Understanding Obesity

Basically the term obesity means excess of body weight due to increase in adipose tissue-mass. It is important to understand the cause of obesity for its effective management. Weight measures in excess of 'ideal body weight' with reference to normal range ideal for age, sex, height and body built. To define obesity we should measure the adiposity by measuring the skinfold thickness at triceps (normal: 23mm in males and 27mm in females) or at inter scapular region (normal: 35mm in males and 42mm in females). In most of the cases the obesity is due to overeating while in minority it could be associated with the metabolic and endocrine disorders. Beyond certain degree, obesity may increase the state of morbidity and cause associated diseases like diabetes mellitus, hypertension, coronary artery disease (CAD), gall stones, osteoarthritis etc.

Understanding patient's eating habits, likes & dislikes, temperaments, lifestyle, work schedules and adaptability to environment are important to decide a course of treatment. Compliance of doctor's advice is important for effective treatment of obesity. Dietary measurements, exercise and slimming pills are always helpful in controlling the obesity. Treatment of associated metabolic or endocrine disorders should be pursued effectively.

Dietary management:

A variety of dietary schedules ranging from zero calorie to isocaloric high protein diets are available for the treatment of obesity. Diet should be adjusted in such a way that weight loss is not in excess of one kg/week. For the success of diet regime it is important to keep a balance between 'forbidden' and 'permitted' items. Too much recommendation of low carbohydrate diet sometimes leads to a notion that non-carbohydrate diets are absolutely harmless. Rapid weight loss through zero calorie diet or fasting may sometimes be non productive as the weight lost due to loss of water would be regained quickly. The 'ad lib' items should be salads and leafy vegetables.

Exercise:

Exercise is known to increase calorie expenditure and thus leads to loss of adiposity. Exercise also increases our metabolic rate and thus supports the weight loss. In practice, however, exercise alone cannot be sufficient way to try to reduce weight. Exercise along with dietary control is good for both the general fitness and weight loss.

Anti-obesity drugs:

There are a variety of drugs for combating the food-obesity axis. There are drugs for decreasing appetite, digestion, absorption and inhibiting lipogenesis. There drugs for increasing heat production or thermogenesis. The drug treatment of obesity is not very promising, as the majority of drugs at effective therapeutic level have been found toxic.

Coronary Heart Disease and Dietary Interventions

Dyslipidemia is the main biochemical feature of coronary heart disease (CHD). Dyslipidemia refers to the elevated level of total cholesterol (TC) as well as triglycerides (TG) or a decreased level of high density lipoprotein (HDL). Dyslipidemia may result from alteration in the production of lipid components or due to abnormal catabolism or clearance as a result of environmental or genetic factors. Single or multiple gene mutations affecting the triglycerides/low density lipoprotein cholesterol are the cause of primary dyslipidemia. Sedentary life style or excessive dietary intake of saturated fat, cholesterol and trans fats can cause secondary dyslipidemia. Secondary dyslipidemia may also be caused due to certain health ailments, such as: diabetes mellitus (DM), obesity, chronic kidney disease, hypothyroidism, primary biliary cirrhosis and cholestatic liver disease. Overuse of alcohol and some drugs can also cause secondary dyslipidemia. Early identification and treatment of children with primary dyslipidemia or hyperlipidemia is important to prevent coronary heart disease. Screening is recommended for children above the age of two having positive family history of premature coronary heart disease, early heart disease. Positive family history of CHD refers to the history of angina pectoris, peripheral vascular disease, myocardial infarction, cerebrocardiac disease, coronary atherosclerosis or sudden death before the age of 55 years in parents, grand parents or first degree uncle or aunt.

Fasting cholesterol and low density lipoprotein (LDL) levels should be determined in the sera of children suspected to have dyslipidemia. Total cholesterol level <170 mg/dl and LDL <110 mg/dl are considered normal, whereas total cholesterol level >200 mg/dl and LDL >130 mg/dl are considered elevated in children. Levels between upper and lower limits could be called borderline values. Physical activity in the form of exercise and brisk walking should be encouraged to maintain weight control and endurance in insulin resistance in diabetics to prevent the risk of developing cardiovascular disease.

Dietary interventions play a vital role in the management of dyslipidemia. A diet low in saturated fat and cholesterol, high in complex carbohydrates should be encouraged for the normal growth and maintenance of desirable weight. Dietary fibre intake should be increased as it helps in reducing the blood cholesterol levels. 'Whole wheat flour bread', corn fakes and barley sattu should be preferred in addition to leafy vegetables. Regular intake of diet containing phytosterols/stanols, omega-3 fatty acid and Soya protein have been found to be effective to reduce the serum LDL cholesterol as well lowering the total cholesterol. Pharmacological treatment is recommended for managing the dyslipidemia in children at 10 years of age and adolescents with LDL>190mg/dl.