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Obesity- An Overview

February 10, 2021
A study published in the International Journal of Obesity estimates that 27.8% of all Indians would be overweight and 5.0% would be obese, by 2030. Since 1975, obesity has nearly tripled globally. Around 39% of the global adult population were classified as overweight or obese in 2014. Bafflingly, about 38.2 million children under the age of five years were overweight or obese in 2019. Nearly, half of the children under five who were overweight or obese in 2019 lived in Asia.
In fact, the prevalence of overweight and obesity in India is increasing faster than the world average. The increasing prevalence could be related to the demographic and epidemiological transitions, where mortality and fertility are declining, and lifestyle-related diseases are becoming common. Surprisingly, many developing countries are facing a double burden of malnutrition. Besides dealing with under-nutrition and infectious diseases, they also have to face obesity burden. In fact, it is not surprising to find under-nutrition and obesity co-existing in many settings.

About Obesity

Obesity is a complex condition caused by accumulation of excessive fat in the body and can impair one’s health in many ways. It is now recognized as a major, independent risk factor for heart disease and many other health conditions.

Obesity is a gradual change that occurs in your body due to imbalance in the calorie intake and energy spent. It is multifactorial in nature and the weight gain can be attributed to many factors including your genetic makeup, dietary and exercise choices along with other environmental factors.

BMI (Body Mass Index)

BMI is a simple way to measure the body fat based on the height and weight of a person. It is calculated by dividing a person’s weight in kilograms by the square of height in meters.

BMI= Kg (Weight in kilogram) /m2 (height in meters squared)

In adults aged 20 years or above, BMI falls into one of the following categories.
BMI Nutritional Status
Below 18.5
Underweight
18.5 – 24.9
Normal
25.0 – 29.9
Overweight
30.0 and above
Obese
BMI often provides a sensible measurement of body fat, however, it may not always produce accurate results, as BMI doesn’t distinguish between excess fat, muscle, or bone mass. Hence, it can be used as a screening tool for body fat measurement, but not for diagnostic purpose.

Causes

Obesity occurs due to number of factors. However, an imbalance between calories consumed and calories expended stays as the fundamental cause for obesity. In fact, the world at large is experiencing a global shift towards increased intake of energy-dense foods and decrease in physical activity due to sedentary lifestyle, change in means of commute, and urbanization. This could be predominantly related to the increase in prevalence of obesity, worldwide. Moreover, genetic, behavioral, metabolic and hormonal changes can also affect the body weight.

One should understand that obesity is acquired only after prolonged changes in dietary and lifestyle choices. The following are the individual contributors to obesity:

  1. Dietary changes : Eating large amounts of processed foods that are high in fats and sugars or consuming too much of sugary drinks can result in fat accumulation in the body. Increased alcohol consumption and unhealthy eating patterns related to portion size or eating schedules can also lead to overweight.
  2. Activity levels : Most of the activity in our daily life is hampered due to modern conveniences in every possible way. Computers, mobile phones, and tablets increasingly made our lifestyles sedentary. Even most of the jobs involve sitting at desk for most of the day. When you are not active, the energy provided by the food you eat get stored in the body as fat.
  3. Genetics : More than 50 genes are identified with strong association for obesity; many studies suggest that genetics contribute to 40-70% of obesity cases. Apart from environmental changes that are major contributors to increased obesity rates, the presence or absence of genetic factors also greatly influence our predisposition for obesity. Single gene defects that are rare can lead to obesity, but it is usually a multi gene disorder where the presence of multiple gene defects predispose a person to gain more weight. They can act in a way to increase the hunger levels, reduce satiety, or increase tendency to store fat among others.
  4. Medical reasons : Some medical conditions, such as underactive thyroid (hypothyroidism), Cushing’s syndrome, polycystic ovary syndrome (PCOS), or any other disorder that interferes with the metabolism and physical activity of a person may cause obesity. Certain medicines such as corticosteroids, antidepressants, and medicines used for epilepsy or schizophrenia may also contribute to weight gain.

