Many people use the term ‘OBESITY’ and ‘OVERWEIGHT’ interchangeably. But these two words are not same. If someone’s weight is 10% - 20 % more than his or her ideal body weight, it is called overweight and 20% or its more, called obesity. In one sentence obesity is defined as a condition in which there is an accumulation of body fat in excessive proportion to total body mass.
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| Weight measuring machine and measuring tape |
We can assess obesity by different methods:
Body weight-
We discussed earlier over weight and obesity. Now you can assess your obesity by calculating the percentage of excess body weight of your ideal body weight.
% body weight excess of ideal body weight |
Degree |
25
|
Mild
|
50
|
Moderate
|
75
|
Severe
|
100
|
Very severe
|
BMI-
You can assess your obesity on the basis of BMI. The full form of BMI is Body Mass Index. It is also called Quetlet Index.
In brief BMI is = weight (kg)/[height (meter)]2
On the basis of BMI grading of obesity
BMI |
CLASSIFICATION |
< 18.5
|
Under weight
|
18.5 – 24.9
|
Normal weight
|
25.0 – 29.9
|
Over weight
|
30.0 – 34.9
|
Class I obesity
|
35.0 – 39.9
|
Class II obesity
|
≥ 40
|
Class III obesity
|
But we cannot get the accurate result by this method.
Waist circumference:
We can evaluate the abdominal fat by estimating waist circumference.
Risk |
Male (cm) |
Female (cm) |
Very high
|
> 120
|
> 110
|
High
|
100 – 120
|
90 – 100
|
Low
|
80 – 99
|
70 – 89
|
Very low
|
< 80
|
< 70
|
Above sizes indicate the obesity.
By this method we can get an idea about amount of visceral fat of coronary heart disease and diabetes mellitus and other endocrinal disorder. Waist circumference should be measured by using the tape around waist line (at the mid-point between top of the iliac crest and below of the rib cage).
Measurement of body fat:
Different types of calipers are used to measure body fat. Harpenden calipers, large calipers, USA MRNL calipers are used for measuring subcutaneous fat at the triceps, abdomen and subcostal sites.
Ponderal index-
This is another method of estimating obesity. Calculation of ponderal index is
PI= height (inches)/3√weight
If the result is less than 13, that is the risk of obesity.
Waist hip ratio-
We discussed earlier the waist circumference. Now we will discuss hip circumference. Hip circumference should be measured around the buttocks by the tape. Hip circumference helps to assess the adipose tissue which is associated with the metabolic disorder that increases the risk of coronary heart disease and diabetes mellitus. WHR (waist hip ratio) is the indicator of fertility. A good waist hip ration is the indicator of fertility capability in men.
The normal ratio: waist/hip= 0.7
Health risk |
Male |
Female |
Low
|
< 0.95
|
< 0.80
|
Moderate
|
0.96 – 1
|
0.81 – 0.85
|
High
|
> 1.0
|
> 0.85
|
Vii) Broka’s index:
This is easy and accurate for measuring ideal body weight (IBW) IBW is the indicator of good health by measuring your IBW, you can understand about your extra weight.
The formula is
(For men) - Height (cm) – 100 = IBW (Kg)
(For women) - Height (cm) – 103 = IBW (Kg)
Always keep in mind that, measurement should be taken from right side of normal patient. Feet should be close to each other and during measurement stay normally means in normal breathing.
Causes:
Physical inactivity:
Lack of physical activity is the main reason of obesity. If you eat high calorie food in large amount but don’t exercise or you may be work whole day but only sitting work like sitting at a desk, that lead to obesity. In brief we can say energy imbalance is the cause for obesity.
Gene defects:
Some scientists discovered the presence of obesity gene in human. That codes for the protein ‘LEPTIN’. This word comes from the Greek word ‘LEPTOSE’ meaning ‘THIN’. Leptin is produced in the blood and binds to receptor in brain. Several actions happen in the brain and leptin signals the brain not to eat more. Leptin helps in maintaining energy balance by regulating intake of food. It helps in suppressing appetite but people with genetic defects of leptin eat more. They cannot control hunger. That may lead to obesity.
Genetic factor:
Obesity comes from genetic factor. If parents or one parent is obese, child is also obese.
Eating habits:
Obesity develops gradually through poor eating habits, sedentary life styles such as
- Eating large amount of junk foods is the main cause for obesity.
- Many people eat very fast but they chew the food improperly so, they tend to consume more food which may lead to obesity.
- People who drink alcohol everyday, they become overweight.
- We observed that Indian house wives who cook for their family make delicious food and force the family member to eat more. It is also the possible cause for obesity.
- Sometimes housewives do not want to through excess food. Then forcibly they consume the food that lead to obesity.
- The persons who work outside, they attend many meetings and consume outside food. That is another reason of gaining weight.
- Indian people like to eat sweet dishes in many occasions and also distribute their neighbor which leads to obesity because calorie intake is increased by consuming sweets.
- Sometimes college students, service men go their college or working place very early in the morning. Then they cannot take the homemade food for Tiffin. So, they eat outside food which is sometimes very oily and they are more prone to obesity.
