Direct links between obesity and diabetes, hypertension, high blood cholesterol, Ischaemic heart disease and stroke are well recognized
OBESITY is doubling every five years in many parts of the world. And if steps aren’t taken to stop this trend, we could very soon have an epidemic on our hands. Direct association between obesity and several diseases, including diabetes, high blood pressure (hypertension), high blood cholesterol and other fats (dyslipidaemia), Ischaemic heart disease (IHD) and stroke are well recognized. Obesity also increases the risk for some cancers.
Adverse effects appear to be closely related to the distribution of body fat. Central obesity (fat in the abdomen) is associated with greater health risk than fat in the buttocks and thighs (peripheral obesity). Central obesity is estimated by measuring the waist circumference or by waist-hip-ratio (WHR). Waist circumference/girth of more than 35 inches in women and more than 40 inches in men carry high risk for developing diabetes and other diseases such as high blood pressure and heart disease. A waist-hip-ratio of over 0.95 in men and over 0.85 in women carry similar risks.
Body weight can also be measured by body mass index (BMI) where weight in kilograms is divided by height in meters squared i.e., BMI=Kg/m2. For example if your weight is 72kg and your height is 1.58 meters, then your BMI would be 28.84. BMI is therefore a measure of total body fat and evaluates weight relative to height. A patient is overweight if BMI is 25 to 29.9 and obese if BMI is 30 or more.
According to the National Diabetes Prevalence Survey conducted by the Diabetic Association of Pakistan in collaboration with the World Health Organization, obesity, both central and peripheral was found to be more common in women than men.
Obesity requires long term treatment similar to type 2 diabetes. Moderate weight loss of five per cent to ten per cent offers health benefits in terms of improved blood sugar control, high-blood pressure and cholesterol levels — weight loss also reduces pain in weight bearing joints such as hips, knees and ankles in those patients who suffer from arthritis. It improves the chances of fertility in infertile women.
TREATMENT
* Lifestyle modification — eat less walk more. Daily brisk walk for 30-40 minutes on empty stomach, i.e. before breakfast or before dinner is very useful. If it is not possible to undertake daily walk do it at least for four days in a week.
* Reduce fat intake and sugar intake
* Behaviour modification — avoid social activities which involve food and drinks. * If concerted efforts to loose weight have not been successful then one may consider the use of drugs for loosing weight. The two drugs that are advocated for weight loss are Sibutramine and Orlistat. Sibutramine is available in Pakistan under the name of Reductil but Orlistat is not yet registered in Pakistan. Like all drugs, along with beneficial effects, they also have some side-effects. Overweight/ obese people are advised to use weight reducing drug only under the supervision of a physician. While on drug they should continue with diet restriction and increased physical activity.
