Obesity is accumulation of excess body fat. It is a major health problem worldwide. Intake of high calorie refined foods and lack of physical activity are mainly responsible for weight gain.
IS OBESITY DANGEROUS?
Obesity is not just a cosmetic problem. Excess weight can lead to more than 200 medical problems including type 2 diabetes, high blood pressure (hypertension) and high blood fat levels (hyperlipidemia).
Obesity increases risk of heart attack & stroke due to fat accumulation in blood vessels,joint pains & osteoarthr it is due to excess weight bearing,obstructive sleep apnea (snoring during sleep with brief periods of cessation of breathing resulting in lack of sleep, excessive day time sleepiness), depression, gall stones, hernias and certain cancers. Females with obesity may have irregular periods, higher incidence of abortions and difficult labor. People with obesity easily become tired and breathless even with limited physical activity. Obesity and associated co-morbid conditions reduce life span by 5 to 20 years.
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AM I SUFFERING FROM OBESITY?
Body fat percentage is greater than 25% in males and 35 % in females indicates obesity.
Body Mass Index (BMI) –
Body mass index is the most commonly used parameter to define obesity. BMI is ≥ 25 kg/m2 (In western countries ≥ 30 kg/m2) indicates obesity in Indians/ Asians. It is easy to calculate BMI.
BMI = Body weight in kilograms/ (height in meters X height in meters) = kg/ m2. Based on BMI individuals are categorized as below
|Categories||BMI for Indians/ Asians||BMI for Western countries|
|Normal Range||18.50 to 22.99 kg/m2||18.50 to 24.99 kg/m2|
|Overweight||23.00 to 24.99 kg/m2||25.00 to 29.99 kg/m2|
|Grade 1 Obesity||25.00 to 29.99 kg/m2||30.00 to 34.99 kg/m2|
|Grade 2 Obesity (Severe Obesity)||≥ 30.00 kg/m2||35.00 to 39.99 kg/m2|
|Grade 3 Obesity (Morbid Obesity)||40.00 to 49.99 kg/m2|
|Super Obesity||50.00 to 59.99 kg/m2|
|Super Super Obesity||60.00 kg/m2 and above|
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Cut off limits for overweight and obesity are 23 and 25 kg/m2 in Indians/ Asians. In western countries these limits are 25 and 30 kg/m2 respectively.
Waist Circumference (Waist Size) & Waist to Hip Ratio –
If only BMI is taken into consideration, muscular individuals will wrongly be categorized as obese. So other parameters, like waist circumference (WC) and waist to hip ratio (WHR), are used.These are more specific parameters than BMI to define obesity. Following parameters indicate obesity.
Waist Circumference > 80 cm in females and > 90 in males
Waist to Hip Ratio > 0.8 in females and > 0.9 in males
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WHY DO WE GAIN WEIGHT?
We get energy from food. Part of this energy is utilized for metabolism and head production. Remaining energy is converted into fat and stored in different parts of the body. This total process is called energy balance.
Energy Balance = Metabolism + Heat Production + Fat Formation
Fat Set Point –
Several hormones and genes control this energy balance. Most of these hormones are produced in stomach and intestine. These hormones and genes decide the amount of fat to be stored in the body. This amount is called “fat set point” or “fat mass”. Fat set point is high in people suffering from obesity and low in thin individuals. These hormones include GLP1, peptide YY, GIP, Ghrelin, and anti-incretins.
Triggers altering fat set point –
Will power can’t alter this fat mass. But following factors can trigger these hormones and genes and reset the fat mass to a higher level.
– intake of unhealthy foods,
– lack of physical activity,
– irregular food habits, stress,
– lack of sleep
– increased stress
– changes in circadian rhythm (working at night, sleeping in the morning)
– certain medications (steroids, psychiatric medicines)
Some people don’t gain weight in spite of eating lot of unhealthy foods. But others gain weight after taking even small quantity of unhealthy foods. Reason for this difference is that the later group people have genetic tendency to gain weight by taking unhealthy food. If any one has genetic tendency to gain weight with one or more triggering factors, they gain weight when they are exposed to those triggers.
