Obesity

WHAT IS OBESITY?

It is a chronic condition defined by an accumulation of excess amount of body fat, to an extent that may impair health. A certain amount of body fat is necessary for storing energy, heat insulation, shock absorption, and other functions. The normal amount of body fat (expressed as percentage of body fat) is between 25-30% in women and 18-23% in men. Women with over 30% body fat and men with over 25% body fat are considered obese.

What are the reasons for obesity?

Individual diet and lifestyle are the 2 basic causes for obesity. The balance between calorie intake and energy expenditure determines a person’s weight. If a person eats more calories than he or she burns, the person gains weight (the body will store the excess energy as fat). If a person eats fewer calories than he or she burns, he or she will lose weight. Therefore the most common causes of obesity are overeating and physical inactivity.

There are many factors that contribute to obesity and individuals genetic make up also plays a major role in this. These factors are:

• GENETICS
  A person is more likely to be obese if one or both parents are overweight / obese. Genetics also affect hormones involved in fat regulation. For example, one genetic cause of obesity is leptin deficiency. Leptin is a hormone produced in fat cells, and also in the placenta. Leptin controls weight by signaling the brain to eat less when body fat stores are too high. If, for some reason the body cannot produce enough leptin, or leptin cannot signal the brain to eat less, this control is lost, and obesity occurs. The role of leptin replacement as a treatment for obesity is currently being explored.
• OVER-EATING
  An individuals diet pattern effects his weight directly. Overeating leads to weight gain, especially if the diet is high in fat. Foods high in fat or sugar (e.g., fast food, fried food and sweets,) have high energy density (foods that have a lot of calories in small amount of food). Epidemiology studies have shown that diets high in fat contribute to weight gain.




• CHOICE OF FOOD
  Food items rich in carbohydrates are also known to lead to obesity. The role of carbohydrates in weight gain is not clear. Carbohydrates increase blood glucose levels, which in turn stimulate insulin release by the pancreas, and insulin promotes the growth of fat tissue and can cause weight gain. Some scientists believe that simple carbohydrates (sugars, fructose, desserts, soft drinks, beer, wine, etc.) contribute to weight gain because they are more rapidly absorbed into the blood stream than complex carbohydrates (pasta, brown rice, grains, vegetables, raw fruits, etc.) and thus cause a more pronounced insulin release after meals than complex carbohydrates. This higher insulin release, some scientists believe, contribute to weight gain.
• FREQUENCY OF EATING
  The relationship between frequency of eating (how often you eat) and weight is somewhat controversial. There are many reports of overweight people eating less often than people with normal weight. Scientists have observed that people who eat small meals four or five times daily, have lower cholesterol levels and lower and/or more stable blood sugar levels than people who eat less frequently (two or three) large meals daily. One possible explanation is that small frequent meals produce stable insulin levels, whereas large meals cause large spikes of insulin after meals.




• SLOW METABOLISM
  Women have less muscle than men. Muscle burns more calories than other tissue (which includes fat). As a result, women have a slower metabolism than men, and hence, have a tendency to put on more weight than men, and weight loss is more difficult for women. As we age, we tend to lose muscle and our metabolism slows, therefore, we tend to gain weight as we get older particularly if we do not reduce our daily caloric intake.
• LIFE STYLES
  Sedentary people burn fewer calories than people who are active. Physical inactivity is strongly correlated with weight gain in both sexes.
• MEDICATIONS
  Medications associated with weight gain include certain antidepressants (medications used in treating depression), anti-convulsants (medications used in controlling seizures), diabetes medications (medications used in lowering blood sugar), certain hormones such as oral contraceptives and most corticosteroids. Weight gain may also be seen with some high blood pressure medications and antihistamines.




• PSYCHOLOGICAL FACTORS
  For some people, emotions influence eating habits. Many people eat excessively in response to emotions such as boredom, sadness, high stress or anger. While most overweight people have no more psychological disturbances than normal weight people, about 30 percent of the people who seek treatment for serious weight problems have difficulties with binge eating.
• DISEASES
  Some diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome and Cushing’s syndrome are also contributors to obesity.

