Overweight or Obesity is possibly mother of all diseases of adult life. Obesity is a disease process which increases the risk of developing a number of other diseases of adult life like high blood pressure, ischaemic heart disease (angina & heart attacks), stroke (paralytic attacks), gall bladder disease, joint problems, sleep apnoea, respiratory problems, cancers of uterus, breast, large intestine and prostate, and even pancreatic malignancy. In fact there is a list of more than 30 diseases which obesity predisposes to.

"If a person looks fat, the person is fat". This is known as eyeball test. Obesity is usually easy to diagnose at first sight

Historically weight for height tables have been used to define normal weight range. A body weight 10-20% more than the desirable weight for height is considered as overweight and more than 20% above the desirable body weight is considered as obesity. However, these tables have their own limitations. Presently, there are three commonly used objective methods for estimating obesity in clinical practice.

BMI ( Body Mass Index )

Body Mass Index (BMI) = weight in kg / (height in metres)2.

A BMI of 18.5 – 23 kg/m2 is considered a good weight for most individuals. BMI is the most accepted unit for defining overweight. For Indians, overweight is defined as a BMI of 23 to 25 and obesity as a BMI of 25 or greater .

WHR ( Waist – Hip ratio )

WHR provides information about distribution of body fat.

Central Obesity is defined as a WHR > 0.95 in males and > 0.8 in females

Waist circumference (WC)

In men there is increased risk if the waist circumference is more than 90 cms and the risk is substantially increased if it is more than 102 cms. The corresponding figures for females are 80 cms and 88 cms. For Indians, WC values of more than 90cms for males and more than 80 cms for females are considered abnormal.

Body Fat Distribution:

Based on the WHR, obesity may be described as android type (central obesity or apple obesity) and the gynecoid type (Pear shape or gluteofemoral). Android type of obesity is associated with risk of serious complications such as heart disease, high blood pressure, diabetes, lipid or cholesterol problems, and cancers. On the other hand, gynecoid obesity renders a person more prone to mechanical problems such as varicose veins and joint disorders. For any level of overweight or obesity, the individuals with greater collection of central fat or visceral obesity (i.e. fat around stomach area/abdomen/liver) are at a higher risk of serious health problems associated with obesity.

Since MEN typically have excess weight in upper body and women in lower body, MEN rather than women should be targeted for weight reduction.

A number of genetic as well as environmental factors including cultural, socio-economic, behavioral factors play an important role in causation of obesity. Most obesity is primary, and no obvious factor for its causation exists other than imbalance in energy intake and expenditure.

A common misconception is that obesity is caused by overeating and reducing food intake is the key to weight loss. A more realistic concept is that weight control is a matter of energy balance. When energy expenditure is less than the energy intake, the result will be weight gain.

Based on this concept, the goal in weight loss should be to work out a comfortable level of exercise and adjust the energy intake to be less than energy expenditure.

Obesity is a chronic disease which increases the risk of a number of diseases of adult life. The risks associated with overweight were well recognized even during the time of Hippocrates. Omar Khayyam, noted Persian physician & philosopher mentioned in his writings "fat people may die happy, nevertheless they die younger".

Despite the established association between obesity and a number of chronic conditions, little recognition has been given to obesity itself as chronic disease. On the contrary, obesity was traditionally believed to be associated with affluent lifestyles in the west. In India, overweight has long been considered as a sign of prosperity. Hence, most of the overweight persons do not care to consult their physicians unless they develop some co-morbid problem or they are told about their obesity by a physician during a visit at his clinic for an unrelated illness.

The physicians consider obesity more like a subacute or insignificant illness which generally results from overeating and lack of physical activity on the part of an individual, only causes some disfigurement of physique of an individual and will respond to a time limited course of treatment and eventually be cured. Also, even after weight loss the patients tend to regain weight, and like diabetes and hypertension, obesity also worsens after the active therapy is stopped. Reversal of high BP or hyperglycemia after stopping the treatment is not considered to be treatment failure, but regaining weight in similar situation is considered as a therapeutic failure in cases of obesity. Also, patients are not blamed for their diabetes or hypertension (High blood pressure), they are blamed for their obesity.

Hence, obesity should be recognized as a chronic disease of multifactorial origin. Considering obesity as a chronic disease has multiple benefits. It removes the stigma associated by obesity, recognizes it as a heterogenous disorder which like hypertension needs to be treated for life, and encourages the physicians and their patients to set realistic goals for weight loss.

Obesity or overweight increases the risk of developing a number of other diseases of adult life like high blood pressure, ischaemic heart disease (angina & heart attacks), stroke (paralytic attacks), gall bladder disease, joint problems, sleep apnoea, respiratory problems, cancers of uterus, breast, large intestine and prostate, and even pancreatic malignancy. In fact there is a list of more than 30 diseases which obesity predisposes to. Even in children with overweight, there is increased risk of developing high blood pressure, high cholesterol levels, early onset of adult type diabetes (Type 2), and of course the psychosocial probems associated with overweight. And losing weight is associated with positive effects on all these illnesses.

Since obesity results from the interaction between a number of risk factors, ideal treatment of an obese patient is based on a multidisciplinary team approach. The team includes a physician, a nurse, nutritionist, psychologist, and exercise physiologist, and a surgeon may be required if nothing works. Various treatment modalities applied for weight reduction include diet regulation, behaviour modification, prescribed exercises, medication, management of complications, and surgery as the last resort.

The management of obesity consists of reduction in calorie intake and dietary modifications, increasing the physical activity, behavior therapy, medically approved drug therapy, and if nothing works surgical management.

It is one of the most important questions which props up in one’s mind before planning for weight loss. And the very thought of trying to achieve ideal body weight appears to be a herculian task leading to demotivation even before starting the weight loss attmpt. But the important thing to remember is that you do not need to achieve or even target the ideal body weight. Losing only 5-10% of your current body weight is sufficient to give you all the health benefits you are looking for.

Well, the answer is a big YES. Losing only 5-10% of your current body weight is not only sufficient to achieve health benefits but is also a realistic and practical target for weight reduction. A modest reduction in body weight of 5-10% is associated with reduction in the risk of diabetes, high blood pressure, angina & heart attacks, improvement in good cholesterol & reduction in bad cholesterol levels, improvement in exercise capacity, better cardio respiratory fitness, and improvement in self confidence.

A weight reduction of 5-10% may not be sufficient to get back a perfect body figure and looks, but it certainly improves your cosmetic appeal to a great extent. And for sure, a healthier individual always looks better than an unhealthy one.

The best strategy to lose weight is to look at multiple factors related to energy balance and correct them. As mentioned earlier, scientific approach to weight loss includes dietary interventions to reduce caloric intake, increasing physical activity, and some medications to help weight loss. Once patient has achieved weight loss, next step is to focus of weight maintenance.