Obesity is a complex issue. It has effects on many aspects of our life. Being overweight is a major risk factor for heart disease, diabetes, fatty liver/cirrhosis, chronic kidney disease, joint, and muscle aches and pains, digestive difficulties like heartburn, and some cancers. The more weight we put on we increase the chance of chronic medical conditions and it makes their management harder.
There are several videos in this post and they are open for debate. We do not agree with every point made in these videos.
Obesity medical definition :
Body mass index: weight in kilograms divided by the square of the height in meters. Calculate your BMI here.
Definition of obesity is body mass index over 30. Healthy weight is BMI between 20-25 and over 25 up to 30 is overweight.
If our weight is in the normal range but we believe we have localized fat, click here for more information.
If we do body-building exercises we should be cautious in interpreting BMI. It may not apply if we have a large bulk of muscles. There are other methods to check on body fat.
Obesity in Australia?
In 2014–15, almost two-thirds (63%) of Australian adults were overweight or obese. 11.2 million adults were overweight or obese (ABS 2015). About 1 in 4 adults (28%) were obese. For obesity, statistics click here.
Should you ever tell someone they are fat?
Obesity in children:
In 2014–15, about 1 in 4 (26%) Australian children and adolescents aged 2–17 were overweight or obese. That’s around 1.2 million children and adolescents (ABS 2015). About 1 in 6 (18%) children and adolescents aged 2–17 were overweight but not obese, while about 1 in 13 (8%) were obese. Read more about obesity statistics in Australia here.
The psychological impact of obesity on our children:
" In one study there were 212 children aged 8 to 13 years at baseline, who were participating in the Childhood Growth and Development (GAD) Study. Questionnaire and interview measures were used to assess children's self-esteem, depressive symptoms, body image, eating disorder symptoms, experiences with bullying, family satisfaction, and quality of life. Linear mixed models were used to consider longitudinal changes in psycho-social variables. Overweight and obese children reported greater psycho-social distress than healthy weight children, and these differences were more pronounced for girls than boys.
The results of this study suggest that psycho-social difficulties show considerable stability in childhood, for overweight/obese and healthy weight children. What has been Known: • Childhood obesity tracks into adolescence and adulthood. • Physical health problems associated with childhood obesity also persist to adulthood. What is New: • Overweight and obese children are at risk of ongoing psycho-social distress from childhood into early adolescence." Link to study.
In our GP practices, we see more children especially young girls ( as young as 6-7 yr old) worried about their weight and suffering from anxiety because of it. While their weight is mostly within normal limits, they listen to adults talking and being worried about their weight. We should be careful about the information and worries we pass to our children.
Obesity Causes and meaning:
Environment factors:
1-Increasing food supplies and consumption, especially high-calorie foods that are often served in large portions,
2-Decreasing time in occupational physical activities
3-Displacement of leisure-time physical activities with Sedentary activities like electronic devices
and watching television,
4- Growing use of medications that have the side effect of weight gain
5- Inadequate sleep
Genetic factors:
Not everyone in the same condition becomes obese which suggests the existence of underlying genetic mechanisms operating at the individual level.
Twin studies indicate that the rate of heritability of BMI is high ranging from 40 to 70%. Eleven rare genetic forms of obesity are found.
Energy-Balance Dysregulation:
Genes and the environment interact in a complex system that regulates energy balance. Two sets of nerve cells in the hypothalamus in the brain control energy balance by regulating food intake and energy expenditure.
Short-term and long-term energy balance is controlled through a coordinated network of central mechanisms and peripheral signals from cells in fat tissue, stomach, pancreas, and other organs.
Obesity treatment:
The first step is the measurement, monitoring, and seeking more information. We need to have a regular measurement of size and weight. By regular monitoring, we can see if we are getting to a healthy weight ( BMI 20-25) or not.
A realistic treatment plan divides into two main sections: losing weight and maintaining weight. We may lose 10 kg in one month with a very strict diet and heavy exercise but we may not be able to maintain it.
To maintain a healthy weight we need to have a healthy lifestyle, balanced diet, and regular exercise.
A weight loss plan should be aligned with other chronic medical conditions, functional limitations, and severity of overweight.
Lifestyle modification is the first option. It has low cost and minimal complications. In lifestyle modification/intervention we change our eating habits and physical activities.
In lifestyle intervention, we learn techniques for a healthy diet and physical activities. The main issues are regular recording of food intake, physical activities, and weight. Most smartphones have apps for monitoring diet, exercise, and weight. If you are looking for additional apps, please click here.
Diet for weight loss: Low-calorie diet, typically 1200-1500 Kcal per day for women and 1500-1800 Kcal per day for men.
Diet for weight loss maintenance: Reduced calorie diet according to reduced body weight.
Physical activities for weight loss: More than 150 min aerobic activity per week ( Swimming, exercise bike, push bike, brisk walking, rower machine,...)
Physical activities for weight loss maintenance: 200-300 min of aerobic activities per week.
Please note that to maintain a healthy weight we may need more physical activities up to 2 times of weight loss program itself.
Regular counseling and encouragement are needed for this weight loss plan. If delivered by a trained and experienced health professional, weight loss of 5-8% (on average) can be achieved.
Recommendation only from general practitioners is not enough. Nutrition counseling, activity modification
Medications:
Medication can be used as a supplement to a reduced-calorie diet and increased activity for weight management. Medications can be considered if BMI is over 30 or 25-30 but with related medical conditions.
Please discuss medications with your GP. There are many aspects of weight loss medications ( like indication, contraindication, side effects, dosage,... ) that we need to talk about with our GP before starting medication.
Orlistat (Xenical): Enzyme inhibitor resulting in fat absorption and reduces energy intake.
Liraglutide (Saxenda): Delays stomach emptying to reduce food intake.
Phentermine ( Duromine): Decreases appetite to reduce food intake.
Naltrexone/Bupropion (Contrave): Has effects on the brain to reduce food intake (appetite)
Bariatric surgery:
There are several techniques and procedures for weight loss surgery :
gastric (stomach) stapling
gastric banding
bowel bypass
jaw wiring.
Whether to have surgery or not is a question that needs a long discussion with GP and later surgeon, dietitian, and plastic surgeon. We need more information about different aspects of procedures and their effects on our bodies.
For a public hospital in VIC see these links:
An excellent resource for Bariatric surgery in a public hospital,VIC
Please see different techniques in the bariatric surgery video:
Patient's experience of bariatric experience:
VIC Medical Doctors as obesity centre:
In our medical centres in Northcote, Doncaster, and Brisbane we have experienced doctors, nurses, dietitians, exercise physiologists, and psychologists to investigate the causes of our obesity/overweight, and make a weight loss plan and monitor our progress through the weight loss plan. If needed we liaise with a different specialists as well.
In preparing this post I enjoyed reading Steven B. Heymsfield MD's review article ( Mechanisms, Pathophysiology, and management of Obesity) in New England Journal of Medicine 2017; 376: 254-66
Please leave your comments about your weight loss experience.