WHAT IS THE EFFECT OF LOCATION OF FAT STORAGE IN THE BODY?

The effect of obesity on individual health is dependant not only at how much fat a person has but also where that fat is located on the body. The pattern of body fat distribution tends to differ in men and women.

PEAR SHAPE BODY
Women typically collect fat in their hips and buttocks, giving their figures a “pear” shape.

APPLE SHAPE BODY
Men usually collect fat around the belly, giving them more of an “apple” shape.
This is not a hard and fast rule, some men are pear-shaped and some women become apple-shaped, particularly after menopause.

Apple-shaped people whose fat is concentrated mostly in the abdomen are more likely to develop many of the health problems associated with obesity. They are at increased health risk because of their fat distribution. While obesity of any kind is a health risk, it is better to be a pear than an apple.

WAIST TO HIP RATIO
In order to identify your body type, doctors have developed a simple way to determine whether someone is an apple or a pear. The measurement is called waist-to-hip ratio. To find out a person’s waist-to-hip ratio, measure the waist at its narrowest point, and then measure the hips at the widest point. Divide the waist measurement by the hip measurement. For example, a woman with a 35-inch waist and 46-inch hips would have a waist-to-hip ratio of 0.76 (35 divided by 46 = 0.76).

Women with waist-to-hip ratios of more than 0.8 and men with waist-to-hip ratios of more than 1.0 are “apples.”

Another rough way of estimating the amount of a person’s abdominal fat is by measuring the waist circumference. Men with waist circumference of 40 inches or greater and women with waist circumference of 35 inches or greater are considered to have increased health risks related to obesity.

ARE HEIGHT TO WEIGHT RATIO TABLES A CORRECT GUIDE TO IDENTIFY OBESITY?

Weight of an individual is dependent on a series of factors like ethnic origin, sex, age, body structure etc. thus there is no exact scale to assess your ideal body weight. Various scales for height-weight calculations can only be taken as guidelines. Measuring a person’s body fat percentage can be difficult; therefore, other methods are relied on to diagnose obesity. Two widely used methods are:

1. Weight-for-height tables;
2. Body mass index (BMI).

While both measurements have their limitations, they are reasonable indicators that someone may have a weight problem. The calculations are easy, and no special equipment is required.

WEIGHT FOR HEIGHT TABLES

Most people are familiar with this table. Doctors and nurses (and many others) have used these tables for decades to determine if someone is overweight. The tables usually have a range of acceptable weights for a person of a given height.One such scale is listed below. You should consult your physician for your height- weight ratio

STANDARD HEIGHT AND WEIGHT FOR MEN AND WOMEN
Sr.No.	Height in Feet	Height in Meters	Weight in Kgs. MEN	Weight in Kgs. WOMEN
1.	5 Ft 0 IN	1.523 Mtr	50.8 – 54.4	50.8 – 54.4
2.	5 Ft 1 IN	1.548 Mtr	51.7 – 55.3	51.7 – 55.3
3.	5 Ft 2 IN	1.574 Mtr	56.3 – 60.3	53.1 – 56.7
4.	5 Ft 3 IN	1.599 Mtr	57.6 – 61.7	54.4 – 58.1
5.	5 Ft 4 IN	1.624 Mtr	58.9 – 63.5	56.3 – 59.9
6.	5 Ft 5 IN	1.650 Mtr	60.8 – 65.3	57.6 – 61.2
7.	5 Ft 6 IN	1.675 Mtr	62.2 – 66.7	58.9 – 63.5
8.	5 Ft 7 IN	1.700 Mtr	64.0 – 68.5	60.8 – 65.3
9.	5 Ft 8 IN	1.726 Mtr	65.8 – 70.8	62.2 – 66.7
10.	5 Ft 9 IN	1.751 Mtr	67.6 – 72.6	64.0 – 68.5
11.	5 Ft 10 IN	1.777 Mtr	69.4 – 74.4	65.8 – 70.3
12.	5 Ft 11 IN	1.802  Mtr	71.2 – 76.2	67.1 – 71.7
13.	6 Ft 0 IN	1.827 Mtr	73.0 – 78.5	68.5 – 73.9
14.	6 Ft 1 IN	1.853 Mtr	73.3 – 80.7	73.3 – 80.7
15.	6 Ft 2 IN	1.878 Mtr	77.6 – 83.5	77.6 – 83.5
16.	6 Ft 3 IN	1.904 Mtr	79.8 – 85.9	79.8 – 85.9

