Obesity and Dieting

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What is obesity?

Obesity is the excessive accumulation of body fat, where a person has a weight 20% over that in standard height-weight tables. It may be mild (20 to 40% overweight), moderate (41-100% overweight), or severe (greater than 100% overweight). The prevalence of obesity in the United States is 24% of men and 27% of women. About 8.4 million Filipinos are obese; 21% of Filipino males are obese. Of these 22% are in Cebu, Bacolod and Iloilo, and 19% in Manila. In the United Kingdom, 14.5% and in France, 7%. Unfortunately, with the western influence on our lifestyle and behavior, there seems to be a trend among Asians towards these U.S. statistics.

What causes obesity?

The specific cause of obesity is unknown but the mechanism is clear: taking in more calories than expended. There are at least 7 factors that contribute to obesity. They are genetic, social, endocrine, psychological, developmental, physical and brain damage. Obesity could be exogenous (eating too much and too little physical activity: intake of calories more than output of calories) or endogenous (caused by internal medical condition, such as endocrine problem, etc.)

How does heredity play a role in obesity?

Heredity provides the genetic predisposition to obesity. However, children of an obese parent or obese parents do not necessarily become overweight, since there are environmental factors (health consciousness and social pressure) that could lead to lifestyle changes that prevent obesity. In cases where all children of obese parents are also obese, this could be due to perpetuation of parental lifestyle and behavior, or there could be some underlying endocrine or metabolic causes.

Why do some people have difficulty losing and maintaining weight?

Body weight is controlled by a "physiologic regulator" in our body. The fact that in some people (genetically) this regulatory "set point" is higher, the "weight threshold level" is also increased. The bodies of those persons "follow the regulator" to attain that "set point" of weight for their bodies. Because each person has a different "set point," it is harder for some of us to lose weight or maintain a certain weight level compared to others. Proper medical work-up and intervention, and self-discipline, can help majority of persons with obesity problem.

Are overweight persons more prone to heart attacks and stroke?

In general, yes. People who are overweight have a greater tendency to have abnormally high cholesterol level in their blood and organs. The cholesterol is deposited in the walls of their coronary (heart) arteries, the carotid arteries (supplying the brain) and other arteries. These people are also more prone to develop high blood pressure. These cholesterol plaques (deposits) gradually build up and clog the inner arterial channels, depriving vitals organs (heart, brain, kidneys, legs, etc.) of their blood supply, leading to a heart attack and/or stroke, etc. Overweight people are also more prone to develop diabetes and other illnesses. Normal weight confers not only a more attractive physical appearance but a healthier body.

Why do obese people have some difficulty breathing?

Obese persons have excess fats all over, including in their chest, around the heart and other organs, inside their abdomen, and the pressure from excess fat on the chest and on the diaphragm (the tent-like dome that separates the chest from the abdomen) makes the normal lung expansion more difficult. Air exchange is less efficient. Besides all these, the obese person has a lot more body surface, and therefore the heart and lungs, and all other organs, have to work much harder. Hence, there is more overall oxygen demand and consumption.

Is snoring really more common in obese persons?

Yes, somehow snoring is more common among persons who are obese. While many people with normal weights snore, this condition appears to be more common among those who are obese. In many of these "snorers" sleep apnea (breath holding while asleep) occurs, leading to poor oxygenation of the blood. This makes these people prone to have high blood pressure, and if the sleep apnea is prolonged, it could lead to hypoxia (insufficient oxygen for the body), heart attack or even death in some persons. This poor oxygenation is the reason why the "snorers" do not get a restful sleep and feel so tired and fatigued when they wake up.

Are diet pills, food and drinks being advertised as quick cures for obesity safe?

Anti-obesity or diet pills are appetite suppresants. Most of them have side effects that could cause heart irregularity and could be dangerous. Some deaths have been reported among people taking diet pills. The diet food and diet drinks in the market are basically low-fat, high protein, and loaded with vitamins and minerals. Depending on the formula, some of these could also have adverse side effects, like diarrhea and electrolyte imbalance. Recently, Xenical (Orlistat) was introduced in the market. It inhibits pancreatic enzyme lipase in the intestine, so about 33% of the fats eaten is not absorbed and is excreted in the stools. (This will be the subject of our column in the future.) Without self-discipline and determination, even these diet pills and diet food products will not work, and most of these people gain back their weight much too soon. Dieting with these aids should be under the supervision of a physician.

What is the safest way to attain a normal weight?

Since most overweight problem is exogenous (eating too much and burning too little calories), the obvious initial strategy is to eat less, and/ or exercise and lose more calories. The common sense approach is to cut down the food intake to half, take one-a-day multivitamin and minerals for supplement, and start a regular daily exercise regimen. Weigh once a week, naked or in underwear only, and record weight. If after one week of (honest and disciplined) reduction in the total food intake, and the weight does not start to come down, it means either there is a need to cut down on the intake some more, or there is a need to increase the physical exercise. Too rapid weight reduction is not healthy, so adjust the food intake accordingly, but maintain the exercise regimen. If it works and the weight starts to come down (about 2-5 pounds a week, depending on the starting weight) simply continue this program. If no success is achieved after a month of this initial strategy, then it is time to consult a physician

Are special diet food preparations being sold in drugs stores or supermarkets more effective?

These commercial preparations are more expensive, yes, but not necessarily more effective. Besides, as we alluded to earlier, there could be adverse side effects from taking them. Eating regular food (obviously low fat, like fish, vegetables and fruits) that is properly portioned in reduced quantity, is as effective, lesser expensive, and definitely safer, than any special preparations in the market today. There is absolutely no medical or scientific reason to eat these special diet food preparation and spend more money, when controlled intake of regular healthy table food will suffice to achieve weight reduction.

©2003Raoul R. Diez, M.A.O.D.