Dr Hector PereraƒÆ’-¡ƒ”š‚  London

ObesityƒÆ’-¡ƒ”š‚ is aƒÆ’-¡ƒ”š‚ medical conditionƒÆ’-¡ƒ”š‚ in which excessƒÆ’-¡ƒ”š‚ body fatƒÆ’-¡ƒ”š‚ has accumulated to the extent that it may have an adverse effect on health, leading to reducedƒÆ’-¡ƒ”š‚ life expectancyƒÆ’-¡ƒ”š‚ and/or increased health problems. There is another method to find out whether someone is over weight or obese. Body mass indexƒÆ’-¡ƒ”š‚ (BMI), a measurement which comparesƒÆ’-¡ƒ”š‚ weight and height, defines people asƒÆ’-¡ƒ”š‚ overweightƒÆ’-¡ƒ”š‚ (pre-obese) if their BMI is between 25 and 30ƒÆ’-¡ƒ”š‚ kg/m², and obese when it is greater than 30ƒÆ’-¡ƒ”š‚ kg/m².

Body mass index

Body mass index is defined as the individual’s body weight divided by the square of his or her height.

ƒÆ’-¡ƒ”š‚ Waist to hip ratio preferred than BMI

BMI is not infallible. For instance, it is possible for a healthy, muscular athlete with very low levels of body fat to be classified obese using this formula.

Another way of assessing overweight and obesity is by measuring girth (waist circumference or, more importantly, waist to hip ratio). It’s recognised that the central fat held in the abdomen is more dangerous than peripheral fat and acts as a toxic inflammatory organ.ƒÆ’-¡ƒ”š‚ Waist to hip ratioƒÆ’-¡ƒ”š‚ is increasingly being used by doctors in preference to BMI as a better measurement of the risk of obesity and cardiovascular disease.

ƒÆ’-¡ƒ”š‚ How common is obesity?

In 2008, the latest year with available figures, nearly a quarter of adults (over 16 years of age) in England were obese (had a BMI over 30). Just under a third of women, 32%, were overweight (a BMI of 25-30), and 42% of men were overweight.

Amongst children (2-15 years of age), one in six boys and one in seven girls in England were obese in 2008. The number of overweight children was also around one in seven.ƒÆ’-¡ƒ”š‚ 

The number of overweight and obese people is likely to increase. The Foresight report, a scientific report used to guide government policy, has predicted that by 2025, nearly half of men and over a third of women will be obese.ƒÆ’-¡ƒ”š‚ 

Why obesity increases, not just too much food.

One might point the finger at just eating only actually there are other reasons as well. Obesity increases the likelihood ofƒÆ’-¡ƒ”š‚ various diseases, particularlyƒÆ’-¡ƒ”š‚ heart disease,ƒÆ’-¡ƒ”š‚ type 2 diabetes,ƒÆ’-¡ƒ”š‚ obstructive sleep disorder, certain types ofƒÆ’-¡ƒ”š‚ cancer, andƒÆ’-¡ƒ”š‚ osteoarthritis.ƒÆ’-¡ƒ”š‚ Heart disease orƒÆ’-¡ƒ”š‚ cardiovascular diseasesƒÆ’-¡ƒ”š‚ are the class of diseases that involve theƒÆ’-¡ƒ”š‚ heartƒÆ’-¡ƒ”š‚ or blood vesselsƒÆ’-¡ƒ”š‚ (arteriesƒÆ’-¡ƒ”š‚ andƒÆ’-¡ƒ”š‚ veins).

ƒÆ’-¡ƒ”š‚ Most countries face high and increasing rates of cardiovascular disease. Each year,ƒÆ’-¡ƒ”š‚ heart diseaseƒÆ’-¡ƒ”š‚ kills more Americans than cancer. By looking at this kind of reports, Sri Lankans have little or less obese people. This again due to busy life style and intake of more fibrous food such as fruits, vegetables and brown rice. Very likely when some people consume takeaway food on regular basis, could gain body weight.

Obesity is most commonly caused by a combination of excessiveƒÆ’-¡ƒ”š‚ food energyƒÆ’-¡ƒ”š‚ intake, lack of physical activity, andƒÆ’-¡ƒ”š‚ genetic susceptibility, although a few cases are caused primarily byƒÆ’-¡ƒ”š‚ genes, endocrine, medicationsƒÆ’-¡ƒ”š‚ orƒÆ’-¡ƒ”š‚ psychiatric illness and disorders.

ƒÆ’-¡ƒ”š‚ Evidence to support the view that some obese people eat little, yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.

