PESHAWAR: Fasting in the month of Ramazan has many health benefits including reduction in obesity, according to an expert.

All the physiological adaptations were temporary and reversible in a short period of time and needed to be supplemented with a maintenance strategy after Ramazan, Prof Mohammad Zarin, the provincial general secretary of Pakistan Society of Metabolic and Bariatric Surgeons (PSM&BS), told Dawn.

“One of the benefits of fasting is improvement of health as refraining from food and liquid during daytime and intake entirely nocturnal for a month lasts for approximately 12 to 18 hours a day, varying according to geographical distribution,” he said.

He said that it resulted in caloric restriction with a positive decrease in body mass, fat mass, total cholesterol low-density lipoprotein, fasting blood glucose levels and resting body metabolic rate.

Laparoscopic surgeon says Pakistan at 144th position in Global Obesity Observatory ranking

“Ramazan is an example of intermittent fasting that falls into the category of time-restricted fasting/eating, which enhances the mobilisation of saturated fats to be utilised in various metabolic processes for the synthesis of adenosine triphosphate that is called the currency of the cell as this is what makes it run. It is the energy we use,” he said.

Prof Zarin said that hormonal milieu also experienced increase in catabolic hormones such as glucagon and adrenaline and a decreased secretion of anabolic hormones like insulin thus the fat synthesis of people was decreased.

He said that a systemic review and meta-analysis conducted in 2021 had shown comprehensive results of the impacts of Ramazan intermittent fasting, causing significant reduction in Body Mass Index (BMI), body weight and relative and absolute fat mass pre and post-Ramazan.

The weight loss and reduction in Body Mass Index are much more pronounced in subjects with high BMI. It was previously reported that Ramazan intermittent fasting results in the reduction of fat-free mass by approximately 20 to 30 per cent in obese and overweight but current studies contradict it and say that rather a positive increase of fat-free mass is demonstrated.

Prof Zarin, a laparoscopic general surgeon at Khyber Teaching Hospital, said that substantial rise in preventable diseases such as cardiovascular, diabetes and cancer labelled obesity was an escalating global epidemic. Since primeval times, natural selection favoured fat storage to endure undernourishment but body fat ended up being a problem that was unrecognised until the late 18th century, he said.

He said that amelioration in the quality and variety of food with a sustained abundance of caloric dense processed food coupled with pervasive marketing led to overeating and the shifts led people to a point in history where physiological adaptation of fat as storage energy became maladaptive.

This disruption caused an exponential increase in obesity over the past 60 years which the World Health Organisation labelled a worldwide public health crisis.

Prof Zarin said that globally 13 per cent of adults were obese and 39 per cent adults were overweight whereas one in five children was overweight. He said that Global Obesity Observatory ranked Pakistan at 144 with 6.26 per cent of the adult male, 166 with 11.7 per cent of adult female, 151 with 3.60 per cent of male children and 181 with 2.52 per cent of female children being obese.

The observatory also demonstrated an upward trend over the period and percentage of obese and overweight adults increased from 40.2 per cent in year 2012 to 50.2 per cent in year 2017.

Obesity is defined by WHO as a condition of excessive fat accumulation in the body to an extent that health and wellbeing are adversely affected. Body Mass Index (BMI) is a widely applied and easily measurable parameter for body fat, utilising weight divided by height in meters square.

Published in Dawn, April 12th, 2022

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