One small problem with using weight-for-height tables is that doctors disagree over which is the best table to use. Several versions are available. Many have different weight ranges, and some tables account for a person’s frame size, age and sex, while other tables do not.

A grave limitation of all weight-for-height tables is that they do not distinguish between excess fat and muscle. A very muscular person may appear obese, according to the tables, when he or she in fact is not.

WHAT IS BODY MASS INDEX (BMI)?

BMI or Body Mass Index is a guide to assess the height weight ratio to identify obesity.  BMI or Quetelet Index is a quotient of body mass which takes into account both height and weight measured as kg/m2. It is used as a simple means of classifying sedentary individuals into groups in relation to their body mass. It was originally developed between 1830 and 1850 by the Belgian polymath, Adolphe Quetelet during the course of developing “social physics”. Despite its age, BMI is still used today by government health bodies to see trends in health and illness.

It is at best a crude population measure of excess fat. The BMI uses a mathematical formula that accounts for both a person’s weight and height. The BMI equals a person’s weight in kilograms divided by height in meters squared (BMI=kg/m2).  WHO defines overweight as a BMI of 25 or more, and obesity as a BMI of 30 or more. These cut-off points can provide a reference for individual assessment.

The BMI measurement however, poses some of the same problems as the weight-for-height tables.

• Not everyone agrees on the cutoff points for “healthy” versus “unhealthy” BMI ranges.
• BMI also does not provide information on a person’s percentage of body fat.
• It may not be an accurate measurement of body fat for body builders, certain athletes, and pregnant women.

However, like the weight-for-height table, BMI is a useful general guideline and is a good estimator of body fat for most adults between the ages of 19 and 70 years of age.

It is important to understand what “healthy weight” means. Healthy weight is defined as a body mass index (BMI) equal to or greater than 19 and less than 25 among all people aged 20 or over.

Generally, obesity is defined as a body mass index (BMI) equal to or greater than 30. Excess weight also places people at risk of developing serious health problems.

The table below has already done the math and metric conversions. To use the table, find the appropriate height in the left-hand column. Move across the row to the given weight. The number at the top of the column is the BMI for that height and weight.

BMI (kg/m2)	19	20	21	22	23	24	25	26	27	28	29	30	35	40
Height (in.)	Weight (lb.) (1Kg=2.2lb)
58	91	96	100	105	110	115	119	124	129	134	138	143	167	191
59	94	99	104	109	114	119	124	128	133	138	143	148	173	198
60	97	102	107	112	118	123	128	133	138	143	148	153	179	204
61	100	106	111	116	122	127	132	137	143	148	153	158	185	211
62	104	109	115	120	126	131	136	142	147	153	158	164	191	218
63	107	113	118	124	130	135	141	146	152	158	163	169	197	225
64	110	116	122	128	134	140	145	151	157	163	169	174	204	232
65	114	120	126	132	138	144	150	156	162	168	174	180	210	240
66	118	124	130	136	142	148	155	161	167	173	179	186	216	247
67	121	127	134	140	146	153	159	166	172	178	185	191	223	255
68	125	131	138	144	151	158	164	171	177	184	190	197	230	262
69	128	135	142	149	155	162	169	176	182	189	196	203	236	270
70	132	139	146	153	160	167	174	181	188	195	202	207	243	278
71	136	143	150	157	165	172	179	186	193	200	208	215	250	286
72	140	147	154	162	169	177	184	191	199	206	213	221	258	294
73	144	151	159	166	174	182	189	197	204	212	219	227	265	302
74	148	155	163	171	179	186	194	202	210	218	225	233	272	311
75	152	160	168	176	184	192	200	208	216	224	232	240	279	319
76	156	164	172	180	189	197	205	213	221	230	238	246	287	328

Body weight in pounds according to height and body mass index.

