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Health Benefits of Exercise: a grossly underutilised therapy

Introduction

Exercise is being increasingly recognised to play an important role not only in the prevention but treatment as well of multiple lifestyle diseases (chronic diseases), health conditions and risk factors associated with these. In view of the above, exercise is now aptly being recognised as medicine. It is the cornerstone of lifestyle modification to achieve Holistic Health. However, like any other medicine, exercise too has some associated risks, though benefits of exercise on health, far outweigh the risks. However, before proceeding with the benefits and risks associated with exercise, it would be pertinent to understand some important related terms. Even though physical activity and exercise are often used interchangeably, they are not synonymous. The definition of these and some closely related terms are given below:

People of different age, gender and categories participating in different physical activities.
People of different age, gender and categories participating in different physical activities.
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Weight Bias: pervasive yet hidden harm of obesity

Introduction

Worldwide prevalence of obesity has been increasing at a menacing pace. As per WHO data, the incidence of obesity worldwide has tripled since 1975. As discussed in my post ‘Is obesity a disease or a risk factor for other conditions?’ in 2016 more than 1.9 billion adults, 18 years and older, were overweight; of these 650 million were obese. It has assumed epidemic proportions in children too. As discussed in my post ‘Childhood obesity: a serious public health challenge’, as per a study led by Imperial College of London and WHO, in a span of just 40 years, the number of school-age children and adolescents (5-19 years of age) with obesity has risen more than 10-fold from 11 million in 1975 to 124 million in 2016. Unfortunately, the obesity epidemic has been accompanied by a parallel epidemic of weight bias.

Rally for end to 'shaming and blaming' people for weight.
Rally for end to ‘shaming and blaming’ people for weight.

In my post ‘Complications of obesity: the mother of all diseases’, I had highlighted that obesity affects almost every aspect of health, from reproductive and respiratory function to memory and mood. Among the various psycho-social complications of obesity, I had discussed weight bias, which negatively affects not only psychological well-being but physical health as well. Although weight bias is pervasive in society and undermines people’s health extensively, awareness about it is very limited. In order to raise awareness about the prevalence, severity and diversity of weight stigma, the World Obesity Federation chose ‘End Weight Stigma’ as the theme for the World Obesity day 2018. To begin with, to help understand the topic better, the term weight bias and other related terms will be explained here briefly.

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Complications of Obesity: the mother of all diseases

Introduction

In my post ‘What is Obesity – is it merely about BMI? I had discussed the definition of obesity, as laid down by the WHO, as “A condition of abnormal or excessive body fat accumulation, to the extent that health may be impaired.” People who are obese are at increased risk for many serious diseases and health conditions, compared to those with a normal or healthy weight. However, in my post “Normal weight obesity – a myth or a reality?” I had discounted a widely prevalent myth amongst the general populace that ‘normal body weight always equals healthy weight’. There I had discussed a subset of individuals, among individuals with normal body weight, who develop and suffer from complications of obesity similar to individuals with a more ‘overt’ obesity.

Obesity affects almost every aspect of health, from reproductive and respiratory function to memory and mood. It decreases both the lifespan and the quality of life and increases costs of health care, both at the individual as well as at the national level. It does this through a variety of pathways; some as straightforward as the mechanical stress of carrying extra weight and some as a result of excessive secretion of certain products by enlarged fat cells and ectopic fat depots. The mechanisms by which obesity gives rise to its various ill-effects on health were discussed in my post “Is obesity a disease or a risk factor for other complications?”

However, the good news is that weight loss can reduce some of the risks associated with obesity. Loss of as little as 5 to 10 per cent of body weight provides substantial health benefits to people, and even if they begin to lose weight later in life.

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Childhood obesity: a serious public health challenge.

Introduction

Childhood obesity has reached epidemic proportions and is today one of the most serious public health challenges of the 21st century. The problem is global; even though, more recently the childhood obesity rates appear to be plateauing in high-income countries, albeit at unacceptably high levels, they continue to soar in low- and middle-income countries. A study led by Imperial College, London and WHO, which analysed weight and height measurements from nearly 130 million people, including 31.5 million children aged 5-19 years of age, was published in ‘The Lancet’, a prestigious medical journal, on the eve of the World Obesity Day on 11th Oct 2017. According to the study, the areas of the world with some of the largest increase in the number of obese children and adolescents were East Asia and the Middle East and North Africa.

The rise in childhood obesity rates has recently accelerated, especially in Asia. According to the study, the world will have more obese children and adolescents than underweight by 2022. Unfortunately, in spite of the rapid rise in child and adolescent obesity rates globally, few countries are taking action against this damaging health issue. To focus world attention on this burning issue, World Obesity federation chose the theme ‘Childhood Obesity’ for the World Obesity day 2017, celebrated on 11th Oct each year.

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Waist Size: Measure your waist, measure your risk.

Introduction

In 1997 the World Health Organisation (WHO) Expert Consultation on Obesity recognised the importance of abdominal fat mass (referred to as abdominal, central or visceral obesity), which can vary considerably within a narrow range of total body fat and body mass index (BMI). It also highlighted the need for other indicators to complement the measurement of BMI, to identify individuals at increased risk of obesity-related diseases. Two such proxy measures of abdominal obesity, which can complement the measure of BMI are waist size (circumference) and waist-to-hip ratio (WHR).

In my post ‘What is obesity – is it merely about BMI? What is obesity? I had highlighted that over the years, starting from the early 1980s, many research studies had confirmed the notion that rather than the excess body fat per se, regional distribution of body fat at different anatomic sites was much more important in driving the risk of cardiovascular diseases and other health hazards linked to obesity. In the same post I had described ‘abdominal obesity’ (individuals with excess intra-abdominal fat) and a characteristic obesity phenotype – ‘Asian Indian Phenotype or Paradox’ (Asians, particularly people in South-East Asia and China, displaying a greater amount of intra-abdominal fat for a given waist size [circumference] or BMI).

