Battle of the bulge –-India’s expanding waist line!

GUEST COLUMN: Dr N Prabhudev

Bengaluru, July 28:
There are three types of fat in your body
White adipose tissue – majority
Brown adipose tissue
Beige adipose tissue
Lancet Global Health – 50% Of Indians are Physically Unfit as per WHO Guidelines! If this trend continues unchecked, 60% of the population could be at risk of diseases related to physical inactivity by 2030. WHO recommends at least 150 to 300 minutes of moderate aerobic activity per week or an equivalent amount of vigorous activity for all adults? “The consequences of a sedentary lifestyle are more pronounced in those aged 40 and above.
Being obese can cause a wide array of medical problems – in fact, more than 200 of them! The prevalence of obesity and abdominal obesity is 13.85% and 57.71% – 254 million had generalized obesity and 351 million had abdominal obesity in India respectively. Both obesity and abdominal obesity are associated with increased risk of morbidities – systematic inflammation, insulin resistance, and lipid abnormalities! It leads to various non-communicable diseases, including cerebrovascular and cardiovascular diseases and cancer and mortality.
Most Indians consider obesity a cosmetic problem, not a disease. The truth is, obesity is a chronic disease-of excessive fat deposition in the body. Being overweight is not a disease, but obesity is. Call it the girth of a nation – India’s collective waistline is expanding-a lot-and that is not a healthy sign.
Waist-to-hip ratio is the circumference of your waist divided by the circumference of your hips. The smaller the waist, the better the life. Indian men appear to be especially prone to a pot belly- also called apple-shaped obesity. Contraceptive pills, full of steroids and water-retentive hormones, also tend to make women fat – a pear-shaped body. In India, the waist cutoff points for men is 78 cm and for women, it is 72 cm.
Fat around the waist has been linked to a greater risk of heart disease, diabetes, stroke, hypertension, breathing problems, disability, some cancers, and higher mortality rates! Visceral fat releases fatty acids and hormones into the blood that push up inflammation, bad cholesterol, triglycerides, blood glucose, and blood pressure, adding to risk of metabolic diseases!
Fat is ugly and dangerous. The major victims of obesity are – 300 million- Indian middle class, with around 35 per cent- reaching dangerous levels of obesity. Meat consumption has more than doubled in India since the 2000s, so has the intake of fat, sugar and salt! We are eating too much high-calorie food and not burning it off!
The Dominos, Pizza Huts and McDonald’s are in a veritable race to pamper the taste buds. The calorie count for French fries served by McDonald’s has jumped from 200 to over 600. In addition, the average meal comes with free add-ons like soft drinks, adding to calorie intake.
Obesity is associated with shortened life expectancy due to a number of adverse health outcomes. BMI is weight in KGs divided by the square of the body height – kg/m2! In most BMI correlates with body fat! India ranks third in the highest number of overweight and obese individuals in the world, after the US and China.
• under weight- less than 18.5,
• Normal – 18.5 to 24.9
• Overweight -Body Mass Index above 25,
• Obesity – class 1 – BMI- 30 – 34.9
• Class 2 obesity 35 to39
• Class 3 obesity more than 40.
What’s causing obesity?
It’s Junk Food and prolonged Sitting along with! It’s Not Just Junk Food or Sitting Too Much! Lack of Sleep, Stress, Antidepressants, Steroids, Hypothyroidism, Menopause, Polycystic Ovary Syndrome etc.
Genetics plays a role! But it is lifestyle – a poor diet and lack of exercise! Obesity is mainly due to eating too many calories, and because they aren’t burning enough of them! The way ultra-processed foods are made — their taste, texture, high calorie content, and appearance —leads to overeating. Processing also makes it easier for the body to absorb more calories, compared to unprocessed or whole foods. Obese Individuals with fatty liver are at a higher risk of developing non-alcoholic fatty liver disease, which can progress to liver fibrosis, scarring and cirrhosis!
A few years ago, heart attacks struck Indians in their late 50s and pot bellies- a decade younger than Western peers due to genetic predisposition. Today, obesity has dragged that age down to the 30s. It’s not just a link. Obesity is turning genetic vulnerability into a giant non-communicable disease burden. Visceral fat disrupts metabolism, clogs arteries, and overloads organs!
Obesity treatment – losing 5% of your body weight over a period of 6 months may be a good initial goal.
• Low calorie diet of 800–1600 kcal/day – Carbohydrate intake <130 g/day! High intake of fruits! Plenty of Vegetables and grains! Reduced intake of meats! Significant weight loss occurs in meal replacement compared to conventional calorie restriction! With no clear leading diet emerging to date, calorie restriction remains the common factor for weight loss!
• Adults should get 150 to 300 minutes of moderate-intensity activity a week, such as brisk walks or jogging. Alternatively, you can aim for 75 to 150 minutes of high-intensity exercise,
Pharmacotherapy – Allopathic medications assist in obesity management. They don’t work alone and must be taken alongside exercise, dietary, and behavioral modifications. Ozempic is making lot of noise! Metformin Liraglutide, tirzepatide- all antidiabetic drugs!
Intra-gastric silicon balloon
Bariatric surgery is the treatment of choice when all other interventions have failed.
• BMI ≥40 kg/m2
• BMI ≥35 kg/m2 with associated co-morbidities that could be improved with weight loss
• BMI of 30–34.9 kg/m2 who have recent-onset T2DM
Many regain weight after initial loss – in 2 to 5 years! Obesity requires Lifelong treatment!