There is also evidence that, on a population level, the risk of chronic disease increases progressively as average BMI increases above 21. A high body mass index is a major risk factor for a number of chronic diseases, including cardiovascular diseases, cancer and diabetes.

WHAT IS THE DIFFERENCE BETWEEN BEING OVERWEIGHT AND BEING OBESE?

Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems.

For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the “body mass index” (BMI).

• An adult who has a BMI between 25 and 29.9 is considered overweight.
• An adult who has a BMI of 30 or higher is considered obese

It is important to remember that although BMI correlates with the amount of body fat, BMI does not directly measure body fat. As a result, some people, such as athletes, may have a BMI that identifies them as overweight even though they do not have excess body fat.

For children and teens, BMI ranges above a normal weight have different labels (at risk of overweight and overweight). Additionally, BMI ranges for children and teens are defined so that they take into account normal differences in body fat between boys and girls and differences in body fat at various ages.

WHAT ARE ESSENTIAL VITAMINS AND WHAT ARE THE IDEAL SOURCES FOR THE SAME?

Nutrients for which reliable data are available directly from experiments conducted with older persons have been reviewed. Wherever possible, the recommendations that follow take into consideration not only the amount of a nutrient required to prevent a deficiency state but also a chronic disease. Additional studies are needed to determine the appropriate level of essential nutrients to maintain optimal immune response and to reduce the burden of disease.

