Obesity is clearly one of the biggest problems in the world, and it’s this black box. We really don’t know why, but we see it and it’s getting worse.
As of 2005 the WHO estimates that at least 400 million adults (9.8%) are obese, with higher rates among women than men.The rate of obesity also increases with age at least up to 50 or 60 years old.
Right now two thirds of Americans are either overweight or obese. The scary part is that we are predicting that by 2015, ie, within 5 years, three fourths of Americans will be either overweight or obese. These are truly staggering numbers.
China probably has one of the fastest growing populations of obesity, and Australia now has said, “look, our number one leading cause of preventable death is now obesity, not smoking, but obesity.”
In India urbanization and modernization has been associated with obesity.In Northern India obesity was most prevalent in urban populations (male = 5.5%, female = 12.6%), followed by the urban slums (male = 1.9%, female = 7.2%). Socioeconomic class also had an effect on the rate of obesity. Women of high socioeconomic class had rates of 10.4% as opposed to 0.9% in women of low socioeconomic class.
Then being obese is costly: If you look at the average obese patient, that person is going to cost the healthcare system 2-3 times what the average person does, and if that person is morbidly obese, it’s now 10-12 times. These are extremely expensive numbers, and we see it regularly at our Diabetic Clinics.
Obesity is recognized by a lot of different groups, such as researchers and healthcare organizations, but as professionals we tend to sometimes ignore it.
If we try to consider the possible consequences of being obese, we see that almost all body systems are affected.
Obese people have increased tendency for problems like Hypertension, Coronary Heart Disease, Diabetes, Dyslipidemia, Severe Pancreatitis, Fatty Liver diseases, Cirrhosis, Gall bladder diseases, Lung diseases like Obstructive Sleep Apnoea, Hypoventilation Syndrome, Gynaecological abnormalities like abnormal menses, infertility, Polycystic Ovarian Syndrome; Increased rate of Cancers of the organs affected, Gout , Skin problems like Acne, etc.
A study that was done many years ago looked at the relationship between the amount of weight that patients gain when they are adults and the development of diabetes. Notice that just a small amount of weight change — and we’re talking about 6, 10, and 15 kg — increases the risk for diabetes 6-fold.
As we talk about treatment, many people think that you have to reduce somebody back to normal weight, but that’s not really true. Many of the co morbid conditions, i.e., the illnesses that are associated with diabetes, can be greatly benefited by small amounts of weight loss.
According to a study done in United States on Diabetes Prevention( Diabetes Prevention Programme, DPPI) consisting of three groups, i.e., lifestyle intervention; a placebo group and then a group treated with medications, such as metformin. They found that when individuals lost 7% of their body weight [i.e., 3.5 kg at the end of a 3-year period] they were able to reduce the development of diabetes by 58% — a modest amount of weight loss; these people [had originally] averaged about 95-100 kg.
Hence when we want to treat our obese patients, it’s important to emphasize that modest amounts of weight loss have great health benefits. Ideally, we’d like to reduce everybody down to normal; they would look wonderful and they would feel better about themselves, but whatever degree of weight loss one gets in a treatment program is very beneficial.
Essentially, if someone is 200 lb and loses 10-15 lb, that person is cutting the diabetes to more than half.
Also their blood pressure will go down; their lipids will get better; and their cholesterol [will improve]. Frequently, they can reduce the amount of medications that they have to take.
Apart from stressing over just weight loss clinicians also consider ways to cut down weight gain with regular monitoring.
A person with BMI more than 30 should be visiting a weight loss clinic.
But the clinician ought to understand that the BMI is not ideal. For example, if you have a big muscular football player, one of the professional football players, he’ll have a BMI of 38 or 40 kg/m2. They’re not fat. On the other hand, your average obese individual who has a BMI of 38 or 40 kg/m2 has 40%-50% body fat. There actually have been some studies looking at these large men who are very muscular, and if you follow them over time, BMI still predicts early death.BMI is a funny number because it’s actually very predictive as to how long you are going to live.
In addition to BMI, recording of the waist circumference is good way to estimate the amount of abdominal fat.
There is a disease called the metabolic syndrome, which is associated with visceral obesity, and it’s a cardiovascular risk. People with “the metabolic syndrome” have lipid abnormalities, a big waist circumference, and high blood pressure. The waist circumference is an additional measure, so when you put the BMI together with the waist circumference, you get a lot of additional information.
Severely obese individuals may also be benefitted by Bariatric surgery.
So clinicians have a spectrum of treatments, and the goal for clinicians is to apply the appropriate treatment to the patient and have realistic expectations for you and the patient, and be supportive. If we do that, we will surely make an impact in treating our obese patients and contributing to the battle against this evil.