Other factors such as stress, emotional health and poor sleep can also have significant effects on weight gain.

Consequences and complications of obesity

Obesity is much more than just a cosmetic concern. Increased weight can negatively affect the health and well-being of the person. When you are obese, your bones must bear extra weight and pressure, thereby leading to pain and difficulty with physical functioning. This can reduce your overall quality of life. Other effects on the quality of life include mental illness, such as depression, anxiety, social isolation/discrimination, and reduced work efficiency. Increased BMI is a risk factor for many serious conditions, which are the leading causes of preventable, premature death, such as:
  • Cardiovascular diseases
  • Type 2 diabetes
  • Hypertension
  • Certain cancers such as breast, colon, and endometrium
  • Stroke
  • Digestive problems
  • Gallbladder disease
  • Fatty liver disease
  • High cholesterol
  • Sleep apnea and other breathing problems
  • Arthritis
  • Infertility

Prevention

Fortunately, obesity is highly preventable, and one can easily improve or prevent many obesity-related co-morbidities even with moderate weight loss. Being part of a supportive community greatly influences people to make healthy food choices and drive them to be physically active. At the individual level, following are some of the essential lifestyle modifications that can help people avoid accumulating excess fat and its related consequences:

Dietary modifications : Simple dietary changes and healthy eating habits can help keep obesity at bay. Including more fruits and vegetables in your diet is a good start, as they contain low calories and are nutritious. According to WHO, a diet rich in fruits and vegetables can help reduce the risk of obesity. Also, it is important to include whole grains in your diet and avoid simple carbohydrates. Processed foods that are high in calories, fats, sugars, and salts should be restricted. The diet should also contain foods with good fats, such as polyunsaturated fatty acids instead of bad fats such saturated fats. One should avoid foods with high sugar content, such as sugary beverages, cakes, ice creams etc. and instead include foods that are rich in fiber content and have low-glycemic index.

Physical activity : Engaging in moderate level physical activity for at least 150 minutes per week or for at least 30 minutes per day, five days a week, is good for health. It is also recommended to stay physically active throughout the day by taking frequent stretch breaks during work or using a standing desk etc. Doing exercise with a partner can help you to stay motivated. A well-balanced weight training regimen that includes all your muscles is important as the muscles tend to burn more calories at rest than other tissues.

Manage stress

Evidences state that chronic stress is linked to obesity. It can raise the levels of stress hormone cortisol that leads to weight gain. High cortisol levels can cause changes in eating patterns or increase cravings for high-calorie foods. Evidences also support that emotional eating (eating in response to negative emotions) is a mediator between depression and obesity. Sometimes, you may tend to crave food when you are emotionally disturbed and may turn to the comfort food, consciously or unconsciously. Such kind of eating can contribute to obesity. Identifying the triggers and gradually changing one’s response towards it can help in managing cravings. It is important to find ways to reduce manage stress. Maintaining a food dairy and taking family and friends support or joining a support group can help manage stress. A short walk, regular yoga or listening to music may help to relax and rejuvenate yourselves.

Get enough sleep

Sleep quality in both qualitative and quantitative ways can affect the overall well-being of a person. It is recommended that adults must sleep for at least seven hours; younger people may need even more sleep. Data suggests that people who sleep late at night tend to gain weight overtime. Studies also states that seven to nine hours of uninterrupted sleep a day is required to gain the health benefits.

Stay motivated

Self-motivation is identified as a predictor of successful weight control and at the same time lack of motivation leads to poor adherence to the weight loss programs. Adherence to the goals can be challenging at times, however it is quite important for successful weight control. Finally, even after significant lifestyle changes, if you are still unable to lose weight, consult a healthcare professional. There can be underlying medical conditions or other factors that are preventing you from weight loss. Sometimes, medication or other treatments may help you in your weight management.