LIST OF VITAMINS AND THE FOODS PROVIDING THE SAME —

S.NO		NUTRIENTS	QUANTITY		COMMENTS		AVAILABLE IN
1.		Energy	1.4–1.8 multiples of the basal metabolic rate (BMR)		to maintain body weight at different levels of physical activity.		Fat, carbohydrates etc.
2.		Calcium	800–1200 mg/day (in the presence of adequate vitamin D nutrition)		Reduced  fracture rates, beneficial for bone mineral density of the femur, neck and lumbar spine. Prevents osteoporosis.		Juices, soy milk, rice milk, tofu and cereals; a variety of herbs, spices, and seaweeds. Examples include basil, chervil, cinnamon, dill weed, fennel, fenugreek, ginseng, kelp, marjoram, oregano, parsley, poppy seed, sage, and savory.
3.		Copper	1.3–1.5 mg/day		Should be adequate for older persons.		turnip greens and molasses, chard, spinach, sesame seeds, mustard greens, cashews, peppermint,  tomatoes,  sunflower seeds, ginger, green beans and potato.
4.		Chromium	50 µg/day		Should achieve chromium balance in older persons.		Romaine lettuce, onions and tomatoes as also brewer’s yeast, oysters, liver, whole grains, bran cereals, and potatoes.
5.		Fat	30% in sedentary older persons and 35% for active older persons		Consumption of saturated fats should be minimized and not exceed 8% of energy.		Butter, oils etc.
6.		Folate	400 g/day		Results in healthy homocysteine levels.		Excellent sources of folate include spinach, asparagus, turnip greens, mustard greens, calf’s liver, parsley, collard greens, broccoli, cauliflower, beets and lentils.
7.		Iron	10 mg/day		Adequate for older men and women assuming there are no excessive iron losses.		Chard, spinach, thyme, turmeric, tofu,  mustard greens, turnip greens, string beans, shiitake mushrooms, lentils, sprouts, broccoli, leeks, and  kelp.
8.		Magnesium	225–280 mg/day		Dietary intakes sufficient for individuals over the age of 65.		Excellent sources of magnesium include Swiss chard and spinach, mustard greens, summer squash, broccoli, blackstrap molasses, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale and a variety of seeds, including sunflower seed, sesame seeds, and flax seeds.
9.		Protein	0.9–1.1 g/kg per day		Beneficial for healthy older persons.		Excellent sources of protein include tuna, shrimp, eggs, dairy foods, fish and poultry. Vegetarians can obtain essential amino acids from beans, grains, nuts, seeds, tofu, mustard greens, mushrooms, soybeans and cheese.
10.		Riboflavin	1.3 mg for men and for 1.1 mg for women.		A riboflavin requirement for older persons is the same as for the young. Deficiency results in soreness of tongue & fissures at angles of the mouth.		Milk & milk products, eggs, liver, pulses and greens, mushrooms, calf liver, spinach spelt, romaine lettuce, asparagus, chard, mustard greens,  broccoli, collard greens, turnip greens, chicken, eggs, yogurt and cow’s milk..
11.		Selenium	50–70 g/day				Grown or raised under ideal soil conditions, however,  button mushrooms, shiitake mushrooms, cod,  shrimp, tuna, halibut, calf’s liver, and salmon, chicken’s eggs, lamb, barley, sunflower seeds, turkey, mustard seeds, and oats.
12.		Vitamin A	600–700 mg retinol equivalents/day		Deficiency results in poor vision		Papaya, mango, tomato, greens & all yellow vegetables and shark fish liver oil
13.		Vitamin B12	2.5 mg/day		either from a vitamin B12 supplement or foods fortified with vitamin B12.		Very good sources of vitamin B12 include venison, shrimp, scallops, salmon, and beef. Within the plant world, sea plants (like kelp), algae’s (like blue-green algae), yeasts (like brewer’s yeast), and fermented plant foods (like tempeh, miso, or tofu) are the most commonly consumed food sources of vitamin B12, although none of these plant foods can be counted on to be a consistently excellent or very good source of the vitamin.
14.		Vitamin C	60–100 mg/ Day		Requirements for vitamin C are the same as for younger people. Deficiency results in Scurvy (bleeding gums)		Grapes, oranges, lime, tomato, gooseberry, greens, fresh vegetables, broccoli, bell peppers, kale, cauliflower, strawberries, lemons, mustard and turnip greens, brussels sprouts, papaya, chard, cabbage, spinach, kiwifruit, snow peas,  cantaloupe, oranges, grapefruit, limes, tomatoes, zucchini, raspberries, asparagus, celery, pineapples, lettuce, watermelon, fennel, peppermint and parsley.
15.		Vitamin D	10–15 g/day		Essential for optimal bone health in older persons.		Salmon, sardines, shrimp, vitamin-D fortified milk, cod and eggs.
16.		Vitamin E	100–400 IU/day		Reduces recurrent cardiovascular disease. Deficiency results in skin and aging problems		Soybean & sunflower oils; whole grains and nuts, mustard greens, turnip greens, chard, sunflower seeds, almonds, spinach, collard greens, parsley, kale,  papaya, olives, bell copper, brussels sprouts, kiwifruit, tomato, blueberries and broccoli.
17.		Vitamin K	60–90 mg/day		an adequate intake for older persons		Spinach, Brussels sprouts, Swiss chard, green beans, asparagus, broccoli, kale, mustard greens, green peas and carrots.
18.		Zinc	For aged over 65 High Zn availability (50+%) Men 4.2 mg/day Women 3.0 mg/day Moderate Zn availability (30%) Men 7.0 mg/day Women 4.9 mg/day Low Zn availability (15%) Men 14.0 mg/day Women 9.8 mg/day				Calf’s liver, crimini mushrooms, spinach sea vegetables, basil,  thyme, spinach, pumpkin seeds, yeast, beef, lamb, summer squash, asparagus, venison,  chard, collard greens, shrimp, maple syrup, broccoli, peas, yogurt, sesame seeds and mustard greens.
19.		Niacin (Vitamin-B3)	16 milligrams				Mushrooms, tuna, halibut, asparagus, sea vegetables, venison, chicken, and salmon.
20.		Thiamin	1.2 mgms				Asparagus, romaine lettuce, mushrooms, spinach, sunflower seeds, tuna, green peas, tomatoes, eggplant and Brussels sprouts.

