CNN has described it as “Fat nation,” while others have called it an epidemic. Whichever way you want to describe it, it is a nightmare which has no end in sight. The impact of obesity on health can’t be underestimated. It is associated with shorter life expectancy and 50-100% higher mortality than healthy weight individuals. Obese patients are at increased risk for developing Diabetes Mellitus, hypertension, heart attack, stroke, arthritis, cancer and depression.
Sixty-four per cent of the US adult population is considered overweight which means a body mass index (BMI) of over 25 kg/m2. About 31% or 59 million people are considered obese (BMI greater than 30kg/m2). Obesity and its complications results in 300,000 deaths and estimated cost in excess of $100 billion. According to National Health Institute Survey, cost of lost productivity was placed at $3.9 billion and resulted in 62.6 million physician visits.
The latest studies show that even a weight loss of 10-20 lbs can improve the health status and significantly diminish the overall risk. Heart Attack and stroke are the two most important consequences of obesity. Reducing weight by even 10% can result in lower blood pressure and cholesterol level. Diabetes Mellitus is another common consequence which results in insulin resistance leading to more heart disease, stroke, kidney problem and blindness.
Several types of cancer are associated with obesity. In women, cases of cancer of uterus, gallbladder, cervix, ovary, breast and colon are common while in men it is colon, rectum and prostate. Obesity can cause sleep apnea and osteoarthritis, a chronic joint disorder effecting knee, hips and lower back. Weight loss can decrease the stress on them and improve symptoms. Gallbladder disease and gallstones are also very common in them as well.
Treatment of obesity includes diet, exercise, behaviour modification, and later surgery for morbidly obese patient. The studies have shown that most important elements in weight loss are reduction in caloric intake and exercise. In general, low calorie diet (LCD) means 1000 to 1200 kcal a day in most women and 1200 to 1600 kcal a day in men who weigh 165 lbs or more. A diet that reduces 500 to 1000 kcal a day should be integral part of any programme aimed at achieving a weight loss of one to two lbs a week. Medication can be prescribed if they have not lost at least one lb a week after six months of therapy. Everyone is recommended to do 30 minutes of exercise, five times a week. There are two federally approved medications available for long term use. One medication works to decrease the appetite while the other decreases the absorption of fat.
Surgical option is available if the patient is morbidly obese (BMI more than 40) or having a BMI of 35-40 with significant obesity related medical problems such as diabetes, hypertension or sleep apnea. He must have failed on multiple attempts at supervised weight loss programme. He must be psychologically fit to accept life time of dietary modification. Surgical option available includes gastric bypass to gastric banding and minimally invasive bariatric surgery.
In conclusion, obesity is a disease which has enormous effect in daily life. We must take some personal responsibility and make serious commitment to achieve the goal of reducing obesity. It also needs involvement of family members, institutions as well as government to tackle this severely complex and challenging problem of growing epidemic.
[Dr. Anis Ansari, MD is Board certified Nephrologist and Medical Associate, Clinton, Iowa, USA. He can be contacted at a.ansari@mchsi.com]