The heavy burden of obesity

Trying to look sharp for your college reunion, family gathering, or office party are good reasons to lose weight. But there are even better reasons: your heart, your joints, your lungs – virtually every organ or system in your body will benefit from your maintaining a healthy weight. For obesity can cause or exacerbate many serious conditions, such as heart disease and stroke. It can also bring about or worsen numerous health problems, including diabetes, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and prostate and other cancers.

It is a fact of life for most people that as we age, we‘ll accumulate excess pounds even if we eat the same amount of food and exercise at the same intensity, because our metabolism naturally slows down. Even if you’ve managed not to gain weight, its distribution has probably changed. For example, men tend to develop "central obesity" – which in plain English, is a potbelly. Women, on the other hand, seem to store more fat around their hips.

Excess weight is a growing public health concern – even in a developing country like ours. That is why, the Philippine Association for the Study of Overweight and Obesity (PASOO), has been campaigning actively in the past few years, for Filipinos to eat a healthy diet and exercise regularly in order to avoid becoming overweight and developing obesity. And obesity is so threatening to cardiovascular health that the American Heart Association has named it one of the major risks for heart disease. Here’s a closer look at the all-important relationship between your health and your weight.

Heart Disease

Excess body fat puts a strain on your heart and directly influences important factors that increase your risk for heart attacks and stroke, including blood pressure, cholesterol and triglycerides – a dangerous type of blood fat. For example, any additional weight can raise your blood pressure, increasing the workload on your heart and causing it to enlarge and weaken over time. Obesity also lowers levels of beneficial HDL cholesterol. Studies show that fat gathered around the waist, the so-called apple shape, is more dangerous to the heart than fat gathered in the hips (pear shaped).

Diabetes

Obesity makes the onset of non-insulin dependent or type 2 diabetes far more likely. In fact, 80-90 percent of all people diagnosed with this condition are obese. Diabetes is a strong precursor of coronary problems. In fact, 80 percent of all people with diabetes die from some form of heart or blood vessel disease.

In particular, excess weight increases insulin resistance, a condition that makes it more difficult to control glucose levels properly. Over time, elevated blood sugars can lead to damaged arteries, which in turn are more prone to atherosclerotic plaques. In short, being obese can be the beginning of a potentially deadly chain reaction.

Arthritis

Any excess pounds you carry will affect the weight-bearing joints – your hips and knees. Perhaps an extra 10 to 20 pounds doesn’t seem like such a a great stress. But consider that the cartilage in the knee, which is supposed to absorb shock and protect the joint, is no thicker than a one peso coin, and it gets easier to understand how even small amounts of extra weight can hurt. Obesity can accelerate arthritis and the need for hip or knee joint replacement surgery.

Back Pain

If you don’t keep to a desirable weight, the flabby stomach you’ll develop will decrease your abdominal muscle strength, which can then put tremendous strain on your spine and lead to bad bouts of back pain. Conversely, when you lose weight, you’re more likely to increase your abdominal strength, which in turn flattens your profile and lessens the strain on your back.

The Good News

There is an upside to this somewhat daunting picture. By targeting just one factor – your weight – you can slow or reverse the progress of any number of conditions or diseases. Thus, weight control should be an integral part of your personal wellness program. Rather than just trying to control your blood sugar or reduce your blood pressure, it makes more holistic sense to get to the potential root of these problems and lose weight.

Experience has shown that with a bit of effort to lose pounds, most people do fairly well. In fact, losing even 10-20 pounds will not only ease the pressure on your joints and back – it may also reduce high blood pressure, lower total cholesterol levels, and help control glucose while improving insulin resistance and raising HDL.

Desirable Weight?

Among the various key markers in assessing who’s really overweight, the body mass index (BMI) is the most widely accepted because it’s an actual measure of excess fat. Since the index identifies weight relative to height, it’s measured using weight (in kilograms) divided by height (in meters squared). If the result is between 18.5 and 24.9, it is regarded as an ideal or healthy weight for you. If your BMI is between 25 and 29.9, you are considered overweight. And if it’s over 30, you’re obese. As your BMI increases, so do your blood pressure and total cholesterol. And the level of your HDL drops.

Last year, the WHO, however, recommended that obesity be redefined – and that a new set of criteria be adopted specifically for Asian populations, including Filipinos. It noted that the current WHO standards of obesity are appropriate for Europeans and North Americans but not for Asians. For one thing, Asians have smaller frames compared to Caucasians, and thus, should not be judged on a similar basis. Furthermore, while the prevalence of obesity is lower in Asia than in Europe, the health risks associated with obesity occur at a lower body mass index among Asians. Indeed, recent research has shown that obesity-related illnesses, such as hypertension, diabetes and cardiovascular diseases, tend to occur at lower BMI levels in Asians.

The WHO proposes that the ideal or healthy weight for Asians should be at a BMI of 18.5 to 22.9 (vs. 18.5 to 24.9), overweight at 23 to 24.9 (vs. 25 to 29.9), and obese, at 25 and above (vs. 30 and above in Caucasians). This new WHO lower cutoff BMI for overweight and obesity for Asians will increase the Filipino overweight population to 23.3 percent (from the current 16.9) and the obese population to 20.1 percent (from the present 3.1 percent).

There are studies which show that the new WHO Asian proposal may prove to be a more realistic classification. An article published only two months ago in the Archives of Internal Medicine found that significant health risks occur even for those who are not quite overweight, based on the Western criteria adopted for measuring obesity.

Alison E. Field, assistant professor of Medicine at Harvard and lead author of the study, said, "It really suggests that the health risks (of extra weight) may have been underestimated." The findings were drawn from two large, longitudinal studies of more than 120,000 middle-aged female professionals. They showed that even those who were in the upper limits of the so-called "healthy weight range" had significantly increased their risk of diabetes, gallstones, high blood pressure, high cholesterol and colon cancer – when compared to those in the lower limits of the healthy BMI range.

"We’re not suggesting that everyone get down to a BMI of 18.5 to 21.9, although that is the healthiest BMI to have," Field said. "But it is important to realize that one is not risk-free when he or she reaches that BMI of 25. It gives people a false sense of security to think that as long as they are still within the ‘normal healthy weight range,’ their health risks are very low." In view of the results of this landmark study, the new WHO weight criteria for Asians now appear to be a more appropriate classification when one compares health risks and morbidity with the degree of overweight and obesity.

Goals

The US National Institutes of Health guidelines suggest that losing 10 percent of baseline weight over six months is an ideal target for most people in reducing obesity-related health-risk factors. It may not be a simple task, but it’s definitely worth it. If you are unsure of how best to lose weight, ask your doctor or get a referral to a nutritionist or dietitian for specific advice. They have special training in the best and safest ways to lose – or just control – your weight. They can help with meal planning, calorie counting, reading food labels and reducing fat grams. In general though, the rules are simple: Eat less and move more.

If you are seriously overweight, your physician may consider some of the newer weight-loss drugs, such as Xenical (orlistat) and Reductil (sibutramine HCI). Although they all have side effects, they can be very effective when used in a medically-supervised program.

In any case, by being aware of the problems that obesity can trigger and by making changes, you’ll look better – and you just might look sharp for that college reunion, family gathering, or office party, you are planning to attend. More important, you’ll feel better and be healthier, too.