HOW DOES BEING OVERWEIGHT OR OBESE AFFECT A PERSON’S HEALTH?

Obesity is not just a cosmetic consideration; it is a dire health condition directly harmful to one’s health. Large number of deaths all over the world, per year, are directly related to obesity, and more than 80% of these deaths are in patients with a BMI over 30. Obesity also increases the risk of developing a number of chronic diseases including:

• INSULIN RESISTANCE (IR)- Insulin is necessary for the transport of blood sugar into the cells of muscle and fat (which is then used for energy). By transporting glucose into cells, insulin keeps the blood glucose levels in the normal range. Insulin resistance (IR) is the condition whereby the effectiveness of insulin in transporting glucose (sugar) into cells is diminished. Fat cells are more insulin resistant than muscle cells; therefore, one important cause of IR is obesity. The pancreas initially responds to IR by producing more insulin. As long as the pancreas can produce enough insulin to overcome this resistance, blood glucose levels remain normal. This IR state (characterized by normal blood glucose levels and high insulin levels) can last years. Once the pancreas can no longer keep up with producing high levels of insulin, blood glucose levels begin to rise, resulting in type 2 diabetes, thus IR is a pre-diabetes condition. Atherosclerosis (hardening of the arteries) associated with diabetes also develops during this IR period.
• DIABETES MELLITUS- The risk of type 2 diabetes increases with the degree and duration of obesity. Type 2 diabetes is associated with central obesity (apple shape body); a person with central obesity has excess fat around his/her waist, so that the body is shaped like an apple.
• HYPERTENSION- High blood pressure or Hypertension is common among obese adults. Weight gain tends to increase blood pressure in women more significantly than in men. The risk of developing high blood pressure is also higher in obese people who are apple shaped (central obesity) than in people who are pear shaped (fat distribution mainly in hips and thighs).
• HIGH CHOLESTEROL (hypercholesterolemia)- High BMI implies excess fat in the body and this increases the risk of high cholesterol levels.
• STROKE (cerebrovascular accident or CVA)
• HEART ATTACK (CORONARY ARTERY DISEASE)- The risk of developing coronary artery disease increased 3 to 4 times in women who had a BMI greater than 29. For every one kilogram (2.2 pounds) increase in body weight, the risk of death from coronary artery disease increased by one percent. In patients who have already had a heart attack, obesity is associated with an increased likelihood of a second heart attack.
• CONGESTIVE HEART FAILURE.
• CANCER-While not conclusively proven, some observational studies have linked obesity to cancer of the colon in men and women, cancer of the rectum and prostate in men, and cancer of the gallbladder and uterus in women. Obesity may also be associated with breast cancer, particularly in postmenopausal women. Fat tissue is important in the production of estrogen, and prolonged exposure to high levels of estrogen increases the risk of breast cancer.
• GALLBLADDER DISEASE &GALLSTONES
• GOUT AND ARTHRITIS- Obesity directly impacts the bones and stress due to this causes Gout and Arthritis.
• OSTEOARTHRITIS- Degenerative arthritis of the knees, hips, and the lower back.
• SLEEP APNEA AND RESPIRATORY PROBLEMS- Excess fat around the larynx causes acute breathing difficulties in obese people and results in interrupted breathing and may even result in death in extreme cases.

TABLE IDENTIFYING THE RISK OF ASSOCIATED DISEASE ACCORDING TO BMI AND WAIST SIZE.

