Obesity means an excess fat collection in the body. There is always an optimal weight for every age and sex. In obesity, this weight exceeds the upper limit of normal by 30%.
Morbid obesity is a condition wherein people are overweight by 45kilos to what is normal for their age and sex.

The prevalence of obesity has increased sharply since the mid-seventies especially in the developed countries. In fact, obesity has become so rampant that more children and teenagers are obese nowadays than ever before. 70 % of the adult population in the U.S.A is considered obese.

Obesity is not just a cosmetic consideration. It is a medical condition associated with illness and disability. It can lead to:

• Diabetes
• High bloodpressures
• Heart diseaseslike coronary heart diseases (CHD)
• Diseases of gallbladder
• Sleep apnea plusother respiratory problems
• Osteoarthritis
• Stroke
• Increased risksfor many cancerous conditions in both men and women.

Causes of obesity

There are many theories explaining what causes obesity.

Genes versus Environment

Identical twins are known to have very identical BMI even when grown apart.This favors the concept that weight gain and obesity are controlled by genes.

However, there are many instances where environmental conditions overwhelm the action of genes in obesity. Famines are known to prevent obesity even in those most prone to it genetically.

A number of conditions have been identified where obesity is a feature right from birth. In these children, along with obesity, there are other symptoms that help to differentiate these conditions from each other.

Race and Socio-economic conditions

The odds of having obesity and obesity-related health conditions varied among persons depending on their age, gender, race, income, and smoking.

In the developed countries, obesity is more prevalent among people in the lower socio-economic strata whereas, in developing countries, obesity is a problem more seen within the higher socio-economic strata.

Medications

• Psychotic Drugs
• There are fourmajor groups of drugs which can cause obesity: Benzodiazepines, Lithium,Antidepressants, Antipsychotic drugs
• Estrogens
• Corticosteroids
• Insulin
• Sulphonyl ureaagents (used in treatments of diabetes)

Medical Conditions

• Pregnancy: The increased demand for energy and the heightenedmetabolic activity of the body on account of the drastic hormonal changes,predispose pregnant women to weight gain and obesity. Women are known to gainas much as 12 to 16 kilos during pregnancy.
• Tumors: Tumorsarising in the brain like craniopharyngeomas -> which is a non-malignanttumor, most commonly occurring in children (5-15 age group) and presenting withobesity, lethargy, poor memory and recurrent headaches.
• Endocrinedisorders: Disordersaffecting the hormone producing plus secreting glands of the body are calledendocrine disorders.
• Poly CysticOvarian Syndrome: a condition where a woman’s sex hormones get out ofbalance. There is an abnormal increase in the production of the male hormones(androgens) causing obesity, irregular periods, acne, hair loss from the scalpbut increased body hair etc.
• Underactivethyroid disorder: can cause obesity inspite of loss of appetite.
• Cushing’s syndrome: adisorder in which the body produces excess cortisols resulting in obesity alongwith other symptoms of fatigue, weakness, facial flushing, round (moon) face,etc.

So how is OBESITY measured?

The most widely used calculator for obesity is the Body Mass Index (BMI). Thisnumber is a ratio of a person’s weight (in kilograms) to his height (in metersquare). BMI from 30 up to 35 indicate obesity. For adults above 35, a BMIgreater than 27 is considered obese.

According to the American Obesity Association (AOA), BMI also indicates the potential health risks that accompany obesity.

BMI less than 19 indicates mal-nutrition, while peoplewith BMIs 25 up to 30 are considered overweight for their age and sex. BMI over40 suggests morbid obesity.

The BMI is a very sensitive indicator of obesity for people between the ages of19 and 70 years.

• Still, BMI is unsuitable in:
• Elderly people with general debility.
• Deformities of the spine like scoliosis (lateral deviation of the backbones) or kyphosis (forward deviation of the backbone)
• Children growing up very fast.
• Pregnant orlactating women.
• Body builders andathletes Scientists use other, more sensitive methods to assessobesity.
• CT & MRI Scans
  These are non-invasive methods which can assess the collection of fat cells.They are very reliable and identify the precise points of fat collection in thebody.
• Abdomino-GlutealRatio/Waist Hip Ratio (WHR)
  This measures the proportion of fat distribution around the torso. Thesemeasurements have a strong correlation with general health and fertility. It isoptimal for men to have a ratio of 0.9. A ratio of 0.7 in women is consideredvery healthy. Ratios in women exceeding 0.9 andin men exceeding 1.0 imply obesity. WHR is abetter tool for assessing a person’s risk for heart attack than the BMI.
• Anthropometry
  The BMI is of limited use in certain occasions. Many conditions render the BMIan unsuitable tool for health assessment. As a person accumulates fat in hisbody, fats are first deposited under the skin before being deposited aroundinternal organs. Instruments that measure the fat deposited under the skin arecalled “skin calipers”.
• Body builders andathletes Scientists use other, more sensitive methods to assessobesity.
• Densitometry: where weight is measured under water
• Water dilutionmethods

Symptoms and Diagnosis

The world health organization (WHO) has categorized obesity as a metabolicdisorder. Often obese people approach their doctors when other healthconditions worsen due to obesity.

