consumed and expended
10. Supportive environments and communities are fundamental in shaping people’s choices and preventing obesity 

What causes obesity and excess weight?
The fundamental cause of obesity and excess weight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

>> An increased intake of energy-dense foods that are high in fat; and
>> An increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.

Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development, and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing and education.

Source: World Health Organization

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