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Obesity

Obesity is common ailment and rather frustrating to encounter. A lot of things are still unclear and present day management is rather inadequate. However, certain things need to be understood and followed till some new wonder drug is available in our treatment armamentarium.

In simple terms, obesity refers to an excess of body fat.
Conventionally this means that the weight is in excess of the appropriate value calculated for age, sex and height. The severity of the problem is usually graded by the degree of weight excess:

Between 100–120% of maximum allowed weight – overweight.
Between 120–130% of maximum allowed weight – obesity.
More than 130% of maximum allowed weight – morbid/severe obesity.

Estimation of Fat
The above definition of obesity is simplistic because it does not actually measure the body fat. There are methods to measure the body fat directly using a variety of research tools, however since these are not available to us routinely, indirect approaches are utilized in clinical practice.
These include:

Measurement of Skin folds at various places and comparing these values with normal.
Weight/Height Ratios: The most widely used clinical tool for the assessment of obesity is the BODY MASS INDEX (BMI of 25 is taken as the upper limit of normal, the range of 25–29.9 is considered overweight and 30 or greater, obesity).

Is All Fat Equal?
Certainly not! Studies indicate that fat around the waist is more closely associated with diabetes, hypertension (high BP) and heart disease rather then fat around the hip. This does not however mean that hip fat is completely harmless. This fat distribution is assessed by measuring a waist/hip ratio.

Causes of Obesity
Most of the time, obesity occurs in the absence of any underlying disease and only rarely can we demonstrate a particular illness which is responsible for the obesity. In simplistic terms, obesity can occur only if the energy intake (food intake) is more than the energy output (exercise). This does not occur overnight but over a large number of years. One may feel that the present diet is not at all excessive but it is a fact that just 10gm of extra food/day can lead to weight gain over a year’s time.

Of course, things are not so simple as they look and there are a lot of other factors contributing to the problem. These include heredity, and a number of processes in our body which influence the way in which energy expenditure is handled. You could say that in an obese person, these processes are so adjusted so as to make the person calorie efficient – this is like some scooters which give more mileage for a lesser amount of fuel. The exact nature of these disturbances is not known and there are as yet no medicines to correct them.

Obesity can certainly occur due to some hormonal problems, but this is an exception rather than a rule. Most cases of obesity are linked to over nutrition as explained above. In children, a simple axiom may be followed: children who are both tall and fat usually do not have an underlying disease. However if they are fat and short then they do deserve investigations.

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