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Obesity The fast food epidemic

Tuesday, April 10, 2018

As we grow older, our metabolism slows down and we should focus on reducing high energy food and incorporate daily exercise to enhance metabolism, says Dr Biswanath Gouda

Obesity is no more a sign of “prosperity” but a medical condition marked by the accumulation of excessive body fat with negative health impacts. It is generally reported in terms of body mass index (BMI), calculated by dividing an individual’s weight in kilograms by the square of their height in meters. A BMI beyond 30kg/m2is considered obese.

Indian obesity differs due to the ‘Thin-Fat Indian Phenotype’ as compared to the western world. We see a markedly higher proportion of body fat, abdominal obesity, and visceral fat in the Indian population, as compared to our Caucasian and European counterparts. Hence, world obesity is generally reported in terms of waist circumference, and a BMI beyond 30, significantly underestimates the prevalence of obesity in India. Therefore, Indian obesity must be estimated according to a lower threshold of BMI 25 kg/m2. World Obesity Federation data shows that the percentage of Indian adults living with obesity is set to jump to around 5% by 2025, from 3.7% in 2014.

About 14.4 million children of India are obese making us the second highest in the world and we still have grappling issues like poverty and malnutrition to tackle at the national health level. It reflects a challenging health issue for the future working community in India who will be morbidly obese with associated co-morbidities like diabetes, hypertension, heart disease at a much younger age. It represents the prevalent, growing and disturbing global public health crisis.
Our country is faced with an epidemic of obesity that affects the growing younger children as well as the working adult population, that would cause a heavy burden on the healthcare.  The increase in mortality and morbidity comes with an added economic burden on the patient’s kin and the country, concurrent increase in medical expenditures, including a rise in outpatient visits and with the growth of the overweight and obese population. This leads to additional stress on the over-burdened healthcare system.

The consequences of obesity
Obesity is more than just the accumulation of fat all around the belly. It causes several health disorders in the obese person that affects the liver( non alcoholic fatty liver), lungs( obstructive sleep apnea, asthma), kidneys (diabetic nephropathy), eyes( retinopathy), heart( dilated cardiomyopathy, heart attacks, heart failure), joints( degenerative joint disease), brain( migraine, depression) and also is a risk factor for several cancers. Interestingly, with loss of weight due to strict diet and exercise, resolution of diabetes and hypertension is also seen.

Childhood obesity is associated with a higher chance of premature death and disability in adulthood. Overweight and obese children are more likely to remain obese into adulthood as well, going on to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age.

Obesity increases cardiovascular mortality fourfold, and cancer-associated mortality twofold. Beyond a BMI of 25, mortality rises by approximately 30% for every 5kg/m2 increase; it lowers the life expectancy of the individual. Additionally, of the four million deaths worldwide, attributed to excess body fat in 2015, nearly 40% occurred among people whose BMI fell below 30, the obesity threshold.  

A study from University of Washington’s Institute for Health Metrics and Evaluation (IHME), asserts, “Excess body weight is one of the most challenging public health problems of our time, affecting nearly one in every three people.” The prevalence of the global issue has shown an alarming increase, steadily affecting more and more low and middle-income countries, especially India.

Prevention the better solution
Prevention plays a major role in tackling obesity in its bud. We need to always watch the rising/ creeping weight  as we grow and add numbers to our age. As we grow older, our metabolism slows down and we should focus on reducing high energy food, short intervals between meals and incorporation of daily exercise to enhance metabolism.

At least 150 minutes of moderate-intensity physical activity per week is the recommended mandatory exercise for every individual. Also, more than 300 minutes of the same, per week, is necessary for sustained weight loss. This physical activity should be incorporated into the daily routine through leisure activities and domestic work, including walking, climbing stairs, household chores, gardening or sports.

Providing exercise facilities and allotting definite time for exercise at workplaces, construction and use of footpaths and bike-paths in urban areas or promoting dance forms or martial arts from a young age are just a few alternatives to physical activity.

Reduce sugar intake in all forms, especially in school children and college students. Recently UK, France, Norway and Mexico rolled out a sugar tax on soft drinks in an attempt to tackle obesity in children. It is high time that India also reduces the sugar in the soft drinks and makes it a national health policy.

Inspite of all dedicated attempts for diet and exercise, there is a role for  pharmacotherapy and surgical treatment in form of bariatric surgery in the obese group of people.

I recommend every health conscious individual  and my obese patients to read ‘Fast Food Nation: The Dark Side of the All-American Meal’ by  Eric Schlosser before they enter any fast food restaurant. Watch what you eat before the food makes you the point of attraction.

Dr Biswanath Gouda is a Laparoscopic Bariatric and Gastrointestinal Surgeon at Somaiya Superspeciality Center and St Elizabeth’s Hospital.

Causes of Obesity

  • Inactive lifestyle: excessive food consumption compared to negligible physical activity
  • Unhealthy diet, widespread availability of fried and unhealthy fast food
  • Growing ‘mall culture’ in the younger generation with easy access to fast food options
  • Collapse of culture: Families in urban cities find it difficult to cook 3-4 traditional meals every day and hence eating outside/ fast food intake has become primary source of intake.
  • High carbohydrate and low protein in diet: Traditional diet of India is rich in carbohydrates, with large quantities of rice in the coastal regions, rotis/ chappatis in the interiors, and heavy consumption of bread all over.
  • Social ladder: It’s seen that the higher people belong on the social ladder, the lesser physical work they perform and they become obese over period of time. The middle class who still view a ‘healthy’ body structure as a reflection of prosperity don’t dedicate time for physical activity. The upper class, with an increased disposable income, are far more conscious of their health and maintain an active lifestyle.
  • Lack of awareness of Obesity related health problems such as diabetes, hypertension etc.
  • ‘Thrifty Gene Hypothesis’ advocated by James Neel, suggests that periods of famines in human evolutionary history resulted in a favoured selection of a thrifty genotype which led to highly efficient fat storage during periods of abundance.
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