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Body Mass Index (BMI) – is it the best measure of obesity?

Introduction

          In my post “What is Obesity – is it merely about BMI? What is obesity? I had defined obesity as an abnormal accumulation of fat such that health is impaired. Body Mass Index is the most widely used measure of identifying obesity. However, in my post, I had cautioned that contrary to the general perception, obesity is not about BMI. In this post, I will be discussing what is Body Mass Index, its advantages and limitations. In addition to describing the method for calculation of BMI, for the ease of readers, I will be briefly discussing ‘BMI calculator tool’ and ‘BMI charts’.

What is Body Mass Index

Body Mass Index is a simple index of weight-for-height that is commonly used to assess ‘normalcy’ for body weight. It is defined as the body mass divided by the square of the body height. It is universally expressed in units of kg/m2, resulting from body mass in kilograms and height in meters. If pounds and inches are used as a measure of body mass and height respectively, a conversion factor of 703 is used. The formula for calculation of Body Mass Index  is as under:

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Normal Weight Obesity – a myth or a reality?

Introduction

There is a widely prevalent myth amongst the populace that normal body weight always equals healthy weight and they do not need to worry about practising healthy lifestyle behaviours. However, nothing could be further from the truth. Normal weight obesity is well recognised entity. In my post “What is obesity – is it merely about BMI?” What is obesity? obesity had been defined as “excessive body fat accumulation (not weighing too much), which is associated with clear risks to health.” Surprisingly, even though obesity has been defined as the presence of ‘excess’ fat, there is no consensus on how to define obesity based on body fat content or body fat percentage.

WHO has established Body Mass Index (BMI) as the parameter for identifying overweight and obesity. Because of its simplicity, it has become a popular tool for assessing the prevalence of obesity and overweight at the population level. However, BMI has some serious limitations which will be discussed in detail in a subsequent post. The main limitation of BMI is that it cannot differentiate body fat from lean (fat-free) mass and central (intra-abdominal fat or visceral fat; colloquially known as belly fat) from peripheral fat. As a result, current BMI criteria miss more than half of the individuals with increased body fat percentage, who would otherwise be categorised as ‘obese’ using the WHO criteria of excess body fat, especially in older adults.

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What is obesity – is it merely about BMI?

Introduction

In my earlier post “Is obesity a disease or a risk factor for other conditions”? I had highlighted that now obesity is recognised universally as ‘a chronic, relapsing, progressive disease process.’ However, misconceptions still abound about ‘what is obesity’, not only in the public at large but even among the health professionals. Traditionally, when talking about what is obesity, we tend to erroneously confuse how we measure obesity with the definition of obesity. One such popular and well-known measure of obesity, which will be discussed subsequently, is Body Mass Index (BMI). BMI However, obesity is not about BMI; at its most basic, the term obesity describes the presence of ‘excess’ fat in the body. 

Definition of obesity

In the year 1998, WHO defined obesity as under:

“A condition of abnormal or excessive body fat accumulation, to the extent that health may be impaired.”

In the year 2010, Scottish Intercollegiate Guidelines Network, part of the NHS Quality Improvement Scotland, described obesity as under:

“Obesity is defined as a disease process characterised by excessive body fat accumulation with multiple organ-specific consequences.”

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Is obesity a disease or a risk factor for other conditions?

Introduction

As I begin writing about obesity on my blog, I want to start by addressing a fundamental question – Is obesity a disease? Or it is primarily a risk factor for other conditions rather than a disease in its own right? What is obesity? The issue has been historically debated. The need to address this question has been warranted by the emergence of obesity as a global epidemic and its implications for health. Chronic Diseases: the Silent Killers.

Obesity bias or weight bias - a hidden harm
Obesity bias or weight bias.

Magnitude of obesity

Before we address the question, is obesity a disease? let us consider the prevalence of obesity globally. As per WHO data, worldwide obesity has tripled since 1975. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these 650 million were obese. In terms of percentage, these figures translate to 39% and 13% respectively, of adults aged 18 years and over. As will be discussed in subsequent posts, obesity is responsible for the growing prevalence of various lifestyle diseases. As a result, obesity has come to be regarded as “the single greatest threat to public health for this century.” More worryingly, childhood obesity has been growing at a menacing pace. As per WHO, 41 million children under the age of 5 were overweight or obese in 2016. Over 340 million children and adolescents were overweight or obese in 2016. Almost half of all overweight children under 5 lived in Asia and one quarter lived in Africa.

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Chronic Diseases: the Silent Killers

Introduction

Chronic diseases, also known as noncommunicable diseases or lifestyle diseases, are the leading killers and cause an unacceptable number of people to die prematurely and often after years of needless suffering and disability. Is obesity a disease? Unfortunately, this trend is increasing at a rapid pace. As per the WHO data, while in the year 2005, 60% of total deaths globally (35 million out of estimated 58 million deaths) were on account of these diseases, in the year 2012 this number jumped to 68% (38 million out of 56 million deaths) and in 2015 this figure increased to 70%. This is more than double the number of deaths from all infectious diseases (including HIV/AIDS, tuberculosis, and malaria), maternal and perinatal (relating to the time immediately before and after a birth) conditions, and nutritional deficiencies combined. More than 40% of these (16 million) were premature deaths under the age of 70 years. Lifestyle diseases: the biggest man-made disaster.

Impact of Chronic Diseases

These conditions not only cause premature deaths, and enormous suffering, severely impacting the quality of life, but also threaten the economy of a country and reduce developmental potential.

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