Obesity
Obesity is a medical word that describes a level of overweight that can or is seriously affecting health.
Obesity has become a serious health problem in Australia with 65% of the population being overweight and up to 25% obese
The Body Mass Index (BMI) measurement is used to compare weight to height and is a good indicator of the degree to which an individual is overweight. A BMI of 18-25 is considered to be a healthy weight range. A BMI higher than this indicates that the individual is overweight and health may be at risk. The greater the degree of overweight, the greater the health risk posed. Once the BMI is over 30, risk to health is significant.
Individuals are considered obese if their BMI is 30 or greater.
BMI Calculator
Today up to one in five people are considered obese.
Obesity may cause or make worse many diseases. The risk of developing Type II diabetes for instance is 400% greater in obese people than the non obese.
Health Risks Associated with Obesity
- Diabetes
- Heart Disease and Stroke
- Sleep Apnoea
- High Blood Pressure
- Osteoarthritis
- Asthma
- Cancer
- Reflux
- Infertility
- High Cholesterol
- Depression
Obesity is now the single most important cause of preventable premature death. For individuals whose BMI is between 37 and 40, the risk of an early death is doubled compared to non-obese individuals.
Of course, obesity has significant impact on quality of life and just doing everyday things like using transport, buying clothes, playing with children or just getting around.
Why Does Obesity Happen?
It is now understood that obesity is not just the result of excess eating but a serious disease with many contributing factors.
Weight gain occurs when the amount of energy consumed (as food) is greater than the amount of energy expended (activity). Excess energy is stored in the body as fat. Eating high calorie foods or eating too much food and not exercising enough certainly sets one up for the possibility of becoming overweight.
This often leads people to feel that the reason for their weight problem is simply lack of discipline or laziness. After all, all you have to do is eat less and exercise more... Simple isn't it!
As anyone who has had a weight problem will tell you, it is incredibly frustrating when you try and try but just can’t seem to keep the weight off! It is easy to feel like a failure. It's easy to think "... but I should be able to do this!!"
It isn’t that simple! Obesity and overweight is a complex problem. Yes, discipline, good food choices and a healthy lifestyle are important as are social and psychological factors.
However, it is clear that there are biological and genetic factors that predispose people to being overweight and obese.
That is why obesity often runs in families. These genetic factors primarily control appetite and food intake but to some extent energy expenditure too. Basically, people with a genetic tendency toward obesity are able to eat large amounts of food before feeling full and often describe more hunger than non overweight people. Furthermore, when they lose weight, various hormonal changes occur all designed to increase appetite and put the weight back on.
This is why even when weight is lost through dieting or exercise, it is virtually always put back on – the so called yo yo effect.
Our modern society is such that food, often high energy food, is readily and cheaply available. Furthermore, at every turn modern technology means we have to do less and less physically. If you have the genes for obesity, this sort of environment makes it impossible to avoid weight gain. With these changes in our environment over the last decade, obesity has increased rapidly – the so called "obesity epidemic".
The following have been identified as important contributing factors in becoming overweight or obese
- Genetics – the genes inherited from your parents that affect appetite and metabolism
- Biological factors such as age, sex and hormonal status
- Behavioural patterns and habits related to eating
- Psychological factors affecting emotions, attitudes, beliefs and thought process related to food
- Environmental influences such as food availability and type and limited need for activity
- Medical conditions such an underactive thyroid gland
Treating Obesity – Diets & Exercise
Most people understand the benefits of healthy eating and regular exercise. Undoubtedly these are important for general well being. For anyone who has considered a weight loss program, there is certainly no shortage of choices. Most non-surgical weight loss programs are based on some combination of diet/behavior modification and regular exercise. Unfortunately, even the most effective interventions have proven to be effective for only a small percentage of patients.
However, rarely is it possible to reverse obesity through lifestyle measures alone. Research has shown that non-operative methods alone have not been effective in achieving significant long-term weight loss in severely obese adults.
The problem is that overweight and obesity is difficult to reverse. While a healthy diet and exercise can achieve weight loss initially, the real challenge is keeping the weight off.
Only 5% of people maintain any weight loss in the long term using diets or lifestyle changes.
Weight is regained, often more than before (the yo-yo effect) which is very frustrating and doesn't achieve any health benefits.
Non Surgical Treatment Options
The main non-surgical treatment options are:
- Diet and behaviour modification
- Exercise
- Over-the-counter & prescription drugs
In 2002, Australian researchers reviewed the effectiveness of treatments available for severe or 'morbid' obesity and concluded that surgery was the only effective option available at the time of the report.
Diet & Behaviour Modification
There are literally hundreds of weight loss diets available. Doctors who prescribe and supervise diets for their patients usually create a customized program with the goal of greatly restricting calorie intake while maintaining nutrition.
These diets fall into two basic categories:
Low-Calorie Diets (LCDs) are individually planned so that the patient takes in 500 to 1,000 fewer calories a day than he or she burns.
Very-Low-Calorie Diets (VLCDs) typically limit caloric intake to 400 to 800 a day and feature high-protein, low-fat liquids. Studies show that the long-term results of Very-Low-Calorie Diets (VLCDs) vary widely, but weight regain is common.
Behaviour modification uses therapy to help patients change their eating and exercise habits. Combining a Very-Low-Calorie Diet (VLCD) with behaviour therapy and physical activity may help increase weight loss and slow weight regain. In the long term, however, Very-Low-Calorie Diets (VLCDs) are no more effective than more modest dietary restrictions.
If diet and behaviour modifications have failed you and surgery is your next option, it is important to understand that diet and behaviour modification will be instrumental to sustained weight loss after your surgery. The surgery itself is only a tool to get your body started losing weight - complying with diet and behaviour modifications required by most surgeons would determine your ultimate success.
Exercise
Exercise is tremendously important in improving health and general well being. It has significant effects on blood sugar control, blood pressure as well as protection against heart and vascular disease.
Many people find it difficult to lose weight with exercise alone however. The problem is that exercise stimulates appetite and often body weight remains stable. In order to achieve weight loss, exercise must be combined with reduced calorie intake – something that is difficult to do.
Exercise is excellent for general health and fitness and is an important part of a healthy lifestyle as well as maintenance of weight and is to be highly encouraged. It should form part of any weight maintenance program, including surgery, but unfortunately it does not work well as a weight loss measure on its own.
Medication
There are various medications available to assist with weight loss. Some of these medications such as Xenical cause the body to absorb less fat from ingested food. Unfortunately, the way it works means that if you do consume fatty food whilst taking the medication, you are likely to experience side effects of abdominal cramping and diarrohea.
Other medications have a principal action on the brain to suppress the appetite. Medications such as Duromine or Reductil work in this way. They can be effective in increasing weight loss, especially when used in combination with lifestyle changes, however often have side effects on mood, irritability and disturbed sleep. They can also affect blood pressure and are contraindicated in patients with high blood pressure.
In general these medications are not recommended for use for greater than 12 months. When the medication stops, weight is usually regained since the appetite is "released" again.
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