Obesity - Causes and Management

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy. Body mass index (BMI), which compares weight and height, is used to define a person as overweight (pre-obese) when their BMI is between 25 kg/m2 and 30 kg/m2 and obese when it is greater than 30 kg/m2.

Obesity is associated with many diseases, particularly heart disease, type 2 diabetes, breathing difficulties during sleep, certain types of cancer, and osteoarthritis. Obesity is most commonly caused by a combination of excessive dietary calories, lack of physical activity, and genetic susceptibility, though a limited number of cases are due solely to genetics, medical reasons or psychiatric illness.

The primary treatment for obesity is dieting and physical exercise. If

this fails, anti-obesity drugs may be taken to reduce appetite or

inhibit fat absorption. In severe cases, surgery is performed or an

intragastric balloon is placed to reduce stomach volume and or bowel

length, leading to earlier satiation and reduced ability to absorb

nutrients from food.

Obesity is a leading preventable cause of death worldwide, with

increasing prevalence in adults and children, and authorities view it

as one of the most serious public health problems of the 21st century.

Obesity is stigmatized in the modern Western world, though it has been

perceived as a symbol of wealth and fertility at other times in

history, and still is in many parts of Africa

source : wikipedia.org

What Causes Obesity?

Obesity is considered a long-term complex disease. Many factors are

involved in determining why some people are heavier than others and how

much risk they have for developing other medical problems.
Science continues to search for answers. But until the disease is

better understood, the control of excess weight is something patients

must work at for their entire lives. That is why it is very important

to understand that all current medical interventions, including weight

loss surgery, should not be considered medical cures. Rather, they are

attempts to reduce the adverse effects of excessive weight and

alleviate the serious physical, emotional and social consequences of

the disease.
You gain weight when you consume more calories from food than your body

uses through its normal functions (basal metabolic rate [BMR]) and

physical activity. The unused calories are stored as fat. You become

obese if you consistently consume excess calories over a long period of

time. For example, eating an extra 100 calories per day can lead to a

gain of about 10 lbs (4.5 kgs) in a year. Gaining 10 pounds a year

eventually will result in a BMI of 30 or higher.
Your activity level is also important. Activity uses calories, which

helps balance the calories you get through food. If you are inactive,

it may be easier to gain weight.
However, calories alone do not explain weight gain and why some people

gain (or lose) weight more easily than others. Other factors that play

a major role in weight gain and obesity include:
Genetic or Hereditary Factors
Research has shown that in many cases a significant underlying cause of

morbid obesity is genetic - you inherit the tendency to gain weight.

Numerous scientific studies have established that your genes play an

important role in your tendency to gain excess weight. The body weight

of adopted children shows no correlation with the body weight of their

adoptive parents who feed them and teach them how to eat. Their weight

does have an 80 percent correlation with their genetic parents whom

they have never met. Identical twins with the same genes show a much

higher similarity of body weights than do fraternal twins, who have

different genes. Certain groups of people, such as the Pima Indian

tribe in Arizona, have a very high incidence of severe obesity. They

also have significantly higher rates of diabetes and heart disease than

other ethnic groups.

We probably have a number of genes directly related to weight. Just as

some genes determine eye color or height, others affect our appetite,

our ability to feel full or satisfied, our metabolism, our fat-storing

ability, and even our natural activity levels.
Environmental Factors
Environmental and genetic factors are obviously closely intertwined. If

you have a genetic predisposition toward obesity, then the modern

lifestyle and environment that has readily available inexpensive food

high in fat and low in fruits and vegetables may lead to weight gain

and obesity. Fast food, long days sitting at a desk, and suburban

neighborhoods that require cars all magnify hereditary factors such as

metabolism and efficient fat storage. For those suffering from morbid

obesity, anything less than a total change in environment usually

results in failure to reach and maintain a healthy body weight by

nonoperative measures.
Metabolism
We used to think of weight gain or loss as only a function of calories

ingested and then burnt. Take in more calories than you burn and gain

weight; burn more calories than you ingest and lose weight. But now we

know the equation isn't that simple.