- Most of the persons especially school children, college students do not like to eat fruits, vegetables. Non inclusion of fruits and vegetables in daily diet is susceptible to obesity.
Stress:
Relation between stress and obesity is very interesting. A person gain weight for stress in various ways. When people are in chronic stress, a hormone named ‘CORTISOL’ releases. This hormone promotes the fats especially in stomach and increases the level of resistance insulin which raised the blood sugar level. That may lead to obesity. Besides this another hormone named ‘GHRELIN’ which is known as ‘HUNGER HORMONE’. This hormone increases the appetite. This hormone releases during lack of sleep is occurred when someone is suffering from sleep disturbances. During stress they tend to gain weight by ‘GHRELIN’ hormone. Stress also causes physical inactivity, improper eating habits which may lead to obesity.
Trauma:
Due to head injury hypothalamus may be damaged and for this reason hypothalamus is unable to regulate appetite. So, person eats excess sometimes and so there is a chance of becoming obese.
Endocrine factor:
Obesity can occur at any age. It is common at puberty. During pregnancy pregnant mother gains their weight. After menopause woman gain their weight. Obesity is common in hypothyroidism, hypogonodism, cushing’s syndromes. So, we can say endocrine may be a factor of obesity.
Medicines:
Due to prolong eating of medicines such as steroid, beta-blocker, diabetes medicine etc may lead to obesity.
Complications:
Obesity creates many complications in our life:
- Obese persons look not beautiful so, more people suffer from stress.
- Different diseases are related with obesity such as heart disease, diabetes, gallstone, hypertensions, certain cancer (colon, prostate, breast) that may lead to death.
- Osteoarthritis of knee, hips and lumbar spine.
- Respiration problem is found.
- Obesity may cause complications during pregnancy.
- Irregular period is also common complication.
Dietary management:
The main principle of weight reducing diet is consumption of low calorie food. Right amount of calorie is given on the basis of obesity grade and the physical activity. Main dietary principle for obesity is high fibre, low calorie, fat restricted, normal protein, vitamins, minerals (except sodium) and adequate amount of water.
Reducing diet:
Reducing diet is low calorie diet. By reducing diet we can reduce our weight by taking low calorie foods. Adequate amount of protein, vitamins and minerals should contain in this diet. You can reduce your weight 3 kg within first month. Then the level of reducing weight will be increased. By reducing diet you can lose 10% body weight from the baseline. This diet should be continued for 6 months. In this therapy patient should be provided 500 – 1000 kcal less than his or her actual requirement of calorie.
Weight maintenance diet:
It is the second step for reducing weight. This diet should contain 1500 – 1800 kcal.
Carbohydrate-
Obese people should be given complex carbohydrate rich foods. 45 – 60 % of carbohydrate should come from total calories. Obese person should not be given potato, sweet potato, arum and rice should be given in limited amounts. Sweet products should be excluded from the diet. Obese people should eat green vegetables and fruits in large amounts but you should keep in mind that high calorie food such as banana, custard apple, mango etc fruits should be omitted from diet. You can eat rose apple, apple, musambi, orange, and guava etc low calorie fruits. You can eat high calorie fruits in limited amounts. Dry fruits are strictly avoided. These may lead to obesity.
Protein-
Obese people should intake 0.8 – 1 gm protein/ kg IBW. Protein is needed for tissue repairing.
Fat-
Fat is strictly restricted especially saturated fat is avoided. Fried fatty foods should be avoided. It is better to avoid animal fat. Nut should be excluded from diet. It is better to use non – stick pan for cooking. It requires less amount of oil. 30 ml oil is better for health.
Vitamins-
For fat restriction there is found the lack of vitamin A and vitamin D. So, you can eat vitamin tablet for fulfill the requirement of vitamins. Requirement of vitamins can be fulfilled by eating vegetables and fruits.
Minerals-
Due to eating of less amount of food, there may be lack of minerals. Therefore you can eat multi - mineral tablet to fulfill the requirement of minerals. Sodium should be avoided because it can raise the body weight. Large amount of sodium retains the water in body that helps in raising the body weight.
Fibre-
High fibre diet should be given. You can eat vegetable salad, whole grains, fruits, vegetables. It helps to reduce blood cholesterol. Fibre rich foods are effective for constipation. Fibre rich foods give satiety.
water-
Water can be taken in adequate amount. It is better to drink 1 glass of water before taking the meal as it help in reducing the amount of food intake and also helps in improving digestion.
Dietary guidelines:
- The main way of reducing weight is to consume fewer calories than the actual requirement.
- Obese person should not consume sugar, sweets, cake, pastries, chocolate, alcohol, fried foods, dry fruits, cold drinks, jam, jelly, pickles etc.
- They should consume skimmed milk or double donned milk instead of high fat content milk.
- The diet should be high in fibre.
- Exercise is very effective way to reduce body fat. Exercise helps to increase muscle mass and also helps in reducing blood cholesterol, blood sugar, blood pressure, stress. It helps to live healthy. You can do morning walk or evening walk for 30 – 40 minutes daily. Swimming is very good for reducing calorie. Other exercise you can do by consulting with your doctor.
- Obese person should be encouraged to eat homemade low calorie food and not to eat processed foods.
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