Some treatments

The best way to tackle obesity is by not putting on too much weight the first place. A combination of a healthy, balanced diet and regular exercise should be sufficient in most instances. Moreover, it is important to improve diet quality by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake ofƒÆ’-¡ƒ”š‚ dietary fibre. There is also concern about the advent of super-size portions. In that case one must be quite conscious about this takeaway food.ƒÆ’-¡ƒ”š‚ 

Experts recommend vigorous exercise such as brisk walking, swimming or cycling five times a week for 20-30 minutes.

For those who are already obese, weight management clinics are available to provide expert help and advice.

Surgery is usually only recommended for the most extreme cases, as it can be risky and patients require life-long monitoring for potential complications.

To supplement this, or in case of failure,ƒÆ’-¡ƒ”š‚ anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption. In severe cases,ƒÆ’-¡ƒ”š‚ surgeryƒÆ’-¡ƒ”š‚ is performed or an intra-gastric balloon is placed to reduce stomach volume and/or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.

Is it a symbol of health and wealth?

Obesity is a leadingƒÆ’-¡ƒ”š‚ preventable cause of death worldwide, with increasingƒÆ’-¡ƒ”š‚ prevalence in adults andƒÆ’-¡ƒ”š‚ children, and authorities view it as one of the most seriousƒÆ’-¡ƒ”š‚ public health problems of the 21stƒÆ’-¡ƒ”š‚ century. Obesity isƒÆ’-¡ƒ”š‚ stigmatizedƒÆ’-¡ƒ”š‚ in much of the modern world (particularly in the Western world), though it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of the world.ƒÆ’-¡ƒ”š‚ 

ƒÆ’-¡ƒ”š‚ WhatƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s to be done?

Firstly and pretty obviously: eat real food, not fake food and processed food that is depleted in nutrients. When we starve the body of nutrients, we also are more likely to experience cravings.ƒÆ’-¡ƒ”š‚ We need nutrients, including certain kinds of fats, to survive. The natural fats found in avocados, seeds, nuts, coconuts, oily fish such as mackerel etc are fats that the body recognises – particularly the omega-3, but also the omega-6 and omega-9. These kinds of food are plenty and cheap in Sri Lanka. Is that one of the reasons for tourist attraction?

There is the common saying, ƒÆ’‚¢ƒ¢-¡‚¬ƒ…-Prevention is better than cureƒÆ’‚¢ƒ¢-¡‚¬ƒ”š‚. Recognizing symptoms of a problem before it actually becomes a problem defines prevention. There are simple ways to recognize if your body and health are deteriorating. Most health related issues can be prevented and obesity is no exception.
We need to cut down over time eating, excess calories leads to weight gain. Without lifestyle changes to increase the amount of physical activity done on a daily basis, or reduce the amount of calories consumed, people can become obese.

What comes with obesity? How the heck am I going to fit into that dress?

Sri Lankans ladies might be asking that question, before returning after the holidays. By the time that heart problems are detected, the underlying cause (atherosclerosis) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such asƒÆ’-¡ƒ”š‚ healthy eating,ƒÆ’-¡ƒ”š‚ exercise, and avoidance ofƒÆ’-¡ƒ”š‚ smoking. ƒÆ’-¡ƒ”š‚ As mentioned earlier, according to Foresight report, the problem is growing rapidly. Experts predict that if the current rate of growth continues, three-quarters of the population could suffer the ill effects of excess weight within 10 to 15 years.

ƒÆ’-¡ƒ”š‚ Hardly any physical activity

TodayƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s way of life is less physically active than it used to be. People travel on buses and cars, rather than walking, and many people work in offices, where they are sitting still for most of the day. This means that the calories they eat are not getting burnt off as energy. Instead, the extra calories are stored as fat. As a matter of fact, in rural areas of Sri Lanka, all men and women have an active life style unlike the urban counter part. Have you not seen, the farmers start work in the fields very early morning. What they do in the field are quite energy demanding. If you not sure what work they do, why not visit these places. The women have to boil the paddy then dry them in the hot sun that is just one task. Then to remove husk, they get together and pound the boiled and dried paddy. Usually it would take more than one hour, so they do what the urban counter part failed to do.

Meantime some lucky urban ladies often drive 4×4 and speed through traffic to their easy office work. From the time they arrive, drink tea, coffee, little easy work on computer, on the phone, on mobile, then go for tea break, lunch break then again afternoon break then a quick shopping in a super market then dash back home to see the favourite TV programmes. A few of them would have a smoke or two as well. Most of the time depends on takeaway food than home cooking. Well one of the reasons may be, ƒÆ’‚¢ƒ¢-¡‚¬ƒ…-DonƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢t know how to cookƒÆ’‚¢ƒ¢-¡‚¬ƒ”š‚. Your comments welcomed perera6@hotmail.co.uk