After Independence, India was struggling with drought, famine and starvation which lead to malnutrition. But in the past few decades, due to economic growth, abundance of crops and change in lifestyle, the country has developed another nutritional problem – obesity.
According to the National Family Health Survey (NFHS-4), in the past 10 years the number of obese people has doubled in the country. As per the survey, people having Body Mass Index (BMI) more than 25 kilogram per metre square have been considered as obese. The prevalence of obesity is 12.6% in women and 9.3% in men. In other words, more than a 100 million individuals are obese in India.
As per the latest Lancet study on the prevalence of obesity among the people of Gujarat from 1990 to 2016, the prevalence of obesity among people above 20 years is rising. There has been a 149% rise among men and 121.6% rise among women in this decade.
Obesity in India differs from the rest of the world and is marked by the ‘thin-fat phenotype’. This refers to a high proportion of body fat, abdominal obesity, and visceral fat. Obesity usually results from a combination of causes and contributing factors including:
Genetics: The genes may affect the amount of body fat store, and where that fat is distributed. Genetics may also play a role in how efficiently the body converts food into energy and how the body burns calories during exercise. We have shifted from the problems of starvation and malnutrition to growth and abundance in just 2 to 3 decades but, unfortunately, our genes have not adopted this quick change.
Family Lifestyle: Obesity tends to run in families. If one or both of the parents are obese, the risk of being obese is increased. That’s not just because of genetics but also because family members tend to share similar eating and activity habits, way of thinking and behaviour.
Inactivity: If a person is not very active, they do not burn much calories. With a sedentary lifestyle, one can easily consume more calories every day than burning them through exercise and routine daily activities. On top of that, if someone has any medical problems, such as arthritis, it can lead to decreased activity which also contributes to overall weight gain.
Our outdoor activities have been restricted due to excessive use of vehicles, and that too self-start vehicles, instead of walking which is the main reason of physical inactivity. At home as well, mobile phone usage, remote control usage, and watching TV has reduced our physical activity. Outdoor games in urban area has now almost reduced and most of the children and youth have restricted themselves to indoor games, thus, contributing to reduced physical inactivity.
Unhealthy Diet: A diet that’s high in calories, lacking in fruits and vegetables, full of junk foods, and loaded with high-calorie beverages and oversized portions contributes to weight gain. Meeting and snacking also add extra caloric burden. Moreover, at home while watching TV or working on mobile, frequent snacking also adds to the caloric burden.
Medical Problems: In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome (PWS), Cushing’s syndrome, and other conditions. Medical problems, such as arthritis, can also lead to decreased activity, which may further result in weight gain.
Certain Medications: Some medications can lead to weight gain if you don’t compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta-blockers.
Social-Economic Issues: Research has linked social and economic factors to obesity. Avoiding obesity is difficult if there is no safe area to exercise. Similarly, one may not have been taught healthy ways of cooking, or may not have money to buy healthier foods. In addition, the people we spend time with may influence our weight are more likely to become obese if we have obese friends or relatives.
Age: Obesity can occur at any age, even in young children. But as the age hormonal changes and a less active lifestyle increase the risk of obesity. In addition, the amount of muscle in the body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs, and can make it harder to keep off excess weight. If you don’t consciously control what you eat and become more physically active as you age, you’ll likely gain weight.
Pregnancy: During pregnancy, a woman’s weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain might contribute to the development of obesity in women later.
Quitting smoking: Quitting smoking is often associated with weight gain. And for some, it can even lead to enough weight gain that the person becomes obese. In the long run, however, quitting smoking is still a greater benefit to the health than continuing to smoke.
Lack of sleep: Not getting enough sleep or getting too much sleep can cause changes in hormones that increase the appetite. It may also lead to a craving for foods that are high in calories and carbohydrates, which can contribute to weight gain.
An individual is more likely to develop a number of potentially serious health problems, including:
- High triglycerides and low high-density lipoprotein (HDL) cholesterol
- Type 2 diabetes
- High blood pressure
- Metabolic syndrome — a combination of high blood sugar, high blood pressure, high triglycerides and low HDL cholesterol, Heart disease, Stroke
- Cancer – including cancer of the uterus, cervix, endometrium, ovaries, breast, colon, rectum, oesophagus, liver, gallbladder, pancreas, kidney and prostate
- Breathing disorders, including sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts
- Gallbladder disease
- Gynaecological problems, such as infertility and irregular periods, polycystic ovarian disease (PCOD)
- Erectile dysfunction and sexual health issues
- Non-alcoholic fatty liver disease – a condition in which fat builds up in the liver and can cause inflammation or scarring
- Osteoarthritis of knees and spine related problems
Obesity is managed and treated to decrease the numerous health risks caused by it and to improve the quality of life. Balanced diet and Fad and crash diets don’t work and can be dangerous. The body needs a minimum amount of energy from food to function normally. Losing weight successfully and maintaining a healthy weight requires life-long changes in eating and exercise habits, as well as an understanding of emotional factors that lead to over-eating. Medications aren’t “magic cures” leading to permanent weight loss. They’re generally used in combination with a proper diet and exercise program.
There are many forms of obesity surgery, but often surgery reduces the size of the stomach so that only a small amount of food can be eaten comfortably.
If someone is concerned about weight-related health problems and think they may be obese, it is advised to consult their doctor or healthcare provider. They would evaluate the health risks and discuss weight-loss options, thereby guiding to live a healthy life.
The author, Dr. Joozer Rangwala is a Senior Consultant – Internal Medicine & Diabetologist, Narayana Multispeciality Hospital, Ahmedabad.