Friday 19 / April / 2024
Obesity is a growing worldwide problem with magnitude bigger than any other disease. The World Health Organisation (WHO) predicts that more than 2.3 billion adults worldwide are overweight, and more than 700 million are obese. Obesity is measured as BMI (body mass index), waist circumference and BMI chart for children up to 18 years of age. BMI can be calculated by dividing body weight (in kg) by square of height (in metre). Obesity with BMI (>30kg/m2) increases the risk of conditions such as type 2 diabetes, high blood pressure, cardiac diseases, high cholesterol, fatty liver disease, gallstones, and gastro-oesophageal reflux disease, as well as psychological and psychiatric morbidities.
Causes of obesity in adults, children and adolescents:
• Underling disease – Diabetes, hypothyroidism, endocrine diseases, cardiovascular disease, hyperinsulinemia, osteoarthritis, dyslipidemia, and sleep apnoea.
• Ethnic and socioeconomic backgrounds.
• Eating behaviour, patterns and physical activity levels.
• Lifestyle, beliefs about eating.
• Reluctance of person to adopt changes and confidence in making changes.
• Psychosocial distress, self-esteem, teasing, and bullying.
• Environmental, social, and family factors, including family history of overweight and obesity, and comorbidities.
• Medical problems and medication.
• Growth and pubertal changes.
Measuring obesity
Adults and BMI
Different weight classes are defined based on a person’s body mass index (BMI):
• Healthy weight: 18.5-24.9kg/m2
• Overweight: 25-29.9kg/m2
• Obesity I: 30-34.9kg/m2
• Obesity II: 35-39.9kg/m2
• Obesity III: 40kg/m2 or more.
Adults and waist circumference
For men, waist circumference of less than 94cm is low; 94-102cm is high and more than 102cm is very high. For women, waist circumference of less than 80cm is low, 80-88cm is high and more than 88cm is very high.
Children
Obesity low: Children with a BMI ≥ 91 percentile.
Obesity high: Children with a BMI ≥ 98 percentile.
Obesity management approach
• Make goal directed approach with realistic goals to be achieved within time frame.
• Self-monitoring of behaviour and progress of weight, eating and physical activity with stimulus control, and goal setting.
• Ensuring social support with problem solving in advanced healthcare facility with experienced specialists adopting strategies for dealing with weight regain.
• Assertiveness and cognitive restructuring (modifying thoughts) by self and specialist doctor as needed for reinforcement of changes for relapse prevention.
Physical activity for adults
Recommend types of physical activity must be incorporated into everyday life, such as brisk walking, gardening, cycling, and swimming.
• To reduce risk of type 2 diabetes and cardiovascular disease: Plan at least 30 minutes of moderate or greater intensity physical activity on ≥ 5 days a week. The activity can be in 1 session or several sessions lasting 10 minutes or more.
• To prevent obesity: Plan 45-60 minutes of moderate-intensity activity a day.
• To avoid regaining weight: Plan 60-90 minutes of activity a day.
Physical activity for children
Recommend regular, structured physical activity, including (outdoor games e.g. football, swimming, dancing, brisk walking and cycling) in consultation with paediatric specialist. Make the choice of activity with the child and paediatrician, and ensure it is appropriate to the child’s ability and confidence.
• To reduced risk of type 2 diabetes and cardiovascular disease: Plan 30-60 minutes of moderate or greater intensity physical activity each day. The activity can be in 1 session or several sessions lasting 10 minutes or more.
• Overweight children: Plan more than 60 minutes activity.
Dietary planning
Tailor dietary changes to food preferences with flexible and individual approach to reducing calorie intake in consultation with specialist doctor. Unduly restrictive and nutritionally unbalanced diets are ineffective in the long term and may be harmful.
Dietary planning for adults
Diets with 600 kcal/day deficit by lowering the fat content (low-fat diets), along with specialist doctor support and intensive follow-up, are recommended for sustainable weight loss. Low-calorie diets (800-1,600 kcal/day), are less likely to be nutritionally complete. Ensure that diet is nutritionally complete and balanced and followed for a maximum of 12 weeks. Discuss the risks and benefits with specialist doctor.
Dietary planning for children
Dietary changes should be age appropriate and consistent with healthy eating advice with consultation of paediatrician to avoid deficiencies and daily requirement for growing kids. Overweight and obese children and young people, total energy intake should be below their energy expenditure and sustainable in long term, providing required nutrition in consultation with paediatrician.
Medicine plan for adults
Drug treatment is advised for people who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes. After discussing the potential benefits and limitations with specialist doctor, discuss the mode of action, adverse effects, and monitoring requirements, and the potential impact on the person’s motivation and outcomes. Doctor and multidisciplinary hospital team offer information, support, and counselling as required on timely basis for favourable outcomes.
Medicine plan for children
Children younger than 12 years, drug treatment may be used only in exceptional circumstances, monitored only in specialist paediatrician.Children aged 12 years and older, treatment is recommended only if physical comorbidities or severe psychological comorbidities are present as advised by specialist paediatrician, under supervision of multidisciplinary hospital team.
Surgical interventions for adults
Bariatric surgery is a treatment option for people with obesity if criteria depending on patient’s condition are fulfilled including:
• Person has a BMI of ≥ 35 kg/m2 and other significant disease that could be improved with weight loss.
• All appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss under supervision of multidisciplinary hospital team and specialist doctor.
• The person and family commits to the need for long-term follow-up after understanding the benefits, longer-term implications of surgery, associated risks, and complications.
Weight reduction benefits
• Symptom improvement of diseases like diabetes, high blood pressure, cardiac diseases, fatty liver disease, gallstones, gastro-oesophageal reflux disease, psychological, and psychiatric diseases.
• Improving quality of life free of morbidity.
• Increases life expectancy by reducing brain stroke and heart diseases.
• Reduces the risk of developing type 2 diabetes in future.
• Controlling diabetes, reduce need for diabetes medications or insulin after surgery.
• Improvements in levels of cholesterol, triglycerides, HDL-C and LDL-C, favouring reduced need of medicine in future.
• Reductions in blood pressure of hypertensive patients and requirement of medicines in future.
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Dr Manish Chaudhary is Specialist Medicine / Diabetes and Medical Director at Shifa Al Jazeera Medical Services.
