Excess Body Fat

Obesity is nothing but excess body fat in a person's body. Excess body fat can lead to chronic health problems such as diabetes, high blood pressure, and heart diseases. It can also increase the risk of several types of cancer, including oesophagal, uterine, post-menopausal breast, etc. The prevalence of obesity in India is 40.3 %. Studies also show that obesity is higher in women (41.88%) than men (38.67%).

1. Increased weight 
2. Tightness of clothes that used to fit before
3. Appearance of extra fat around the waist
4. Increased BMI (Body Mass Index) to a level that fits the criteria of obesity
5. Frequent bouts of breathlessness and exhaustion
6. Increased perspiration
7. Back and joint pains

1. Calories: The major cause of obesity is consuming high calories and not doing enough physical activities to burn them. When these extra calories lie idle, the body stores them as fat. (Calories are a unit to measure the energy value of food). The body of an active man and woman requires 2500 and 2000 calories per day respectively for proper functioning. Anything above this limit (without physical activities) is going to be stored as fat.
2. Reduced Physical Activity: The average Indian lifestyle is physically less demanding, which means, calorie burnt by the body is also less. Most of us have jobs that require sitting in one place for long durations, and even for recreational activities, we use our phones, laptops, or TV. Other conveniences such as escalators, elevators, home delivery, and drive-through banks have also reduced our physical activities to a large extent. 
3. Genetics: In rare genetic conditions, such as the Prader-Willi syndrome, leads to obesity. A person with this disorder has constant hunger pangs throughout the day.

Obesity is a multi-factorial problem, which means that many factors and causes can lead to an excess of body fat in a person. Some of these factors are:-

Age-Related 

1. Lifestyle changes like reduced physical activities
2. Lowering muscle mass in the body leading to decreased metabolism
3. Reduced need for calories (may make it difficult for a person to avoid gaining excess weight)

Generic 

1. The habit of following an unhealthy diet, which lacks the necessary proteins, nutrients and minerals that boost metabolism in the body.
2. Cushing Disease - It occurs due to the development of a noncancerous tumour on the pituitary gland. Progressive weight gain is the most common symptom of this disease. 
3. Weight gain during pregnancy can contribute to obesity in later years.
4. Inadequate sleep (less than 8 hours a day) causes hormonal changes, which in turn, increases the appetite and lowers the body metabolism.
5. Stress, which can cause a person to eat high-calorie food for comfort.
6. Microbiome - The gut bacteria might get affected by certain types of food and can lead to weight gain or make it difficult for the affected person to lose weight.
7. When people quit smoking, the most common withdrawal symptom is resorting to comfort food and unhealthy bingeing.

1. Understanding the health history: At first, the doctor may ask questions related to the patient's health history. These questions may be related to exercising and eating habits, steps taken for appetite control, stress levels, issues about the patient's health, and medicines. 
2. Physical Examination: The doctor monitors the vitals to check heart rate, blood pressure, and body temperature. The doctor also examines the patient's height and abdomen.
3. Calculating BMI: The doctor examines the BMI of the patient. The BMI of an obese person is more than 30 kg/m2. Note: BMI of more than 30 can immensely affect the quality of life and lead to major health risks. It is advisable to check the BMI at least once a year to take necessary precautions before any complications develop. 
4. Measuring Waist Circumference: The doctor examines the waist circumference at the midpoint between the lower border of the rib cage and pelvis (iliac crest). If the waist measurement is more than 35 inches in women and more than 40 inches in men, they are at higher risk of metabolic complications such as diabetes, fatty liver, etc. The doctor may also examine the waist-hip ratio (WHR) to check abdominal fat accumulation. 
5. Assessment of Other Health-related Issues: The doctor may also assess if the patient is suffering from other health-related issues, such as high blood pressure, high cholesterol, underactive thyroid, and liver problems. 

People with obesity need to make the necessary lifestyle changes to reach and maintain a healthy weight. Healthcare professionals and dieticians can help in setting realistic goals regarding eating habits and planning physical activities to reduce the risks of developing obesity-related complications. 