These triggering factors are responsible for obesity in 90 percent of individuals.In remaining 10 percentendocrine and genetic problemsare responsible. Overeating of unhealthy foods and lack of physical activity are most common triggering factors.Technology increased our comfort levels leading to reduced physical activity. In addition to this, increased intake of unhealthy high calorie refined foods is responsible for weight gain.
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HOW TO PREVENT WEIGHT GAIN?
Lifestyle modifications are necessary to maintain fitness and prevent obesity. They are also necessary to lose weight. These include healthy diet, regular exercise, taking food on regular timings, adequate sleep and stress free life.
Obesity prevention should start at childhood. Even children should follow healthy food habits and exercise daily.
Healthy Diet –
- Eat right type of food. Quality is more important than quantity.
- Stop eating when you are satisfied but not when you are full.Avoid overeating.
- Eat slowlyand chew adequately.
- Use a smaller plate, glass and bowl at meals to control intake.
- Use food labels to help you make better choices while shopping.
- While shopping check the labels for the dietary information and select the products with low or no added sugars, zero cholesterol, low or fat free, low or zero trans-fats, low or no sodium, high dietary fiber etc.
- Check for calories on the labels. Look at the serving size and how many servings you actually take each time. Increasing the number of servings increases the number of calories.
- Prefer eating at home as you have control over what you are eating.
- When you eat outside, choose low calorie healthy foods, choose dishes that include vegetables, fruits, protein, share the food or take home part of your meal if you are satisfied before you finish what you have ordered.
- Choose smaller size dishes, order what you can eat. There is no point in ordering a lot and later struggling to finish by filling up too much.
- Don’t reward or treat your children or friends with food items like sweets, chocolates or biscuits.
- Instead reward with hugs, non-food items like stickers and kind words.
- Don’t replace your kid’s meal with candies, chocolates cookies or biscuits.
- You are the role model for your children.
- Children pay attention to what you do rather than what you say. Be an example to them by following healthy eating habits.
- Healthy meals include protein rich foods like egg white, chicken, fish, lean meat, dal, nuts, beans, low refined carbohydrates and fats,vegetables, green leafy vegetables and fruits with less sugar.
- Cut back on foods high in refined carbohydrates, fats, added sugars, and salt.
- Avoid white rice, sugar, pizzas, burgers, ice creams, cakes, sweets, fries, chips soft drinks, chocolates, biscuits, idly, dosa, vada, poori, samosa, bajji and pakoda
- Eat fruits, vegetables, or unsalted nuts as snacks.
- Drink water or other calorie-free beverages or 100% juicewhen you are thirsty. Soft drinks contain a lot of sugar and are high in calories.
- Alcohol provides lot of empty calories. Avoid alcohol.
- Breast feeding helps to lose extra weight gained during pregnancy
Do regular physical exercise unless you are advised not to do so by your doctor. Do physical activity of 30 to 60 minutes a day.Concentrate on muscle strengthening exercises like weight training. Muscle strengthening exercises are better than aerobic exercises to build muscle mass. Limit screen time like watching TV and computer games. Get up and move during commercial ads or in between work to get some physical activity.
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HOW TO LOSE WEIGHT?
Reducing the excess weight is a big problem for several individuals. Majority of the individuals with mild obesity benefit from lifestyle modifications. If your BMI is < 30 kg/m2you can get rid of excess fat by diet modification, regular physical activity.We need to find out the triggering factors for weight gain and those need to be addressed.
In most individuals overeating of unhealthy foods and lack of exercise trigger weight gain. Dieting (diet restriction) without altering food habits will not result in long lasting weight loss. If the cause of weight gain is unhealthy diet and lack of exercise, then changing to healthy diet and doing regular exercise can reduce fat mass. As long as healthy diet and regular exercise are followed fat mass remains low. Once stopped, fat mass increases again. So healthy diet and exercise need to be continued forever to prevent weight regain. If obesity is mild, lifestyle modifications help to maintain weight loss. If endocrine, genetic problems and medicationsare triggering weight gain, then they need to be dealt with.
