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What is obesity
Universally, one out of every three adults is said to be overweight. Of them, roughly 13% can be considered obese. As per predictions, by 2030, these numbers will grow, and 20% of the world population may end up obese. The prevalence of obesity is common in children, too, with 1 out of every 5 children and adolescents either overweight or obese. In India, the numbers become scarier, with one in every four adults either overweight or obese, according to National Family Health Survey (NFHS) data.
Obesity is said to be spreading like an epidemic and is far more concerning than for some aesthetic reason. For those who do not know what obesity is, it is the major cause of premature deaths, and India is no anomaly. In 2017, 4.77 million deaths were linked to obesity globally.
There are severe medical and health complications associated with obesity. It can also raise the risk of serious diseases like type-2 diabetes, heart attack, cancer, and other metabolism-related medical conditions. While imbalance in food intake and lack of physical activity are considered the only reasons for weight gain, many other factors can lead to obesity.
It is important to know what obesity is, the different obesity definitions, the leading causes of obesity, and the complications involved.
How is obesity defined?
Obesity is a chronic condition when the body accumulates excessive or abnormal fat, which can impair health and cause medical complications. Obesity is usually measured based on Body Mass Index (BMI). According to the Centers for Disease Control and Prevention (CDC), an adult with a BMI of 30 or higher is categorised as obese.
While BMI is a commonly used weight-for-height index to determine overweight and obesity in adults, it is not a precise indicator.
CDC states, “Factors such as age, sex, ethnicity, and muscle mass can influence the relationship between BMI and body fat. Also, BMI does not distinguish between excess fat, muscle, or bone mass, nor does it indicate the distribution of fat among individuals.”
If an adult has a BMI of 40 or higher, their condition is considered severe. Severe obesity is the cause of many ailments and medical issues. An adult with a BMI of 25 or above is categorised as overweight. In children, obesity is measured using growth charts relative to their age.
How is obesity classified?
Obesity can be classified into three major categories. Here is a look at the table showing the different classes and the corresponding BMI value for an adult of 20 years of age or higher:
| Class | BMI (Kg/m2) |
|---|---|
| Underweight | Less than or equal to 18.5 |
| Normal weight | Between 18.5 and 25 |
| Overweight | Between 25 and 30 |
| Class 1 obesity | Between 30 and 35 |
| Class 2 obesity | Between 35 and 40 |
| Class 3 obesity (previously, morbid obesity) | More than 40 |
A primary care physician diagnoses obesity in children in relation to their age and sex at birth. A child aged 2 or older is considered obese if their BMI score is higher than 95% of the peers in the same age and sex category.
Medical practitioners also measure the BMI score of children against growth charts which may present slightly different pictures based on the population sample used to write the growth chart.
What causes obesity?
While poor lifestyle, excessive calorie intake, and lack of physical activity are considered major causes of obesity, they are not the only ones. The cause of obesity can be many:
Genetic causes:Advancement in medical science has led to the identification of several genes involved in making obesity a heritable trait. However, the efficacy of the genes depends on the family history and ethnicity of any individual. One can avoid the risks of heritable obesity by changing their diet, lifestyle, and other factors.
Metabolic causes:Metabolism is the body’s capability to convert calories, taken in as food, into energy. When a person consumes more calories than they can use, the body converts the extra calories into lipids and stores them in the fat cells.
When no more fat cells are left to store lipids, the fat cells enlarge themselves. These enlarged cells secrete hormones that cause body inflammation which can cause many issues like type 2 diabetes, cardiovascular diseases, fatty liver disease, kidney disease, gallstones, etc.
Inflammation caused by obesity also leads to insulin resistance, which renders the body incapable of using insulin to lower blood glucose and lipids. This increases blood pressure, high blood sugar, and high cholesterol. These risk factors reinforce each other and are grouped as metabolic syndrome risk factors.
Sedentary lifestyle:Sedentary lifestyle has become one of the major reasons for the rise in obesity, and the rise in screen time is said to be one of the causes. The more a person sits still, the less motivated they feel about moving and exercising. This behaviour is prevalent in adults and children as well.
Poor food consumption habits:The increased intake of processed and packaged food items high in sugar, salt, and preservatives and low in nutritional content is also the main reason for the increase in obesity.
Studies have revealed that psychological distress, such as boredom and loneliness, and disorders like anxiety and depression can often lead people to eat high-calorie and unhealthy food.
Hormonal causes:Hormones regulate the human body, including appetite and satisfaction from food. In case of a hormonal imbalance, the food cravings may increase, and a person may continue to eat even if they do not need more calories.
Medications:There are certain kinds of medications used to treat other disorders, for instance, antidepressants, which cause weight gain.
Pregnancy and other factors:Weight gained during pregnancy can be challenging to shed. It may become permanent and make the woman prone to chronic issues related to obesity. People with physical disabilities may also be prone to obesity and related risks.
