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Obesity is the state at which your body has excess fat. It is a common but often underestimated a condition of clinical and public health importance in many countries around the world. Its general acceptance by many societies as a sign of well-being or a symbol of high social status. But then, there is a denial by health care professionals and the public alike that it is a disease. In its own right, it has contributed to its improper identification and management and the lack of effective public health strategies to combat its rise to epidemic proportions.
WHAT IS OBESITY ALL ABOUT?
This health condition is defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired. The amount of excess fat in absolute terms, and its distribution in the body – either around the waist and trunk (abdominal, central or android obesity) or peripherally around the body. (gynoid obesity) have important health implications.
Being overweight or obese carries a range of negative health consequences. It is often a major risk factor for the development of several non-communicable diseases, significant disability, and premature death. The health risks associated with obesity are many. They include an overall increased risk of death from all causes, hypertension, type 2 diabetes, heart disease, stroke, osteoarthritis, and mental illness. Obesity is a common and preventable disease of clinical and public health importance.
There is presently a global epidemic of obesity in all age groups and in both developed and developing countries. The increasing prevalence of obesity places a large burden on health care use and costs. Weight loss is associated with significant health and economic benefits.
Effective weight loss strategies include dietary therapy, physical activity, and lifestyle modification. Drug therapy is reserved for obese or overweight patients who have concomitant obesity-related risk factors or diseases. Population-wide prevention programmes have a greater potential of stemming the obesity epidemic. And also of being more cost-effective than clinic-based weight-loss programmes. Obese children are more likely to grow into obese adults than their non-obese counterparts.
Data from a number of studies also provide robust evidence that children who are growth retarded at birth have an increased risk of becoming obese in later life. This phenomenon, which implies fetal programming of adult obesity, is particularly likely to occur when a low body weight at birth from intrauterine growth retardation (IUGR) is over-compensated for by a catch-up growth later in Life. Which makes this adiposity rebound occurs early in childhood.
Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally in 2010, the number of overweight children under the age of five is estimated to be over 42 million. Close to 35 million of these are living in developing countries.
CAUSES OF CHILDHOOD OBESITY
It is widely accepted that the increase in obesity results from an imbalance between energy intake and expenditure. Also with an increase in positive energy balance being closely associated with the lifestyle adopted and the dietary intake preferences. However, there is increasing evidence indicating that an individual genetic background is important in determining obesity risk. Research has made important contributions to our understanding of the factors associated with obesity not just in children but also in adults.
Genes are one of the biggest factors examined as a cause of obesity. Some studies have found that BMI is 25–40% heritable. However, genetic susceptibility often needs to be coupled with contributing environmental and behavioral factors in order to affect weight.
The genetic factor accounts for less than 5% of cases of childhood obesity. Therefore, while genetics can play a role in the development of obesity, it is not the cause of the dramatic increase in childhood obesity.
FAST FOOD CONSUMPTION
Increased fast food consumption has been linked to obesity in recent years. Many families, especially those with two parents working outside the home, opt for these places as they are often favored by their children. And are both convenient and inexpensive. Foods served at fast food restaurants tend to contain a high number of calories with low nutritional values.
Another factor that has been studied as a possible contributing factor to childhood obesity is the consumption of snack foods. Snack foods include foods such as chips, baked goods, and candy. Many studies have been conducted to examine whether these foods have contributed to the increase in childhood obesity. While snacking has been shown to increase overall caloric intake, no studies have been able to find a link between snacking and overweight.
A study examining children aged 9–14 from 1996–1998, found that consumption of sugary beverages increased BMI by small amounts over the years. Sugary drinks are another factor that has been examined as a potential contributing factor to obesity. Sugary drinks are often thought of as being limited to soda, but juice and other sweetened beverages fall into this category.
Many studies have examined the link between sugary drink consumption and weight and it has been continually found to be a contributing factor to being overweight. Sugary drinks are less filling than food and can be consumed quicker, which results in higher caloric intake.
