Overweight and obesity are defined at lower levels of BMI (Body Mass Index) for Indian population. This is because the health risks of obesity occur at a lower level of BMI in Asian Indians as compared to Caucasians.
Overweight: BMI ≥23 kg/m2 but <25 kg/m2 (irrespective of gender)
Generalized obesity (GO): BMI ≥ 25 kg/m2 (irrespective of gender)
Abdominal obesity (AO): Waist circumference (WC) ≥ 90 cm for men and ≥ 80 cm for women
How to measure your waist circumference:
• Feel and locate the lowest point of your ribs
• Similarly locate the top of your hips.
• Find the middle point (halfway) between the two
• Wrap a measuring tape around this middle point
• Maintain some traction on the tape but not too much (it should not dig into the skin)
• Breathe normally and take your measurement when you breathe out.
• Take another measurement to be certain
Any type of obesity (Generalized or Abdominal) or a combination of both is not healthy
Excess fat in body is associated with many complications (bad effects)
Once you decide to start working on losing the fat, knowing the following facts can help you along the journey.
1. Obesity is a disease. It is actually a chronic disease but nevertheless a treatable one. The cause being:
• Social environment that promotes Unhealthy Lifestyles and excess fat accumulation.
• Body biology: food intake is regulated by multiple hormones and mediators
2. Being fat is NOT your mistake. It is a result of an interaction between the obesogenic environment and body mechanisms. Hence,
• The society is equally responsible for your obesity.
• It’s your well-wishers responsibility also to see you through this journey.
• Ensure a support group
*Share this blog with anyone who engages in teasing.
3. Weight re-gain is common and expected. Be prepared and don’t get disheartened!
It is NOT due to any deficiency in willpower or motivation to maintain the lifestyle changes.
The body is hardwired with mechanisms to attain the previous weight.
• Weight loss induces irresistible appetite hormones.
• Weight loss also prompts the body to conserve energy and to spend lesser calories for the same activities as compared to before weight loss.
These mechanisms have evolved over centuries to counter starvation. It’s just that the food shortages are very rare in current times. In fact, very high calorie food is more easily available than healthy food.
Each cycle of weight loss confers some health benefits. So don’t hesitate to start again.
4. Set Realistic Goals especially in the initial phase.
First goals may not always be losing weight. First goals can be adopting a healthy lifestyle.
An important part of Healthy Lifestyle is including the following as a part of daily routine:
• Healthy eating habit
• Physical exercise
This routine will help in both: Weight loss and Maintenance of weight loss
Exercise is known to suppress appetite (alters appetite hormones) and to increase muscle mass which utilizes more calories even in the face of body trying to conserve it. Hence:
First goal is to increase activity and healthy eating without attempting weight loss
Next step: A target of 5% weight loss, not higher. This is a realistic and sustainable.
Moreover, achieving a weight loss of 5-10% has demonstrated substantial clinical advantages.
• Reduced BP, reduced risk of DM and cancer etc.
Goals should be specific and measurable and time specific.
Examples of initial goals which are realistic, measurable and time specified:
• To be able to walk to the garden gym and do 25 rounds of shoulder builder wheel everyday: achieve within 2 weeks
• Improve blood sugar control with lifestyle and minimize diabetes drugs to minimum possible in next 6 months
• Establish a routine of maintaining a daily food diary and ensure truthful documentation of dietary intake
5. Healthy Lifestyle (Exercise and healthy eating behavior) should become an essential part of daily routine – not just for the duration of weight loss regimen.
• Some effective healthy lifestyle advice is given here
What is eventually desirable is a total shift to healthy lifestyle. This is the only thing that works in the long run
• Failure to do so may result in weight regain, which can be disheartening and lead to the abandonment of efforts.
Therefore, long-term support, such as maintaining monthly photographs, is crucial.
Even if the desirable weight is not attained, the harmful effects of fat are offset to a large extent by the healthy lifestyle attained.
6. If the onset of obesity is from childhood and teenage, it is very difficult to lose.
• Keep that in mind and be determined for the tough journey.
• It is crucial not to blame individuals who are obese
• Introduce comprehensive, multi-modality treatment options.
• Ultimate goal is to establish healthy eating and lifestyle behavior only.
But initially it may not be wise to target all the areas of lifestyle change. Select one area at a time; as suitable to the individual. Whatever he/she is comfortable with. Proceed on to other areas gradually taking time in consultation with the individual.
7. Drugs/bariatric surgery may help in extremely difficult cases.
Remember each drug/surgery has some side effects.
The selection of medication and/or surgery needs to be customized to each individual, taking into account their specific clinical condition and possible adverse effects
Appropriate drug and/or surgery needs to be tailored to the individual, based on his/her clinical conditions and possible side effects of the drug or surgery.
The effectiveness and tolerability of treatments can differ significantly from person to person
Most importantly:
• These drugs are not recommended for children, pregnant and lactating women
• Drugs may induce weight loss but the rate slows with time
• Weight may return with time or once medication is discontinued
Hence, once 10% weight loss is achieved, take steps to develop adequate exercise routine for weight maintenance
Drugs and surgery for weight loss MUST be used in combination with lifestyle change. Otherwise the weight lost initially will come back.
References:
• Misra A et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009 Feb;57:163-70. PMID: 19582986.
• Mahajan K, Batra A. Obesity in adult asian indians- the ideal BMI cut-off. Indian Heart J. 2018 Jan-Feb;70(1):195. doi: 10.1016/j.ihj.2017.11.020. Epub 2017 Nov 27. PMID: 29455779
• Public Health England. Changing behaviour in families. Available from:
https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
• Durrer S D et al. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts. 2019;12(1):40-66. doi: 10.1159/000496183. Epub 2019 Jan 23. PMID: 30673677.
• Australian National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. 2013. Available at: https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guideli...
• Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011 Jan;111(1):92-102. PMID: 21185970
• King NA et al. Individual variability following 12 weeks of supervised exercise: identification and characterization of compensation for exercise-induced weight loss. Int J Obes (Lond). 2008 Jan;32(1):177-84. PMID: 17848941.
• Stensel D. Exercise, appetite and appetite-regulating hormones: implications for food intake and weight control. Ann Nutr Metab. 2010;57 Suppl 2:36-42. PMID: 21346335.
• Blundell JE et al. Appetite control and energy balance: impact of exercise. Obes Rev. 2015 Feb;16 Suppl 1:67-76. PMID: 25614205.
• Lean MEJ, Astrup A, Roberts SB. Making progress on the global crisis of obesity and weight management. BMJ. 2018 Jun 13;361:k2538.. PMID: 29898885
Some healthy lifestyle advice: https://ihatepsm.com/blog/some-lifestyle-advice
मोटापे के बारे में दिलचस्प तथ्य: वजन घटाने की यात्रा से पहले जानें: https://ihatepsm.com/blog/%E0%A4%AE%E0%A5%8B%E0%A4%9F%E0%A4%BE%E0%A4%AA%...
स्वस्थ्य जीवनशैली सम्बंधित कुछ सलाह: https://ihatepsm.com/blog/%E0%A4%B8%E0%A5%8D%E0%A4%B5%E0%A4%B8%E0%A5%8D%...
Some Lifestyle advice: https://ihatepsm.com/blog/some-lifestyle-advice
Smart Facts about Obesity – Must Know before Beginning the Weight Loss Journey: https://ihatepsm.com/blog/smart-facts-about-obesity-%E2%80%93-must-know-...