Obesity researchers now talk about a theory called the "set point" - a

sort of thermostat in the brain that makes people resistant to either

weight gain or loss. If you try to override the set point by

drastically cutting your calorie intake, your brain responds by

lowering metabolism and slowing activity. You then gain back any weight

you lost.

Health Hazards of Morbid Obesity

Severe obesity damages the body by its mechanical, metabolic and

physiological adverse effects on normal bodily function. These

"co-morbidities" affect nearly every organ in the body in some way, and

produce serious secondary illnesses, which may also be

life-threatening. The cumulative effect of these co-morbidities can

interfere with a normal and productive life and can seriously shorten

life, as well. The risk of developing these medical problems is

proportional to the degree of obesity.
Years of life lost
People who are obese do not live as long as those who are not obese and

the earlier a person become obese; the more years of life are lost. A

recent study in the Annals of Internal Medicine (Jan 2003) concluded

that obesity and overweight are associated with large decreases in life

expectancy and increases in early death.
- Forty year old female nonsmokers lost 7.1 years of life because of

obesity
- Forty year old male nonsmokers lost 5.8 years because of obesity
- Obese female smokers lost 13.3 years & obese male smokers lost 13.7

years compared with normal weight nonsmokers
People who are obese are at greater risk of death from cancer. In the

United States, compared to people of a healthy weight, people who are

Obese (BMI of 30-34.9) have a 9% (men) or 23% (women) increased risk of

death from cancer. Very obese (BMI of 35-39.9) have a 20% (men) or 32%

(women) increased risk of death from cancer.
Dysmetabolic Syndrome X
This recently recognized syndrome involving abdominal obesity, abnormal

blood fat levels, changes in insulin sensitivity and inflammation of

the arteries is associated with a markedly increased risk of heart and

blood vessel disease. It is also a precursor to the onset of Diabetes

in adults.
Heart Disease
Severely obese persons are approximately 6 times as likely to develop

heart disease as those who are normal-weighted. Heart disease is the

leading cause of death today and obese persons tend to develop it

earlier in life and it shortens their lives. Coronary disease is

pre-disposed by increased levels of blood fats and the metabolic

effects of obesity. Increased load on the heart leads to early

development of congestive heart failure. Severely obese persons are 40

times as likely to suffer sudden death, in many cases due to cardiac

rhythm disturbances.
High Blood Pressure
Essential hypertension, the progressive elevation of blood pressure, is

much more common in obese persons and leads to development of heart

disease, and damage to the blood vessels throughout the body, causing

susceptibility to strokes, kidney damage, and hardening of the

arteries. If your doctor finds you have high blood pressure, the first

thing he or she will recommend to you is weight loss (but doctors have

never been able to tell : How?
High Blood Cholesterol
Cholesterol levels are commonly elevated in the severely obese --

another factor predisposing to development of heart and blood vessel

disease. This abnormality is not just related to diet, but is an effect

of the massive imbalance in body chemistry which obesity causes.
Diabetes Mellitus
Overweight persons are 40 times as likely to develop Type-2,

Adult-Onset, diabetes (earlier called non insulin dependent). Elevation

of the blood sugar, the essential feature of diabetes, leads to damage

to tissues throughout the body: Diabetes is the leading cause of

adult-onset blindness, a major cause of kidney failure and the cause of

over one half of all amputations. Diabetics suffer severely from their

disease and once Diabetes occurs, it becomes even harder to lose

weight, because of hormone changes which cause the body to store fat

even more than before.
Sleep Apnea Syndrome
Sleep apnea - the stoppage of breathing during sleep -- is commonly

caused in the obese, by compression of the neck, closing the air

passage to the lungs. It leads to loud snoring, interspersed with

periods of complete obstruction during which no air gets in at all. The

sleeping person sounds to an observer like he is holding his breath,

but the sleeper is, himself, usually unaware that the problem is

occurring at all, or only notices that he sleeps poorly and awakens

repeatedly during the night. The health effects of this condition may

be severe, high blood pressure, cardiac rhythm disturbances and sudden

death. Affected persons awaken exhausted and often fall asleep during

the day, sometimes even at the wheel of their car, and complain of

being tired all the time. This condition really has a high mortality

rate, and is a life-threatening problem.
Obesity Hypoventilation Syndrome
This condition occurs primarily in the very severely obese -- over 350