BMI	Category	Waist less than or equal to 40 in. (men) or 35 in. (women)	Waist greater than 40 in. (men) or 35 in. (women)	Comments
18.5 or less	Underweight	N/A	N/A	You must be starving. Find some food!!!
18.5 – 24.9	Normal	N/A	N/A	I envy you. Keep it up.
25.0 – 29.9	Overweight	Increased Risk	High Risk	Need Dieting and Exercise
30.0 – 34.9	Obese	High Risk	Very High Risk	Must Work-out & Diet.
35.0 – 39.9	Obese	Very High Risk	Very High Risk	Must Work-out & Diet.
40 or greater	Extremely Obese	Extremely High Risk	Extremely High Risk	Consult your Physician. You need to Work-out and Diet

The more overweight a person is, the more likely that person is to have health problems. Among people who are overweight and obese, weight loss can help reduce the chances of developing these health problems. Studies show that if a person is overweight or obese, reducing body weight by 5 percent to 10 percent can improve one’s health.

WHAT CAN I DO ABOUT MY EXCESS BODY WEIGHT?

Most of the times obese people tend to aim to reach the ideal body weight condition. Some amount of weight loss is invariably achieved but this returns in about 3-5 years time. It is seen that 95% people tend to regain the weight lost. It is clear that a more effective, long-lasting treatment for obesity must be found, lest obesity lead to oblivion.

We need to learn more about the causes of obesity, and then we need to change the ways we treat it. When obesity is accepted as a chronic disease, it will be treated like other chronic diseases such as diabetes and high blood pressure. The treatment of obesity cannot be a short-term “fix,” but has to be an ongoing life-long process.

Instead of staring nearsightedly at the goal of attaining an “ideal weight,” obesity treatment must acknowledge that even modest weight loss can be beneficial. For example, a modest weight loss of 5 to 10% of the initial weight and long-term maintenance of that weight loss can bring significant health gains.

It is not necessary to achieve an “ideal weight” to derive health benefits from obesity treatment. Instead, the goal of treatment should be to reach and hold to a “healthier weight”. The emphasis of treatment should be to commit to the process of life-long healthy living including eating more wisely and increasing physical activity.

Here are some steps that you can take to reduce your weight:

1. Write down the details of what you eat and how much you eat. That way you will know your total average calorie intake and help in identifying which food to avoid and which food has to be eaten less.
2. Weigh yourself everyday and maintain a chart.
3. Sit down and eat your food patiently while chewing properly.
4. Food should be eaten in small quantities and slowly.
5. Drink plenty of water especially before the meals and during the day.
6. Do not eat left-overs because they may be wasted.
7. Physical exercise and mental activity is very essential.
8. Preferably do not eat alone- Older people tend to eat more when they are lonely.

WHAT IS THE ROLE OF DIET IN MANAGING / CONTROLLING OBESITY?

Weight gain is the direct result of excess input to less output- Input is what we eat and output is the calories burnt (used) by the on a daily basis. In any weight loss plan it is important to set realistic and achievable goals.

1. The first goal of dieting is to stop further weight gain.
2. The next goal is to establish realistic weight loss goals.
3. Recognise achievement of each goal.
4. Reevaluate your goals after brief intervals

While the ideal weight is a BMI of 20-25, this is difficult to achieve for many people. Thus success is higher when a goal is set to lose 10% to15% of baseline weight as opposed to 20% to 30% or higher. It is also important to remember that any weight reduction in an obese person would result in health benefits.

One effective way to lose weight is to eat fewer calories. One pound is equal to 3500 calories. In other words, you have to burn 3500 more calories than you take-in to lose one pound. Most adults need between 1200- 2800 calories/day-depending on body size & activity level to meet the body’s energy needs.

If you skip that bowl of ice cream, then you will be one-seventh of the way to losing that pound! Losing one pound per week is a safe & reasonable way to get off those extra pounds. The higher the initial weight of a person, the more quickly he/she will achieve weight loss.