1. Healthy Eating Habits: Changing eating habits to reduce calories is crucial to overcoming obesity. Rapid weight loss may be experienced initially, but more important is maintaining the reduced weight. Following changes can be made to the diet:-
   1. Consult the doctor about the right amount of calorie intake per day for losing weight. Typically, 1200-1500 calories per day is considered the right amount for women and 1500-1800 for men. 
   2. Avoid junk and sugary food items which contain high calories in small portions. Consider fruits and vegetables that contain fewer calories in large portion sizes. 
   3. Consume fat in small amounts and ensure that they come from heart-healthy sources such as olive, canola, and nut oils. 
   4. Be aware of fad diets that make unreasonable claims for fast weight loss and health improvements. 
2. Exercises and Activities: A minimum of 150 minutes of moderate-intensity physical activity is required in a week for people having obesity. The doctor may increase the intensity of exercises gradually. It is also advised to include extra physical activities in the daily routine to burn calories. They may include:- 
   1. Using stairs instead of an elevator
   2. Parking the car a little farther from the destination to walk more
   3. Employ a pedometer to count the daily steps taken
   4. Make it a point to increase the number of steps every day
3. Behavioural Changes: It is also helpful to talk to a mental health care professional to address emotional and behavioural issues related to eating. Therapy can also be effective in increasing mindfulness about eating habits and raising awareness about what triggers food cravings to cope in a better way. Becoming a part of support groups can also help to share and discuss the problems related to obesity. 
4.  Anti-Obesity Drugs: The doctor may also suggest weight loss medication depending on the patient's medical history and possible side effects. Drugs are prescribed if BMI is 28 kg/m2, other obesity-related health risks, or if BMI is more than 30 kg/m2. These medicines are prescribed to supplement the diet, exercise, and behaviour changes. Following drugs can cause loss of appetite, but they also have side effects like bloating, nausea, oily stools, etc:
   1. Sibutramine
   2. Orlistat
   3. Phentermine
   4. Bupropion
   5. Metformin
5. Bariatric Surgery: It is performed under serious circumstances when a person's BMI is more than 35 kg/m2 with obesity-related health risks, or if the BMI is over 40 kg/m2. When other methods, like dietary changes, exercise, medication, etc., fail to reduce a person's weight. After the surgery, the patient needs to follow essential dietary restrictions and exercises to maintain the reduced weight. Types of Bariatric surgery include:-
   1. Gastric Banding: In this procedure, a band is placed inside the upper stomach to divide it into two parts. It creates a small pouch connected to the rest of the stomach. The section above the band fills quickly and gives a full and satisfying feeling even after eating a small portion of food. 
   2. Gastric Bypass: It involves creating a small pouch (15-20 ml) from the stomach to form a restrictive element. This newly created pouch empties directly into the lower portion of the small intestine. This way, the food bypasses most of the stomach and the first section of the small intestine, causing a malabsorptive element which means the food doesn't get absorbed in the bypassed section of the intestine.
   3. Sleeve Gastrectomy: In this surgery, the stomach is permanently reduced to 25 per cent of its original size. Reducing the size of the stomach also reduces the amount of food consumed.

Obesity exposes the affected person to severe health risks, including:-

1. Cardiovascular Disease: Obesity increases the risk of high blood pressure. Obesity is associated with high levels of LDL (low-density lipoprotein), a bad type of cholesterol that can lead to heart disease and stroke. 
2. Type 2 Diabetes: Obesity impairs the body's responsiveness to insulin, raising blood sugar and insulin levels. This increases the risk of diabetes. 
3. Certain Cancers: Obesity also increases the risk of developing certain cancers, including cancer of the rectum, colon, endometrium, ovary, breast, cervix, uterus, gallbladder, kidney, prostate, oesophagus, and liver. 
4. Sleep Apnea: It is a serious sleeping disorder in which breathing repeatedly stops and starts in slumber. People with obesity are more exposed to the risk of having sleep apnea. 
5. Osteoarthritis: Increased weight due to obesity results in causing higher pressure on the weight-bearing joints. Obesity can also promote inflammation within the body. These complications may lead to Osteoarthritis. 
6. Psychological effects: Obesity can lead to stress and even depression in a person. An obese person might avoid social interaction and may even encounter discrimination. This may result in shame and guilt, social isolation, and depression. 
7. Worsening of COVID-19 symptoms: Obesity can worsen covid 19 symptoms. If a person with obesity is experiencing severe COVID-19 symptoms, he/she may be kept in intensive care units for treatment.