lbs. It is characterized by episodes of drowsiness, or narcosis,

occurring during awake hours and is caused by abnormalities of

breathing and accumulation of toxic levels of carbon dioxide in the

blood. It is often associated with sleep apnea, and may be hard to

distinguish from it
Respiratory Insufficiency
Obese persons find that exercise causes them to be out of breath very

quickly and even during ordinary activities. The lungs are decreased in

size, and the chest wall is very heavy and difficult to lift. At the

same time, the demand for oxygen is greater, with any physical

activity. This condition prevents normal physical activities and

exercise, often interferes with usual daily activities, such as

shopping, yard-work or stair climbing, making even ordinary living

difficult or miserable, and it can become completely disabling.
Heartburn - Reflux Disease and Reflux Nocturnal Aspiration
Acid belongs to the stomach, which makes it to help digest food, and it

seldom causes any problem when it stays there. When it escapes into the

esophagus, through a weak or overloaded valve at the top of the

stomach, the result is called “gastro-esophageal reflux”. The real

problem is not with digestion, but with the burning of the esophagus by

the powerful stomach acid, getting to where it doesn't belong. When one

belches, the acid may bubble up into the back of the throat, causing a

fiery feeling there as well. Often this occurs at night, especially

after a large or late meal and if one is asleep when the acid

regurgitates, it may actually be inhaled, causing a searing of the

airway, and violent coughing and gasping.
This condition is dangerous, because of the possibility of pneumonia or

lung injury. The esophagus may become strictured, or scarred and

constricted, causing trouble with swallowing. Approximately 10 - 15% of

patients with even mild sporadic symptoms of heartburn will develop a

condition called Barrett's esophagus, which is a pre-malignant change

in the lining membrane of the esophagus, a cause of esophageal cancer
Asthma and Bronchitis
Obesity is associated with a higher rate of asthma, about 3 times

normal. Much of this effect is probably due to acid reflux (described

above), which can irritate a sensitive airway and provoke an asthmatic

attack. The improvement of asthma after surgery is often very dramatic,

even before much weight loss has occurred.
Gallbladder Disease
Gallbladder disease occurs several times as frequently in the obese, in

part due to repeated efforts at dieting, which predispose to this

problem. When stones form in the gallbladder, and cause abdominal pain

or jaundice, the gallbladder must be removed.
Stress Urinary Incontinence
A large heavy abdomen and relaxation of the pelvic muscles, especially

associated with the effects of childbirth, may cause the valve on the

urinary bladder to be weakened, leading to leakage of urine with

coughing, sneezing, or laughing. This condition is strongly associated

with being overweight, and is usually relieved by weight loss.
Degenerative Disease of Lumbo-Sacral Spine
The entire weight of the upper body falls on the base of the spine and

overweight causes it to wear out, or to fail. The consequence may be

accelerated arthritis of the spine, or "slipped disk", when the

cartilage between the vertebrae squeezes out. Either of these

conditions can cause irritation or compression of the nerve roots and

lead to sciatica -- a dull, intense pain down the outside of the leg.
Degenerative Arthritis of Weight-Bearing Joints
The hips, knees, ankles and feet have to bear most of the weight of the

body. These joints tend to wear out more quickly, or to develop

degenerative arthritis much earlier and more frequently, than in the

normal-weighted person. Eventually, joint replacement surgery may be

needed to relieve the severe pain. Unfortunately, the obese person

faces a disadvantage there too -- joint replacement has much poorer

results in the obese and complications are more likely. Many orthopedic

surgeons refuse to perform the surgery in severely overweight patients
Venous Stasis Disease
The veins of the lower legs carry blood back to the heart. They are

