Obesity

Obesity is an abnormal and excessive accumulation of body fat well above the normal range of weight for a given age, sex and height. It poses a major health risk due to its manifold effects on multiple organs of the body as also due to its psychological impact on the individual concerned. Obese persons have been found to be maladapted socially as well as psychologically giving rise to wide ranging health concerns.

Obesity is essentially the outcome of an imbalance in the intake and output ratio. If the calories ingested are not expended, they pile up in the body and over a period of time result in obesity. That is the most simple explanation of obesity. However it is much more complicated than seems otherwise. Factors which may result in obesity include genetic, psychological and social influences to which are added the complex effects of man and environment interactions.

We have two centres in the brain which influence eating patterns,

 A feeding centre, which sends signals to the brain and stimulates appetite and

 A satiety centre, which inhibits the feeding centre.

After a meal due to the presence of food in the stomach and due to increased levels of the hormone insulin which is secreted in response to carbohydrate intake, the satiety centre is stimulated which inhibits the feeding centre which in turn sends signals of ‘STOP EATING’ to the brain. In many obese patients, their response to these internal signals are overwhelmed by their response to external signals like sight, smell and taste of food, company of friends, social setting etc. The result is that they ignore these internal cues and tend to overeat. Lifestyle factors like sedentary habits, limited physical exercise, indulgence in rich fatty food, preoccupation with electronic gadgets and reluctance for open air sports, ingestion of carbonated drinks and packed, processed foods – all lead to a complex interplay of forces which eventually upset the metabolic balance of the body and lead to obesity. Prolonged inactivity due to illnesses, hospitalization or injuries also diminish the expenditure of calories. Endocrinal disturbances and certain drugs also predispose to obesity.

Obesity leads to the following effects on the human body

1. Dyslipidemia – Increase in cholesterol, triglycerides with a skewed lipid ratio.
2. Diabetes Mellitus – Overfeeding leads to an overworked pancreas and eventual exhaustion of insulin secretion which leads to diabetes.
3. Hypertension – Excessive fat is deposited on the inner wall of arteries leading to atherosclerosis ie narrowing of arteries and reduction of blood supply to various organs. Salt and water retention causes increase in blood pressure.
4. Cardio-vascular complications – Arise due to heightening of cardiac activity with poor body resources to meet the demands of the body.
5. Gall bladder diseases – Dysregulation of cholesterol metabolism leads to gall bladder pathology in the form of gall stones.
6. Fatty liver – Extra fat is deposited in the liver and other organs leading to deranges liver function tests.
7. Polycystic ovarian disease, Infertility – Extra body weight disrupts the hypothalamo-pituitary- ovarian axis and leads to menstrual irregularitis, pcod and infertility.
8. Respiratory problems – Obstructive sleep apnoea and hypoventilation are common due to difficulty in mobilisation of the thoraco-abdominal wall and the respiratory organs.
9. Osteoarthritis – The body weight is borne by the knees which are our largest weight bearing joints. Due to increase in weight, wear and tear begins early and the knees become prone to osteoarthritis soon.
10. Stroke – Due to a combination of factors like atherosclerosis, hypertension, dyslipidemia, altered blood flow through the brain occurs with its resultant complications.
11. Cataracts – Early occurrence of cataract due to deposits and hardening of the lens is not infrequently seen.
12. Gout – Inability to metabolise the protein load results in its deposition in various organs and joints leading to gout.
13. Hernia – Results from inefficient muscles of supporting viscera due to fat deposition.
14. Psychological disturbances – Low self-esteem, anxiety, depression, maladaptation and emotional deprivation is frequently associated with obesity.
15. Cancer – Depleting resources of the body due to overwork and a gradual disarray of the control mechanisms leads to a spectrum of chronic, degenerative and debilitating diseases which can prove to be fatal in the long run.

Obesity, thus, cannot be attributed to any one reason, hence the approach to it has to be panoramic. The relation between the patient and the physician-therapist is central to the concept of achieving optimum weight. A consideration of medico-genetico-psycho-socio-economic factors can help to develop an insight into the relevant causes of obesity in the individual concerned. One has to remember that there is no standard formula to ‘lose weight and keep it that way’.