For every one-kilogram (2.2 pounds) of body weight, approximately 22 calories are required to maintain that weight. So for a person weighing 100 kilograms (220 pounds), he or she would require about 2200 calories a day to maintain his or her weight while a person weighing 60 kilograms (132 pounds) would require only about 1320 calories. If both ate a calorie-restricted diet of 1200 calories per day, the heavier person would loose weight faster. Age also is a factor in calorie expenditure. Metabolic rate tends to slow as we age, so the older a person is, the harder it is to lose weight.

There is controversy in regard to carbohydrates and weight loss. When carbohydrates are restricted, people often experience rapid initial weight loss within the first two weeks. This weight loss is due mainly to fluid loss. When carbohydrates are added back to the diet, weight gain often occurs, simply due to a regain of the fluid.

WHAT FOOD ITEMS SHOULD BE TAKEN / AVOIDED TO LOSE WEIGHT?

FOOD ITEMS TO BE AVOIDED

FOOD ITEMS TO BE TAKEN

Starchy root items like potato, tapioca, yam etc. Nuts and oilseeds e.g. ground nuts, cashew nuts, coconut, pistachio, almonds etc. Meat products especially red meat like mutton, liver, brain, crabs, prawns, egg-yolk etc. Saturated milk and milk products like whole milk, butter, butter oil, cream, cheese, curds made from whole milk, milk sweets, ice creams etc. Sweets, soft drinks (colas), puddings / desserts, chocolates, cakes etc. Fried foods. Preserved foods containing preservatives and dry fruits. Alcohol except in moderate quantity (not more than 60 ml a day)

Low fat milk Low fat Yoghurt Cereals high in fibre content- oats, muesli Fruits Salads Poha Stuffed roti’s without oil (vegetables, paneer ) Home made soups Sprouts Vegetables Baked and Grilled Chicken/fish/meat Fresh fruit juices Roasted Namkeens

WHAT STEPS SHOULD I TAKE TO MAINTAIN A HEALTHY WEIGHT?

Controlling obesity and maintaining a balanced body weight is not only essential to look good but also to be healthy. It does not take much effort but a lot of determination to be healthy.

A safe and effective long-term weight reduction and maintenance strategy has to be based on:

1. Determination.
2. Education about diet and calorific value of various foods.
3. Regular monitoring.
4. Exercise and self control.

To retain a healthy weight it is essential to have balanced, nutritious foods to avoid vitamin deficiencies and other diseases of malnutrition.

1. Eat foods that have “low energy density.” Low energy dense foods contain relatively few calories per unit weight (fewer calories in a large amount of food). Examples of low energy dense foods include vegetables, fruits, lean meat, fish, grains, and beans. For example, you can eat a large volume of celery or carrots without taking in many calories.
2. Consume less “energy dense foods.” Energy dense foods are high in fats and simple sugars. They generally have a high calorie value in a small amount of food.
3. It is recommended that a healthy diet should have less than 30% fat. Fat contains twice as many calories per unit weight than protein or carbohydrates. Examples of high-energy dense foods include red meat, egg yolks, fried foods, high fat/sugar fast foods, sweets, pastries, butter, and high fat salad dressings.
4. Cut down on foods that provide calories but very little nutrition, such as alcohol, non-diet soft drinks and many packaged high calorie snack foods.
5. About 55% of calories in the diet should be from complex carbohydrates. Eat more complex carbohydrates such as brown rice, whole-grain bread, fruits and vegetables.
6. Avoid simple carbohydrates such as table sugars, sweets, doughnuts, cakes, and muffins. Cut down on non-diet soft drinks-these sugary soft drinks are loaded with simple carbohydrates and calories. Simple carbohydrates cause excessive insulin release by the pancreas, and insulin promotes growth of fat tissue.
7. Educate yourself in reading food labels, estimating calories and serving sizes.
8. Consult your doctor before starting any dietary changes. Your doctor should prescribe the amount of daily calories in your diet.