equipped with an elaborate system of delicate one-way valves, to allow

them to carry blood "uphill". The pressure of a large abdomen may

increase the load on these valves, eventually causing damage or

destruction. The blood pressure in the lower legs then increases,

causing swelling, thickening of the skin, and sometimes ulceration of

the skin. Blood clots also can form in the legs, further damaging the

veins, and can also break free and float into the lungs -- called a

Pulmonary Embolism -- a serious or even fatal event.
Emotional / Psychological Illness
Seriously overweight persons face constant challenges to their

emotions: repeated failure with dieting, disapproval from family and

friends, sneers and remarks from strangers. They often experience

discrimination at work, and cannot enjoy theatre seats, or a ride in a

bus or airliner. The severely overweight person takes challenges even

in small routine acts like that others cannot fathom. Many may be on

starvation diet but friends and relatives scrutinize their eating

habits – convinced that that are sneaking food. They cannot perform

simple things ; walking up stairs or tying shoes is a major ordeal.

Stereotypes of obese people – such as that they are lazy – may result

in lower self esteem and poor body image. There is no wonder that

anxiety and depression might accompany years of suffering from the

effects of a genetic condition -- one which skinny people all believe

should be controlled easily by will power.
Social Effects
Severely obese persons suffer inability to qualify for many types of

employment, and discrimination in employment opportunities, as well.

They tend to have higher rates of unemployment, Ignorant persons often

make rude and disparaging comments, and there is a general societal

belief that obesity is a consequence of a lack of self-discipline, or

moral weakness. Many severely obese persons find it preferable to avoid

social interactions or public places, choosing to limit their own

freedom, rather than suffer embarrassment.

obesity and fitness market in India

Obesity is increasingly posing itself as a grave problem in India, just

as in many developed countries such as the US and UK. Though India’s

obesity level is less as compared to the US and UK, at approximately

8%, against over 25% in US and 15% in Europe, the problem can soon

reach that magnitude if not adequately addressed.

The Union health ministry last year slimmed down the Body Mass Index

(BMI) to 23 kg/m2 as against 25 kg/m2 globally. BMI is the body weight

of an individual measured in proportion to his height. The primary

reason to lower BMI levels was to fight the danger of India becoming a

diabetes hub by 2050.

According to experts, obesity is more of an urban phenomenon with a

prevalence of at least 30-50% general obesity levels and 40-70%

abdominal obesity. Indian women are more prone to abdominal obesity as

opposed to men. The obesity levels are half or even lesser than these

in rural areas, says Dr Anoop Mishra, director of diabetology, obesity

and metabolism department, Fortis Group.

Dr Mishra asserts that a lower BMI guideline is necessary for Indians

living anywhere in the world. “Indians are more prone to Type 2

diabetes, hypertension and heart disease. We are developing diseases at

lower BMI too, so it was absolutely necessary to revise these in India.

We have also revised exercise guidelines to 60 minutes, all 7 days of

the week. But a lot more still needs to be done. The government needs

to launch a major programme to counter the obesity issue. Otherwise

there will soon be a diabetic factory in India.”

Sharp words there. But hips don’t lie. According to a National Family

Health Survey-3(NFHS) survey in 2005-06, the problem has been

particularly observed in older women, women living in urban areas, well

educated women and women in households falling in the highest wealth

quintile and Sikhs. The survey found that obesity is particularly

prevalent for both men and women in Delhi, Kerala, and Punjab. The

percentage of women who are overweight or obese is highest in Punjab

(30%), followed by Kerala (28%) and Delhi (26%). It’s no wonder then

that the anti-obesity market has become a huge opportunity area which

brands want to tap it. Expanding waistlines now mean big bottomlines

for companies too.

Digest this: The present market size for the anti-obesity market in the

country is estimated as being over Rs 1,800 cr, according to leading

management consulting organisation Technopak Advisors. This overall

market—comprising fitness centres/gymnasiums, slimming services, food

supplements and ayurveda treatments—is projected to grow at a rate of

13% CAGR through 2010.

Fitness and diet centres, FMCG companies, apparel brands and even fast

food joints are all cashing in on the keep fit mantra. The Indian

healthcare market, comprising healthcare delivery, pharma and medical

technology, is estimated at a huge $34 billion and growing at 15%

annually, according to the Technopak analysis

http://economictimes.indiatimes.com/Features