What is BMI?
BMI, or Body Mass Index, is a tool that assesses a person's weight relative to their height. Defined by the WHO, BMI is calculated by dividing a person's weight in kilograms by the square of their height in metres, resulting in units of kg/m^2. It serves as an indicator of whether an individual is underweight, healthy, overweight, or obese. While BMI is a consistent measure across genders and adult ages, it suggests that a higher value corresponds to greater body fat. Nonetheless, it may not accurately represent every individual's body composition. For instance:
- In the case of bodybuilders, athletes, and sportspersons, BMI is not the true indicator of body mass. A bodybuilder may have a higher BMI due to muscle mass and not because of excess fat levels.
- A person with a normal BMI might still be at risk for obesity-related conditions. This is because the person may have average body weight, but the fat content in their body may be higher.
- Ethnic differences also play a covert role in determining the health risks posed by obesity. Asians are prone to obesity-related issues at a lower BMI, while Africans will be susceptible to obesity-related complications at a higher BMI.
Therefore, a primary care physician or a trained health care provider should diagnose obesity or body fat using appropriate tests and assessments besides BMI.
Physical assessment, such as the circumference of the waist, can also be used to indicate obesity. For a male or female (sex assigned at birth), the ideal waist circumference should be equal to or less than 40 inches and 35 inches, respectively.
Who is at risk for obesity?
The NFHS 2019-2020 report sheds some light on the people at greater risk of obesity in India:
- According to the report, obesity in women rose from 21% to 24% and in men from 19% to 23% in 4 years.
- Children below the age of five years and elders above the age of 60 years were prone to obesity more than people from other age groups.
- The incidence of obesity is 33% in urban residents and 19.7% in rural residents.
- 57% of women and 48% of men have a waist-to-hip ratio (WHR) that would increase their chances of metabolic complications and put them at risk.
- The rise in wealth proportion was observed to be directly correlated with the increase in weight gain. As the household income increases, people become less thin. For instance, 28% of thin women belong to lower economic backgrounds, while only 10% belong to the wealthiest class in India.
These stats depict how people of different ages, gender, and economic backgrounds show similar tendencies to gain weight. Lifestyle shifts and unhealthy eating habits significantly contribute to the heightened risk of obesity in individuals.
Complications of obesity
Obesity is a chronic condition and can worsen with age. When excess fat is in the body, the body's functions change for the worse, leading to direct health issues like asthma, sleep apnea, obesity, hypoventilation, and osteoarthritis, among others.
Besides, the mechanical effects of obesity on one’s body cannot be ignored. Extra weight causes more pressure on the skeleton and joints. There are studies to prove that knee arthritis risk increases by 36% for every 5 kg weight gain.
Also, obesity may lead to changes in the blood composition, which in turn can act as a trigger for metabolism-related complications. These risk factors make obesity more chronic as the person cannot lose or maintain the weight loss. Metabolic syndrome can lead to the following health risks and diseases:
- 7x increase and 12x increase in the risk of type-2 diabetes in males and females (sex assigned at birth).
- Cardiovascular diseases such as heart failure, stroke, coronary artery disease, etc.
- Liver diseases such as fatty liver, chronic liver inflammation or hepatitis, and liver cirrhosis.
- Kidney diseases and gallstones
Obesity in children has numerous negative impacts on their health. It can result in persistent weight gain and related disabilities in adulthood, as well as early mortality. Besides these future risks, childhood obesity can lead to immediate health issues like breathing difficulties, hypertension, insulin resistance, greater risks of fractures, early signs of cardiovascular disease, and other psychological issues.
Obesity is also linked with premature deaths and cancer risks, though researchers are yet to know the connection between obesity and cancer. There are several indirect health risks and disorders which are linked to obesity. These include Alzheimer’s disease, dementia, female infertility, depression, and mood disorders.
However, with lifestyle changes and a well-balanced, nutritional diet, the negative effects of obesity can be reversed. Losing extra body fat, even by 5% to 10%, can prove a boon for the body's health.
How to stop overeating?
The human race evolved to find food for itself. With the variety of food choices available today, our taste buds are spoilt for choice, and people end up eating more than they should. So, what can be the possible tricks and tips to avoid overeating?
There are many ways to avoid overeating and making unhealthy food choices. The initial and most significant step is to familiarise oneself with food – nutrients, calories, fat content, portion sizes, and the optimum calorie intake. One could consult a dietician or research themselves, opt for fibre-rich food, and stay hydrated. Controlling portion size and avoiding skipping meals can go a long way in building healthy eating habits.
Being mindful of one's dietary choices and eating habits is beneficial. For that, you can remove all the distractions while eating, take note of the easy food items to binge on and avoid, and always chew the food well.
With mindful adjustments to diet and lifestyle, obesity can be addressed. A sound mind in a sound body is the foundation for a contented life.
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