INCREASED INSULIN SECRETION
This is a common consequence of obesity. The coexistence of hyperinsulinemia with normal or elevated blood glucose levels in obese individuals suggests the presence of ‘insulin resistance’, now well accepted as the common underlying mechanism for a number of disease states including hypertension, dyslipidemia, and cardiovascular diseases.
The aggregation of several of these cardiovascular disease risk factors, including obesity, in the same patient indicates the presence of the metabolic syndrome which has significant implications for
The increasing prevalence of obesity places a large burden on health care use and costs. A few studies show that 2–7 % of total health care expenditure in a country may be directly attributable to obesity, with the costs of hypertension representing 53 – 60% of the total direct costs of obesity. On the other hand, weight loss in obese individuals is associated with both clinical and economic benefits.
WEIGHT LOSS STRATEGIES
Weight loss and maintenance strategies include dietary therapy, physical activity, lifestyle modification, behavior therapy, pharmacotherapy, and occasionally surgery. Using these techniques, the goals are, at least to prevent further weight gain, or achieve weight reduction and maintain the lower body weight over the long term.
Several expert panels have suggested the best methods of assessing and treating obesity. Currently, weight loss therapy is recommended for patients with a BMI ≥ 30 kg/m2 and those with a BMI between 25 and 29.9 kg/m2 or a high-risk waist circumference who additionally have two or more cardiovascular risk factors. Treatment must be geared to a 10-percent body weight reduction over a 6-month period, at a rate of 0.5 to 1 kg per week (2 – 4 kg per month).
Dietary therapy should ensure an intake reduced by 500 to 1,000 kcal/day from the current level. Low-calorie diets (LCDs) containing 1,000 to 1,200 kcal/day for most women and between 1,200 kcal/day and 1,600 kcal/day for men can result in sufficient weight reduction. Very low-calorie diets (VLCDs) containing less than 800 kcal/day are no more effective than LCDs in producing weight loss and are to be discouraged.
Human Physical Activities
Physical activity increases energy expenditure and also reduces the risk of heart disease more than that achieved by weight loss alone. Physical activity (walking, dancing, gardening, household chores, and team or individual sports) should be increased slowly to a level that ensures at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week. Behavioral strategies including self-monitoring, stress management, and social support can enhance the gains from dietary methods and physical activity.
Drug therapy should be used only in conjunction with diet, physical activity changes, and behavior therapy and only when these measures have failed to promote weight loss after six months. Orlistat, an oral pancreatic lipase inhibitor which inhibits the absorption of 30% of ingested fat from the intestine, is currently the only drug approved by the “Ghana Food and Drugs Board” for long-term treatment of obesity.
The side-effects of the drug therapy may include abdominal pain, flatulence and oily stools following a meal containing fat. Weight loss surgery, using various techniques, is an option only for well-informed and motivated patients who have clinically severe obesity and accompanied by serious co-morbid conditions.
Prevention is the key to controlling the obesity epidemic. The various prevention strategies recommended by the WHO include; a universal or public health approach directed at all members of a community; a selective approach directed at high-risk individuals and groups; and a targeted approach directed at individuals with weight-related problems and those at high risk of diseases associated with overweight and obesity.
The population-wide obesity prevention programs have a greater potential of stemming the obesity epidemic and being more cost-effective than the clinic-based treatments. The WHO has further suggested the incorporation
of the objectives of obesity prevention into the strategies and programmes for controlling other CVD-related non-communicable diseases (NCDs) since many of these conditions share common risk factors.
They also work at training healthcare professionals so that they can effectively support people who need to lose weight and help others avoid gaining weight. Here’s what you can do to lose weight or avoid becoming overweight or obese:
- Eat more fruit, vegetables, nuts, and whole grains.
- Exercise moderately, for at least 30 minutes a day.
- Cut down your consumption of fatty and sugary foods.
- Use vegetable-based oils rather than animal-based fats.