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WHY DO PEOPLE REGAIN WEIGHT OR FAIL TO LOSE WEIGHT?
When you start dieting and exercise, you need to fight against the hormones and genes controlling fat mass to lose weight. If you fight, these hormones and genes won’t keep quiet. These hormones fight back and induce counter changes in the body – increase hunger, reduce metabolism and heat production to conserve energy. A stage will come when you can’t tolerate hunger, start eating more food resulting in weight regain. Even though there is initial weight loss, weight will come back over a period of several months and sometimes you gain more weight.
Lifestyle modifications are not enough for long lasting weight loss when BMI is ≥ 30 kg/m2, as body gets adopted to a higher fat mass. 96 out of 100 members who try to reduce weight by these methods regain weight if BMI is ≥ 30 kg/m2. Even if healthy diet and exercise are followed, there will not be much weight loss.
Very low calorie diet,
can’t help when fat mass is high and BMI is ≥ 30 kg/m2.
Those individuals who fail to achieve long lasting weight loss with conservative methods,benefit from bariatric surgery. Bariatric surgery is very safe, highly effective and scientifically prove method for weight loss.
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CAN MEDICINES HELP IN WEIGHT LOSS?
Anti obesity medicines help you to increase weight loss to some extent, when you are losing weight by diet modifications and exercise especially when BMI is <30 kg/m2.There are several anti obesity medicines in which only orlistat, fenteramine + topiramate has FDA (Food and Drug Administration) approval. Their effect is very less compared to bariatric surgeries. If you lose weight with medications, weight loss will be maintained as long as these medicines are taken. Once discontinued, all the lost weight will come back within two years, because of the effect of hormones and genes controlling fat mass.
Role of medicines in the treatment of obesity is limited
Sibutramine, an anti-obesity drug which act on brain and reduces appetite, is banned in India, USA and other countries due to its cardiovascular side effects. Side effects of sibutramine include increased blood pressure, insomnia, headache, constipation, dryness of mouth, risk of heart attack and stroke. Orlistat prevents absorption of up to 30 percent of fat in food by antagonizing the action of pancreatic lipase enzyme in digestive juices. It has no effect on digestion & absorption of carbohydrates. So it is not useful for those consuming excess sugars and eating very excess fat foods. As certain percentage of fat is not absorbed, side effects include steatorrhoea (foul smelling sticky stools because of presence of undigested fat in stools) and sometimes incontinence of stools. According to several reports orlistat has been implicated in liver failure, acute kidney injury and pancreatic injury.
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WILL LIPOSUCTION AND COOL SCULPTING HELP IN WEIGHT LOSS?
Liposuction and cool sculpting are body shaping procedures. These are not for weight loss. In these procedures fat is removed from differentbody parts to improve cosmetic appearance.
Liposuction and cool sculpting can’t alter body fat mass. So whatever amount of fat that is lost will come back in other parts of the body. They may help as a supplementary to healthy diet and exercise when BMI is <30 kg/m2. Those who can’t reduce weight by lifestyle modifications, will not achieve long lasting weight loss even after liposuction and cool sculpting.
Liposuction & Cool sculpting are for body shaping, not for weight loss
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WHAT IS BARIATRIC SURGERY? WHAT IS METABOLIC SURGERY?
Surgeries performed for long lasting weight loss are called bariatric surgeries. These are performed on stomach and intestine by laparoscopic method (by putting small holes on tummy).
Bariatric and metabolic surgeries are essentially same. If the purpose of surgery is weight loss, then it is called bariatric surgery. If the purpose of surgery is remission from diabetes and other co-morbid medical conditions, it is called as metabolic surgery.
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