References :

  1. https://www.sciencedirect.com/science/article/abs/pii/S1871402118303655
  2. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5918520/
  4. https://www.nature.com/articles/ijo2008102?type=access_denied

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Obesity- An Overview

A study published in the International Journal of Obesity estimates that 27.8% of all Indians would be overweight and 5.0% would be obese, by 2030. Since 1975, obesity has nearly tripled globally. Around 39% of the global adult population were classified as overweight or obese in 2014. Bafflingly, about 38.2 million children under the age of five years were overweight or obese in 2019. Nearly, half of the children under five who were overweight or obese in 2019 lived in Asia.
In fact, the prevalence of overweight and obesity in India is increasing faster than the world average. The increasing prevalence could be related to the demographic and epidemiological transitions, where mortality and fertility are declining, and lifestyle-related diseases are becoming common. Surprisingly, many developing countries are facing a double burden of malnutrition. Besides dealing with under-nutrition and infectious diseases, they also have to face obesity burden. In fact, it is not surprising to find under-nutrition and obesity co-existing in many settings.

About Obesity

Obesity is a complex condition caused by accumulation of excessive fat in the body and can impair one’s health in many ways. It is now recognized as a major, independent risk factor for heart disease and many other health conditions. Obesity is a gradual change that occurs in your body due to imbalance in the calorie intake and energy spent. It is multifactorial in nature and the weight gain can be attributed to many factors including your genetic makeup, dietary and exercise choices along with other environmental factors.

BMI (Body Mass Index)

BMI is a simple way to measure the body fat based on the height and weight of a person. It is calculated by dividing a person’s weight in kilograms by the square of height in meters.

BMI= Kg (Weight in kilogram) /m2 (height in meters squared)

In adults aged 20 years or above, BMI falls into one of the following categories.
BMI Nutritional Status
Below 18.5
Underweight
18.5 – 24.9
Normal
25.0 – 29.9
Overweight
30.0 and above
Obese
BMI often provides a sensible measurement of body fat, however, it may not always produce accurate results, as BMI doesn’t distinguish between excess fat, muscle, or bone mass. Hence, it can be used as a screening tool for body fat measurement, but not for diagnostic purpose.

Causes

Obesity occurs due to number of factors. However, an imbalance between calories consumed and calories expended stays as the fundamental cause for obesity. In fact, the world at large is experiencing a global shift towards increased intake of energy-dense foods and decrease in physical activity due to sedentary lifestyle, change in means of commute, and urbanization. This could be predominantly related to the increase in prevalence of obesity, worldwide. Moreover, genetic, behavioral, metabolic and hormonal changes can also affect the body weight.

One should understand that obesity is acquired only after prolonged changes in dietary and lifestyle choices. The following are the individual contributors to obesity:

  1. Dietary changes

Eating large amounts of processed foods that are high in fats and sugars or consuming too much of sugary drinks can result in fat accumulation in the body. Increased alcohol consumption and unhealthy eating patterns related to portion size or eating schedules can also lead to overweight.

  1. Activity levels

Most of the activity in our daily life is hampered due to modern conveniences in every possible way. Computers, mobile phones, and tablets increasingly made our lifestyles sedentary. Even most of the jobs involve sitting at desk for most of the day. When you are not active, the energy provided by the food you eat get stored in the body as fat.

  1. Genetics

More than 50 genes are identified with strong association for obesity; many studies suggest that genetics contribute to 40-70% of obesity cases. Apart from environmental changes that are major contributors to increased obesity rates, the presence or absence of genetic factors also greatly influence our predisposition for obesity. Single gene defects that are rare can lead to obesity, but it is usually a multi gene disorder where the presence of multiple gene defects predispose a person to gain more weight. They can act in a way to increase the hunger levels, reduce satiety, or increase tendency to store fat among others.    

  1. Medical reasons

Some medical conditions, such as underactive thyroid (hypothyroidism), Cushing’s syndrome, polycystic ovary syndrome (PCOS), or any other disorder that interferes with the metabolism and physical activity of a person may cause obesity. Certain medicines such as corticosteroids, antidepressants, and medicines used for epilepsy or schizophrenia may also contribute to weight gain.

