Hyderabad, March 4th, 2021: As the world commemorates the ‘World Obesity Day’ (March 4th, 2021), obesity is gaining endemic proportions and is likely to impact a significant section of the world population. It has enormous significance especially in India, as there is an alarming rise in incidence of obesity among children with serious repercussions for future. Addressing media on obesity and its implications, Dr Saratchandra, Sr. Consultant Cardiologist, Indo-US Hospitals; Dr NG Sastry, Director & Sr. Consultant, Dr Mohan's Diabetes Specialties Centre, Hyderabad Cluster; Dr Surender Ugale, Sr. Consultant - Obesity, Diabetes Bariatric & Metabolic Surgeon; Dr Dilip Gude, Chief Consultant Physician & Diabetologist, Virinchi Hospitals and Ms Aparna Nemalikanti, Nutritionist; said, we Indians are highly prone to lifestyle diseases or Non-communicable diseases of Hypertension, Diabetes, Heart disease, Stroke and Cancer, these coupled with obesity can only amplify the health complications.
Dr Saratchandra pointed out that, obesity is becoming a major issue especially in India to grapple with, and the problem is manifesting from a young age as the number of obese children is rising rapidly in our country. India with 14.4 million obese children has the second-highest number of children with obesity in the world, next only to China. The prevalence of overweight and obesity in children is 15% and those studying in private schools catering to upper-income families, the incidence has shot up to 35-40%, indicating a worrying upward trend. The causes for this phenomenon absolute lack of physical activity for kids, spending most of the time on gadgets or studies, also the rise in our affluence has led to over consumption of junk food. According to ICMR-INDIAB study 2015, prevalence rate of obesity varies from 11.8 % to 31.3% and central obesity from 16.9%–36.3%. Totally 5% of Indian population is morbidly obese, (>30 BMI). Obesity in the central part of the body has a strong link to heart disease and a major cause for worry, he adds.
Obesity is associated with an increased risk of disease and death, particularly from Coronary Vascular Disease and Cancer. It is primarily due to overeating, physical inactivity, reasons of genetics, metabolism, environment, behavior and culture. Sedentary lifestyle is the single most cause among majority of the obese, as they burn fewer calories than what they consume. Studies indicate that life expectancy of persons with severe obesity (BMI ≥40) is reduced by as much as 20 years in men and by about 5 years in women. Obesity is associated with higher rates of death driven by comorbidities such as type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension, obstructive sleep apnea (OSA), certain types of cancer, steatohepatitis, gastroesophageal reflux, arthritis, polycystic ovary syndrome (PCOS), and infertility.
Dr NG Sastry said, we are all aware that obesity is high in India and one of the consequences of obesity is Type 2 diabetes. Our bodies tend to accumulate more fat content in the body mass, which leads to insulin resistance. This insulin resistance can lead to other complications like overweight, rise in cholesterol and triglycerides, hypertension etc. Studies indicate that people who modify their lifestyle to be healthy have seen 55% reduction in diabetes, while those who were managed just with medication saw 30% to 35% reduction in diabetes. We Indians have a strong genetic pool and therefore we need to be extra careful to maintain right bodyweight from the beginning to keep diabetes at bay effectively.
Bringing BMI to less than 22 should be the goal of every patient, both diabetics and non-diabetics, as it has been shown to prevent future heart, kidney and liver disorders, cancers, arthritis, sleep apnea etc. Overall healthy weight loss is known to improve one's longevity and Quality of life as well, emphasizes Dr Dilip Gude. Body fat can lead to multiple health issues like rise in cholesterol, sleeplessness, heart problems, kidney problems, every other organ is impacted, besides diabetes. Insulin resistance grows with body weight, as fat grows in the body the insulin need also grows, but pancreas can’t meet the increasing demand, therefore we supplement insulin through medication, but the best option is to reduce weight and thereby reduce the demand for insulin. he added.
The classes of BMI reported by the WHO are 18.5–24.9 kg/m2 for normal, 25.0–29.9 kg/m2 for overweight and >30 kg/m2 for obesity. However, these parameters are much more stringent for Indians, with values being 18 to 22.9 for normal, 23 to 25 for overweight and more than 25 for obesity. For the same BMI, Indians are at a higher risk of cardiovascular morbidity and mortality. The risk of CAD in Indians is 3-4 times higher than White Americans, 6-times higher than Chinese, 20-times higher than Japanese. Indians are prone as a community to CAD at a much younger age, 5-10 years earlier than other communities. Indians also show higher incidence of hospitalization, morbidity, and mortality than other ethnic groups.
Dr Surender Ugale said, obesity is the mother of multiple ailments, fatty liver is a huge issue in the society currently as it leads to liver cirrhosis, heart problems, sleeplessness, heart problems, knee problems, kidney failure, cancers which are strongly linked to obesity. There are surgeries to reduce weight and they are successful, bariatric surgeries are safe and effective options but need to judiciously select depending on the patient and his need. Surgery is one part, but what the patient does after a successful operation is the second part. If someone is obese, he needs to lose weight through natural methods, intermittent fasting and doing exercise is good to get rid of fat from the body and liver. If one can’t reduce through natural ways, living with obesity is dangerous and surgical options have to be looked for. The problem of child obesity is grave, if they are obese at a young age, they also fall victim to diabetes at a young age. As a surgeon, earlier we used to see a Type 2 diabetes case after 30 years of age, now we are seeing children as young as 12 years coming to us with Type 2 diabetes because of obesity, they already have other endocrinology issues, joint issues, they are already exposed to heart disease, with cholesterol, triglycerides, girls developing risk of infertility. Obesity also leads to psychological problems, depression at a young age.
There are a whole variety of options in foods for combating obesity, whole fruits without discarding the fiber in fruit juices; vegetables, not starches like potatoes; whole grains and millets, nuts, white meat like fish, poultry for proteins; using plant oils on rotation like groundnut, mustard oil, til, flower oils. Eat home food, chew properly and drink water and other beverages which are calorie free, this should be coupled with physical activity for about 45 minutes daily, says Aparna Nemalikanti. The foods which cause obesity and need to be avoided are simple sugars like squashes, readymade juice packs, daily meat consumption without vegetables in the plate, refined cereals like maida and related products like noodles, pasta, bread, biscuits etc; mutton, beef, pork and other red meat; animal fat like cheese, butter, margarine, mayonnaise ghee, etc., and outside foods which carry plenty of trans fats. Also avoid sedentary and stress filled like style, she adds.
Dr Saratchandra advises that the most important step towards improving one’s health is to bring the Body Mass Index to 22 or less. Understanding that the closer to normal the BMI is, the better sugar control in diabetics, the lesser the chances of future cardiovascular disorders and most importantly the better chance for longevity and quality of life overall.