Signs and symptoms that suggest its time to tackle obesity are:

• Your diabetes doesn’t improve in spite of medications and you are overweight. Remember that all obese persons do not develop diabetes, but 80% of diabetics are obese.
• You have trouble conceiving. Impotence and infertility are conditions worsened by obesity.
• The menstrual cycles have become irregular. You either have them too often or they seem to be diminishing in flow and appear later than usual.
• You have lately developed high blood pressure or your existing high pressures are not responding well to medications.
• Off-late you suffer from increased daytime sleepiness. Chances are you may suffer from sleep apnea.
• Obesity increases chances of skin infections. Fungal infections are common in skin folds of the abdomen, torso and lower limbs.
• Obesity can result in many chemical changes in the body. In some people, the Uric Acid content in the blood rises sufficiently to cause gout-> a common condition causing joint inflammation.
• The weight-bearing joints of the body: backbones, knees, ankles etc. can suffer from joint inflammation (osteoarthritis). Pains in the back and knee are common complaints associated with obesity.
• Young Children who are obese are more prone to joint problems, especially of the knee joints and lower limbs.
• Obesity can cause hemodynamic changes that result in the stasis of blood flow especially in the lower limbs which lead to varicose veins.

Treatment of Obesity

Optimal treatment plans for obese people consist of the following:
Changing diet and behavior.
Introducing Exercise, Drugs, and surgery (last option)

Dietary + Life style changes

Excess calories consumed end-up being stored as fat. A good diet plan must havefoods high in nutritive value and low in empty calories.
Give up the idea of starving yourself. Crash diets rarely remedy the situation. You are likely to quit the regimen very soon either out of frustration or from progressive weakness.
Instead, try to eat more of the right kind of foods. The realistic approach is to achieve a “healthier weight” and not what is touted as the “ideal weight”.

Don’t avoid carbohydrates have less simple carbohydrates (sugars) and consume more complex carbohydrates. Most naturally occurring complex carbohydrates also provide sufficient vitamins and minerals for energy production. Wheatgerm, bran, oats, cornmeal, maize, buckwheat, and barley are excellent sources of complex carbohydrates.
These foods are best consumed as they are that is in their natural states.

Complexcarbohydratesminimum 60% of your daily calories must come fromcarbohydrates. If you are uncomfortable using complex carbohydrates routinely, there are plenty of choices you may opt for

pasta and itsvarieties

whole graincereals

muesli

shredded wheat

porridge oats

corn

yam

oat cakes

lentils

beans

brown rice

potatoes

brown bread

pitta bread

Avoid food fadswhich promise dramatic weight lose in little time. Rapid weight loses generallymean you are losing a lot of proteins and body fluids. This eventually depletesyour body’s muscle mass and leading to exhaustion. The ideal diet will enablethe body to burn fat while conserving muscle proteins.

Add more highfiber foods. Vegetables, fruits, beans and whole grains are high in fiberswhich prevent excess absorption of carbohydrates from the intestines.
Have plenty of red, yellow and orange fruits which are high in antioxidants.

Avoid having animal fats. These are high in saturated fats which lead to conditions like high blood pressures and diabetes. Animal fats are very rich in cholesterol which can cause heart diseases along with obesity.

Drink plenty of water. Recent studies have shown that simply having more water can increase your metabolic rates thus help in burning more calories in the form of fat.

Maintain a balance between caloric intake and energy expenditure. It is true that obese people consume more calories than they require and burn lesser calories. So an ideal balance needs to be maintained.

Start being moreactive.

Walk more, use thecar less often.

Avoid using thecar for short distances -> try cycling or walking instead.

Climb stairsinstead of always using the elevators.

Pursue activerecreational sports when home rather than watching television or surfing thenet.

Increase your fitness levels by including activities that you enjoy. It takes about 3,500 excess calories to gain just 0.5kg (1lb). Few people gain more than 2lb to 5lb each year. Weight fluctuates from day to day, but you should aim to stay about the same weight from week to week.

Have moderate sizing when at the restaurant. Try having starters instead of heavy desserts. Restaurants generally provide very large servings, try to split your dish with a friend and do not order for anything offered super-sized.

Eat a variety of foods. Try and get your vitamin and mineral nutrients from food and not through supplements.

Have adequate amounts of calcium. Calcium is essential for strong bones and teeth.