Other factors such as stress, emotional health and poor sleep can also have significant effects on weight gain.

Consequences and complications of obesity

Obesity is much more than just a cosmetic concern. Increased weight can negatively affect the health and well-being of the person. When you are obese, your bones must bear extra weight and pressure, thereby leading to pain and difficulty with physical functioning. This can reduce your overall quality of life. Other effects on the quality of life include mental illness, such as depression, anxiety, social isolation/discrimination, and reduced work efficiency. Increased BMI is a risk factor for many serious conditions, which are the leading causes of preventable, premature death, such as:
  • Cardiovascular diseases
  • Type 2 diabetes
  • Hypertension
  • Certain cancers such as breast, colon, and endometrium
  • Stroke
  • Digestive problems
  • Gallbladder disease
  • Fatty liver disease
  • High cholesterol
  • Sleep apnea and other breathing problems
  • Arthritis
  • Infertility

Prevention

Fortunately, obesity is highly preventable, and one can easily improve or prevent many obesity-related co-morbidities even with moderate weight loss. Being part of a supportive community greatly influences people to make healthy food choices and drive them to be physically active. At the individual level, following are some of the essential lifestyle modifications that can help people avoid accumulating excess fat and its related consequences: Dietary modifications Simple dietary changes and healthy eating habits can help keep obesity at bay. Including more fruits and vegetables in your diet is a good start, as they contain low calories and are nutritious. According to WHO, a diet rich in fruits and vegetables can help reduce the risk of obesity. Also, it is important to include whole grains in your diet and avoid simple carbohydrates. Processed foods that are high in calories, fats, sugars, and salts should be restricted. The diet should also contain foods with good fats, such as polyunsaturated fatty acids instead of bad fats such saturated fats. One should avoid foods with high sugar content, such as sugary beverages, cakes, ice creams etc. and instead include foods that are rich in fiber content and have low-glycemic index. Physical activity Engaging in moderate level physical activity for at least 150 minutes per week or for at least 30 minutes per day, five days a week, is good for health. It is also recommended to stay physically active throughout the day by taking frequent stretch breaks during work or using a standing desk etc. Doing exercise with a partner can help you to stay motivated. A well-balanced weight training regimen that includes all your muscles is important as the muscles tend to burn more calories at rest than other tissues.

Manage stress

Evidences state that chronic stress is linked to obesity. It can raise the levels of stress hormone cortisol that leads to weight gain. High cortisol levels can cause changes in eating patterns or increase cravings for high-calorie foods. Evidences also support that emotional eating (eating in response to negative emotions) is a mediator between depression and obesity. Sometimes, you may tend to crave food when you are emotionally disturbed and may turn to the comfort food, consciously or unconsciously. Such kind of eating can contribute to obesity. Identifying the triggers and gradually changing one’s response towards it can help in managing cravings. It is important to find ways to reduce manage stress. Maintaining a food dairy and taking family and friends support or joining a support group can help manage stress. A short walk, regular yoga or listening to music may help to relax and rejuvenate yourselves.

Get enough sleep

Sleep quality in both qualitative and quantitative ways can affect the overall well-being of a person. It is recommended that adults must sleep for at least seven hours; younger people may need even more sleep. Data suggests that people who sleep late at night tend to gain weight overtime. Studies also states that seven to nine hours of uninterrupted sleep a day is required to gain the health benefits.

Stay motivated

Self-motivation is identified as a predictor of successful weight control and at the same time lack of motivation leads to poor adherence to the weight loss programs. Adherence to the goals can be challenging at times, however it is quite important for successful weight control. Finally, even after significant lifestyle changes, if you are still unable to lose weight, consult a healthcare professional. There can be underlying medical conditions or other factors that are preventing you from weight loss. Sometimes, medication or other treatments may help you in your weight management.

References :

  1. https://www.sciencedirect.com/science/article/abs/pii/S1871402118303655
  2. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5918520/
  4. https://www.nature.com/articles/ijo2008102?type=access_denied