The health risk associated with Obesity

ByJuandri Steytler

My Diet Clinic, Intercare Silver Lakes

What is Obesity?

Obesity can be classified as a state of adiposity in which body fatness is above the ideal of a body mass index of 30-39.9. Obesity and overweight are a result of an imbalance between food consumed and physical activity. National data have shown an increase in the calorie consumption of adults and no change in physical activity patterns. However, obesity is a complex issue related to lifestyle, environment and genes.

Many underlying factors have been linked to the increase in obesity prevalence such as:

  • Increasing portion sizes
  • Eating out more often
  • Increasing television or computer viewing
  • Changing labor markets
  • Fear of crime, that prevents outside activity

Overweight adolescents often become obese adults; obese individuals are at increased risk for comorbidities of Type 2 diabetes, hypertension, stroke, certain cancers, infertility and other conditions.

Management of Obesity

Etiology:

  • Excess energy intake
  • Physiologic, metabolic and genetic factors
  • Inadequate physical activity

Classification:

  • BMI>30
  • Excess body fatness (Male:8%-24%, females: 21%-35%)
  • Android vs gynoid fat distribution
  • Hormonal changes (e.g. insulin and leptin)

Associated Chronic disorders metabolic syndrome:

  • Glucose intolerance
  • Insulin resistance
  • Hyperlipidemia
  • Hypertension

Metabolic Syndrome is also known as Insulin Resistance Syndrome or Syndrome X. The syndrome is characterized by the simultaneous presence of insulin resistance, high blood pressure, elevated blood cholesterol, increased blood glucose levels and abdominal obesity. Whether this syndrome is purely genetic is not known yet but factors that contribute are indicated as:

  • Family history of diabetes, hypertension, heart diseases, gestational diabetes and impaired glucose tolerance test.
  • Excessive energy intake.
  • Physical inactivity.
  • Overweight (BMI > 25kg/m2) and Obesity (i.e. BMI > 30 kg/m2).
  • Older than 40 years of age.
  • Smoking.

Having an apple shaped figure (when most of the excess weight is around the abdominal region), which is most common amongst men and post menopausal women, also contributes to the development of Metabolic Syndrome. Fat in the abdominal area is situated around the organs and becomes metabolically active (not only storage fat).

Diagnosing Metabolic Syndrome:

Any 3 of the following:
  • Waist circumference of > 102cm in men *; > 88cm in women *
  • Triglycerides > 1.7mmol/L
  • HDL Cholesterol < 1.0 mmol/L in men; < 1.3 mmo/L in women
  • Blood Pressure > 130 / 85 mmHg
  • Fasting glucose > 6.1 mmol/L
  • 120 minute post prandial glucose challenge: 7.8 – 11 mmol/L

*The the latest European guideline is: 80 cm for women and 94 cm for men.

Consequences:

Metabolic Syndrome increases risk for the development of diabetes type 2, gout, hypertension, heart diseases, stroke and atherosclerosis (a condition in which the arteries and veins become blocked due to a build-up of fat / cholesterol. This fat build up can also tear lose from the arterial wall in the form a clot which then passes through the brain or heart causing either an embolism or stroke).

Treatment – Lifestyle change:
  • Weight loss: considered the first line of treatment for overweight patients with Metabolic Syndrome.
  • Appropriate dietary intervention (following a low GI diet, with regular meals and controlled portion sizes). The low GI eating plan will result in moderate insulin demands and therefore improve insulin resistance and most likely a reduction in waist circumference. The correct dietary adaptations will also reduce cholesterol levels.
  • Physical activity will promote weight loss and improve insulin sensitivity.
  • Weight loss medication can be prescribed by a doctor in severe cases when lifestyle modification alone does not achieve the desired results. These drugs must still be taken with a kJ restricted well balanced diet.
  • Other medication: Insulin sensitizing drugs may be prescribed to increase insulin sensitivity BUT it has to be accompanied by a life style change!
  • Surgery: bariatric surgery

Nutritional Management:
  • Energy intake reduction
  • Appropriate nutrient supplementation
  • Nutrition, meal planning and portion size education

Lifestyle modification strategies:
  • Setting easy-to-achieve short –term goals
  • Self-monitoring
  • Food and activity records
  • Regular weighing and measuring
  • Stimulus control
  • Shop when not hungry and with a grocery list
  • Eat when not on the run, do not eat in your car of in front of the television
  • Confronting barriers
  • Problem-solving steps
  • Planning your day e.g. packing in your lunchbox
  • Stress management
  • Social support

They key to dietary treatment is that the eating plan has to be tailor made as nutritional needs are unique to each person.

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