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Author : Dr G C Khilnani M.D, FCCP(USA), FAMS, FICCM, FICP, FNCCP, FISDA Chairman, PSRI Institute of Pulmonary, Critical Care & Sleep Medicine PSRI Hospital, New Delhi
India
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Chandigarh, December 07, 2023:
Obesity affects approximately 42% of US adults (23% of Indian adults (15-43 yrs) in India) and is associated with increased rates of type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and premature death. In men with a BMI of 30 to 39, cardiovascular event rates are 20.21 per 1000 person-years compared with 13.72 per 1000 person-years in men with a normal BMI.
Obesity treatment includes interventions addressing 5 major categories: behavioural interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures. Physical activity without calorie reduction typically causes less weight loss (2-3 kg) but is important for weight-loss maintenance
Anti-obesity medications are recommended conjunction with lifestyle modifications. Weight loss from metabolic and bariatric surgeries ranges from 25% to 30% at 12 months. Weight loss improves glucose, lipids, blood pressure, and obesity-related comorbidities, however, maintaining long-term weight loss is difficult.
According to Dr G C Khilnani, “60% of persons with BMI of more than 30 Kg/m2 & 98% with BMI of > 40 have sleep apnea which is largely unrecognized which can be easily diagnosed by doing a Sleep study (performed in Hospital as well as at home).
Symptoms of Sleep Apnea include:
Loud, habitual snoring , Witnessed apneas (Choking at times) , Nocturnal awakening , Nocturia(Frequent urination in the night) nocturnal sweating , Unrefreshing sleep, morning headaches , Excessive daytime sleepiness , Automobile or work related accidents , Decreased libido, impotence , Irritability, memory loss, personality change.
Causes of Obesity are :
Adverse workplace, school, social, and home environments.
Greater availability of fast-food in restaurants and `Online”
Depression
Lack of exercise
Conditions associated with obesity include asthma, type 2 diabetes, hypertension, osteoarthritis, and cardiovascular disease, and sleep apnea. Weight loss beyond 15% is associated with lower rates of all-cause mortality and improved quality of life.
Strategies for weight reduction include:
Reduction or elimination of ultra processed foods (eg, sugar-sweetened beverages), Increased fruit and vegetable intake combined with increased physical activity. This should include 150 to 300 min/wk of moderate or 75 to 150min/week of vigorous physical activity as well as resistance training 2 to 3 times a week is recommended.
Use of weight-loss supplements, such as green tea extract or herbs, is not recommended. Anti-obesity medications and bariatric surgery are also available which should be taken only under medical supervision and should be the last resort
As India is growing economically, there is worrying increase in obesity in children, adolescents and young adults. Lac of Physical activity (out door activities in school and neighbourhood is receding) and consumption of `fast food’ at all times of the day and night is adding to that.
This has long term impact on health of our whole population as childhood obesity would usually continues in adulthood and later. The age old Indian tradition of consuming `home made’ food with discipline of time along with fixed sleeping hours have gone for a toss.
Dr G. C. Khilani said, every `artificial intervention’ to tackle morbid obesity including bariatric surgery and anti-obesity medication have their adverse effects. A change in life style starting from early childhood is the need of the hour. It is a wake up call for us with the knowledge that prevalence of obesity in USA that is o the tune of 42% .
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