Combating Obesity - One of the fastest growing epidemics

One of the fastest growing epidemics, obesity is affecting the lives of individuals globally, irrespective of age and gender. 

The World Health Organisation (WHO) defines obesity as an “abnormal or excessive fat accumulation that may impair health”.

It states that the fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Obesity was classified as a disease in 2013 by the American Medical Association.

People are considered obese when their body mass index (BMI) - a measurement obtained by dividing a person’s weight by the square of the height - is over 30kg/m2.

Nida Khan, clinical dietician at Eurodiet Muscat says, “Obesity can set in from the age of six or seven years. A child with unhealthy eating habits may tend to gain excess fat which can lead to him or her being overweight, and ultimately obese.”

Dr-Jishy-Seby

Jishy Seby

She says that many reasons lead to obesity at various stages of life.

“Teenagers going through puberty tend to have cravings for various foods, which sometimes leads to overeating. A lot of people in their mid-20s tend to gain fat mainly due to unhealthy eating habits, timing and work pressure. Also, psychological factors can affect people at different stages. Many adults become emotional eaters in their 20s and 30s due to stress and busy lifestyles.”

Obesity affects women more than men due to their lower metabolism rate, says Nida.

“Women tend to have more cravings than men due to their menstruation cycles and emotional stress. Abdominal obesity is more prevalent in men and lower abdominal obesity is more common in women. People with obesity are more likely to suffer from Type 2 diabetes, cardiovascular diseases, blockage of arteries, cancer, skin diseases, osteoporosis and gout.”

JishySeby, diet consultant at KIMS Oman Hospital, says that changes in diet and lower physical activity are believed to be the two prime causes for the recent increase in the incidence of childhood obesity.

Because childhood obesity often persists into adulthood and is associated with numerous chronic illnesses, children who are obese are often tested for hypertension, diabetes, hyperlipidemia and fatty liver.

“Expectant mothers should maintain good BMI during their pregnancy. According to WHO, babies who are only breastfed for the first six months have less chances of becoming obese later in childhood,” says Jishy.

Nida advises that a healthy lifestyle coupled with a balanced diet and exercise are key solutions to this universal problem.

Health education and awareness can play a major role in addressing this growing issue as most people are not aware of the right sources of nutrients and the quantities that should be consumed.

“There is a lot of generalised information but knowledge is limited and not customised, according to individual needs, which is why people find it difficult to lose weight,” she says.

Mini Padikkal, clinical nutritionist at Atlas Hospital, says that educational institutions and teachers have an important responsibility.

“Children eat junk food at school canteens. These facilities should focus on providing healthy meals rich in vegetables and fruits and contain less refined sugars and carbohydrates. Fizzy drinks and other fructose-containing juices should be restricted. Most important is to raising children’s awareness and helping them switch to healthy food.”

Mini says a diet should be planned according to the age, gender, type of work and medical conditions of a particular person.

Food can be in its natural form or as supplements and meal replacements. It can also be grown organically or through genetic modification (GM), says Nida.

Dr-Mini-Padikkal

Mini Padikkal

“When natural food is not enough to provide the required amount of nutrients for a specific condition, then nutrients are extracted and made into supplements and meal replacements, she says.

Is Bariatric surgery an option? 

According to American Society for Metabolic and Bariatric Surgery (ASMBS), most bariatric surgery patients maintain successful weight loss long-term.

Successful weight loss is arbitrarily defined as weight loss equal to or greater than 50 per cent of excess body weight. Bariatric operations vary in the extent of malabsorption they may cause.

The more malabsorptive bariatric procedures also increase the risk for protein deficiency. Deficiencies in micronutrients (vitamin and minerals) and proteins can adversely affect health, causing fatigue, anaemia, bone and muscle loss, impaired night vision, low immunity, loss of appropriate nerve function and even cognitive defects.

Fortunately, nutrient deficiencies following surgery can be avoided with appropriate diet and use of dietary supplements.

According to ASMBS, the selection criteria for adolescents being considered for a bariatric procedure should include a BMI of ≥35 kg/m2 with major comorbidities (Type 2 diabetes mellitus, moderate to severe sleep apnea etc) or a BMI of ≥40 kg/m2 with other comorbidities (hypertension, insulin resistance, glucose intolerance, substantially impaired quality of life or activities of daily living, dyslipidemia).

The associated analysis should also include potential long-term health risks of untreated or inadequately treated obesity for the individual.

Tips for a healthy and balanced diet

Balanced-Diet
  • Reduce the consumption of energy-dense foods, such as those high in fat and sugars and increase intake of dietary fibre, lean proteins and whole grain carbohydrates.
  • Diet should include fresh fruits and vegetables with lots of water.
  • Avoid junk foods, processed juices and soft drinks.
  • Never cut calories too low as this causes the metabolism to slowdown, leading to loss of muscle mass. It’s vital to boost basalmetabolic rate by eating at least six small, healthy meals a day.
  • Red meat consumption should be limited.

Statistics in Oman and around the World

  • According to a 2015 WHO study, obesity is a leading preventable cause of death worldwide, with increasing incidence in adults and children. In 2014, 600mn adults (13 per cent) and 42mn children under the age of five were found to be obese.
  • Oman ranks 14th among the top 25 countries with most number of obese citizens, according to the WHO report.
  • In 2014, a report published by the Sultan Qaboos University (SQU) stated that 30 per cent of the Omani population was overweight and 20 per cent of Omanis was obese. The study also shows that 37.7 per cent of Omani women was obese.
  • Awareness on obesity is increasing in Oman compared to earlier. A lot of initiatives are still needed to prevent obesity, especially in the age group of ten to 25 years.

Sources: WHO report (2015)/ SQU report (2014)

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