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:

1. Between 100–120% of maximum allowed weight – overweight.
2. Between 120–130% of maximum allowed weight – obesity.
3. 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

1. Measurement of Skin folds at various places and comparing these values with normal.
2. 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.

Treatment of Obesity
Certainly yes! It is now quite clear that a number of illnesses like diabetes, high BP and cholesterol, heart problems and problems like arthritis of weight produces not only a sense of physical well–being but also improves self–image and decidedly reduces the risks of the complications listed above.

At the present time, no specific drugs are available to treat obesity. A number of alternative medicines proclaiming miracle cures are available, but these are inadequately researched, and it might be dangerous to use such ‘Over the counter’ preparations. The hard fact remains that the present treatment of obesity is dietary modification and exercise.

Best Diet to Lose Weight
Weight gain is not related to a particular food stuff but to the total number of calories that one consumes in a day. There is no advantage of, say jowar over rice and so on. On must add lots of salads to the diet since they produce a feeling of satiety and reduce hunger. When snacking – always thin low cal and choose items that are baked and not fried. Multiple small snacks are better than long periods of starvation. Try and avoid saturated fats like dalda, butter, cheese, red meat like pork, salami, mutton and beef. White meat like chicken and fish has less fat content.

Exercise to Lose Weight
Any exercise that raises your heart rate to a value of 80% of Maximal Target Heart Rate (MHR) and maintains it for at least 20 minutes is good for you. MHR is calculated by subtracting your age in years from 220. Such an exercise needs to be performed at least five times a week to be useful. Such exercise is useful not only for losing weight but also for toning up your heart, reducing your BP and controlling your diabetes. Please however consult before you embark on exercise programs so that the type and intensity of exercise can be individualized. In general, walking at a fairly brisk pace or light jogging are the best forms of exercise. Exercise like weight lifting which place a strain on the heart are best avoided. ‘Yoga’ is good for developing flexibility of the body but may not be enough alone to achieve weight loss.

Some Facts about Weight Loss

• Lifelong effort & Commitment
  One needs to realize that obesity is a lifelong problem and to counter it, one needs a basic change in lifestyle. This alteration should not be sudden and drastic but a step wise program designed to last life–long. Fat diets and intense exercise will certainly produce some weight loss in the short–term but the world experience suggests that most of the weight lost in this manner will be regained soon if proper maintenance diet/exercise is not continued. It is therefore more beneficial to plan your own diet and exercise with the help of a trained dietician/doctor rather enroll in fashionable short–term weight loss programs.
• Pattern of weight loss
  Once diet and exercise is begun, there is an initial period of rapid weight loss and this is mostly due to losses of water and not fat. The speed of weight loss then slows down progressively. This happens because your body is actually fighting your attempts to lose weight by slowing down its own functions – this is a natural tendency to maintain a status quo. One needs to become 7000 calories negative in the energy intake/expenditure balance to achieve a wt. loss of 1 kg ! Please therefore set practical goals of weight loss. Remember that you cannot lose in 3 months what you have built up in the last several years.
• YO–YO Effect
  Individuals who are intermittently on diets and exercise have phases of weight loss and gain. This is known as the Yo–Yo effect. It is believed that these cycles of weight loss and gain are more dangerous than persistent mild overweight.

Overall, the crux of the matter is in rationally altering your lifestyle and maintaining it indefinitely without losing hope.