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OBESITY (OVERWEIGHT)

What is Obesity ?

Obesity means overweight to a degree which is affecting health or could affect health in the future. It makes it more likely for people to develop arthritis, high blood pressure, diabetes, gallstones and heart disease and it doesn't look nice.

How does Obesity occur ?

Weight is put on if the energy from food and drink (measured in calories) is more than can be burned up by the body's chemical processes. The burn-up (metabolic) rate is hard to measure, but varies to some extent from person to person. It is difficult to increase the metabolic rate except by activity or exercise of some type. Inactivity, resting and even strict dieting lowers metabolic rate. In some people, the start of their weight problem appears to have been an illness during which they were not able to get about so much.

Why does Obesity occur ?

Overweight problems often appear to run in families. A small number of people with obesity have been shown to have an abnormal gene which affects the way that their body handles food. Much of the « family effect » however is due to family eating, drinking and exercising habits Over-feeding in infancy may result in overweight later in life. There is also a suggestion that being underweight at birth may be more likely to result in overweight in adulthood. Most often, the amount and type of food eaten is wrong for an individual's metabolism. Fats (even from vegetable) and sugars are the biggest culprits. People forget that alcoholic drinks (even low alcohol) are loaded with calories. The in-between meal snacks mount up too.. About one out of every three people eat more when they are upset or bored and these people are particularly likely to gain weight if they have the sort of metabolism which makes them prone to obesity. On the same diet, one person may gain weight while another is not affected. The exercise pattern may also be wrong for an individual. Inactivity is one of society's big problems: stop/start chores like housework and office activity may produce tiredness, but hardly speed up metabolism.

Treatment Involved for Obesity

Some tests of blood and urine may be done to make quite sure that there is no medical problem present. Some people think that they may have a deficiency of thyroid hormone, but this is rarely the case :only rare cases are shown to result from a hormonal imbalance. It is often worth working out how many calories are really being taken over a week. A diary and a calorie-counter from the local bookstore make this quite a reasonable calculation for anyone with a little time to spare. It can also be calculated more accurately by a dietitian. A dietitian can assess what is eaten and work out where things are going wrong. It is worth agreeing with the doctor about a realistic target (goal) weight. Very few people lose weight without cutting back to less than 1500 calories a day. Some people appear to need as little as 800 calories in the early stages. Eating less than this is harmful to the heart, muscles and bones. These structures can lose their strength by the breakdown of their protein content to provide the body with calories. Use only ordinary foods in reduced amounts: formula diets are expensive and are not a long-term solution to a weight problem. Foods that are high in fibre (fibrous fruits and fresh vegetables) satisfy hunger. They also tend to be low in calories. Fats and any type of fried food need to be cut right back or stopped altogether. The body doesn't need them.

Alcohol is a particularly rich source of calories! Big benefits may result from cutting down or stopping it. Exercise should be built up steadily: every bit counts. Avoiding lifts, getting off the bus one stop earlier, and other forms of contrived exercise sometimes work. Brisk, continuous walking for an extra 60 to 90 minutes a day will regularly result in a weight loss of half a pound a week (two stones in a year!). If under age 50, and otherwise healthy, it may be worth taking up regular sport: only if this is done two to three times a week is it likely to have much effect. Drugs are of little help in the long term. Fluid tablets (diuretics) get rid of fluid, not fat. They can obviously cause weight loss, but of the wrong part of the body. Some drugs do stop appetite, but will almost always lose their effect with time. They are rarely prescribed as they have side-effects and can be very addictive. The drug orlistat interferes with the breakdown and absorption of fats in the bowel. Although costly, it is often effective, and a good way of starting a weight-loss program. Another drug, sibutramine is capable of suppressing appetite and is probably not addictive. It also keeps the metabolic rate up when people lower their food intake. If weight is very high - so-called morbid obesity - an operation on the stomach may be considered, with the purpose of reducing its capacity : some procedures can even be carried out by keyhole surgery (laparoscopy). In skilled hands a 50% weight reduction is usual. There are significant side effects. This limits this approach to the small minority of obese patients with such a severe problem. Cosmetic surgery is sometimes used for any skin folds that are left after weight reduction. The doctor will advise if this is needed in a specific case. Claims have been made that acupuncture and a variety of devices can result in local weight loss. There is little evidence to support these claims.

During Treatment for Obesity

If advice is followed, without breakouts , weight will be lost. The first month is usually the most impressive, due to loss of fluid as well as fat. Weight should be checked every week , but a loss of no more than 2 to 4 pounds (1 to 2 kg) a month should be expected over a longer period of time. Some people are not realistic and expect more. Disappointment then leads to despondency and lack of commitment to the programme. Some people find support from going to Weight Watchers groups or to other self-help organizations, which keep up the all-important level of motivation.

After Treatment for Obesity

Treatment for overweight is a lifelong commitment. Unless this is accepted, the weight problem will come back. There is some evidence that people whose weight fluctuates widely due to on-and-off dieting may be more at risk from heart disease than those whose weight stays up at a constant level. This is possibly due to fluctuating levels of cholesterol and other fats.

If Obesity is Left Untreated

Some people find it difficult to lose weight without destroying their lifestyle. In them, at least agreeing to hold the weight where it is may be a reasonable approach. Progressive gain in weight is a very unhealthy state and leads to all the problems mentioned earlier. It is no good putting off the treatment plan for another day. The older you get, the harder it will be to achieve anything useful.

Effects on Family of Obesity

Good habits are catching. The new eating and exercise habits often rub off on family and friends. As mentioned earlier, children often share their parents' tendency to put on weight, and setting a good example for them is doubly important.

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