Obesity projections for 2020 are grim.

The Colosseum amphitheater located in the centre of Rome, Italy. (Dr. Noorali Bharwani)
The Colosseum amphitheater located in the centre of Rome, Italy. (Dr. Noorali Bharwani)

Obesity is generally caused by eating too much and moving too little. Fat and sugar are high in calories. They are your big enemies. Add to that lack of exercise and physical activity. All that leads to surplus energy that will be stored by the body as fat.

Here are the facts.

In 2020, 83 per cent of men and 72 per cent of women will be overweight or obese.

Currently, 72 per cent of men and 63 per cent of women are overweight or obese (people who are overweight have a BMI of 25 to 29, people who are obese have a BMI of 30 or greater).

More than 50 per cent of these individuals will suffer from diabetes. or pre-diabetic conditions. These projections were presented by Northwestern Medicine researchers at the American Heart Association (AHA) Scientific Sessions recently in Orlando.

The AHA has set a target to help North Americans improve their overall heart health by 20 per cent in 2020. To achieve this target, we have to make a drastic change in out eating habits and increase our physical activities.

More people would need to improve health behaviors related to diet, physical activity, body weight and smoking, and health factors, related to glucose, cholesterol and blood pressure.

Believe it or not, less than five per cent of Americans currently are considered to have ideal cardiovascular health. Can you believe that – only five per cent!

The modest six percent improvement in cardiovascular health that is projected for 2020 means better cholesterol and blood pressure numbers for Americans and fewer smokers.

Achieving a healthy weight through diet and physical activity is the best way most Americans can improve their cardiovascular health. Add to that not smoking is the number one preventable cause of preventable death.

Obesity is a chronic and often progressive disease, similar to diabetes or high blood pressure. Many organizations including Obesity Canada, the Canadian Medical Association, the American Medical Association, and the World Health Organization now consider obesity to be a chronic disease.

It is estimated that one in 10 premature deaths among Canadian adults age 20 to 64 is directly attributable to obesity.

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off. Habits that have been ingrained in your system since childhood.

Experts agree there is no single solution to the problem of obesity. We should help people make better choices. People are addicted to sweet and high-fat foods that are inexpensive and easily available.

Can you think of a law that will make us exercise more, eat less and eat healthy?

Finally, a question to think about. Is BMI the best way to measure ideal weight?

A study published in the Frontiers in Public Health (July 24, 2017) by Philip B. Maffetone and colleagues say using BMI to measure obesity likely underestimates the problem. They propose measuring a person’s waist instead of their weight to assess health risks. Abdominal fat or obesity has more severe health effects than fat in other parts of the body.

Ideally, all should aim to keep their waist measurement less than half that of their height.

If you want to lose weight then 75 per cent of your effort should be spent on eating less and eating right. Twenty-five per cent of your effort should be spent on physical exercise. Have a wonderful healthy and happy 2020.

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Statistics Show Majority of Canadians Overweight and Overfat

Photograph by Dr. Noorali Bharwani.
Photograph by Dr. Noorali Bharwani.

According to Statistics Canada, 61.3 per cent of adult Canadians were overweight or obese in 2015, says an article in the Canadian Medical Association Journal (CMAJ August 31, 2017). That means three in five Canadians are overweight or obese.

In 2015, the percentage of those who were obese rose to 26.7 per cent, up from 23.1 per cent in 2004. Obesity has continued to increase in adult men and women who are age 60 years and older.

Researchers warn us focusing on body mass index (BMI) misses the risks of high body fat in people of normal weight.

BMI is a person’s weight in kilograms divided by the square of height in meters. BMI does not measure body fat directly. But BMI is an inexpensive and easy-to-perform method of screening for weight category.

Your BMI may be normal for your height and weight but you may still have more fat than is good for you. It may misclassify someone who is short and muscular.
On the other hand a high BMI can be an indicator of high body fatness.

BMI can be used for population assessment of overweight and obesity. Because calculation requires only height and weight, it is inexpensive and easy to use for clinicians and for the general public. BMI can be used as a screening tool for body fatness but is not diagnostic.

How is BMI interpreted for adults (over age 20)?

  1. BMI below 18.5 – underweight
  2. BMI 18.5 to 24.9 – normal or healthy weight
  3. BMI 25.0 to 29.9 – overweight
  4. BMI 30.0 and above – obese

The question is – Is BMI the best way to measure obesity?

The CMAJ article says, “A provincial spokesperson for Manitoba (where child obesity is climbing) questioned the value of the measurement because BMI does not consider lifestyle behaviours like dietary quality, physical activity, which are, in fact, stronger determinants of death and disease.”

The CMAJ article goes on to give many examples where BMI may not accurately reflect a person’s risk of serious obesity related illnesses. Incidence of coronary heart disease, stroke, cancer and type 2 diabetes is higher in overweight and obese person.

A recent study in Frontiers in Public Health (July 24, 2017) by Philip B. Maffetone and colleagues say using BMI to measure obesity likely underestimates the problem. They propose measuring a person’s waist instead of their weight to assess health risks. Abdominal fat or obesity has more severe health effects than fat in other parts of the body.

A person has to reduce abdominal girth to reduce adverse health risks. A person’s waist should be less than half their height. This waist-to-height ratio may be the single best clinical indicator of health risk as it can be used throughout childhood, into adult life, as well as throughout the world.

Most clinicians usually know if the patient in front of them has too much body fat. They should not have to wait for the latest consensus to encourage lifestyle changes: lose weight, make dietary quality changes and increase physical activity. Simply put… eat less and exercise more.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

The Secret to Losing Weight – Eat Right and Eat Less

Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)
Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)

If you want to lose weight then 75 per cent of your effort should be spent on eating less and eating right. Twenty five per cent of your effort should be spent on physical exercise. If you made a New Year’s resolution on losing weight then this is a good time to take stock of your achievement. We are into April. Have you lost at least four pounds?

If yes, then keep it up. Slow and steady wins the race. If you haven’t then you should know that there are 37,000 books in the market on how to eat right and lose weight. According to the Canadian Medical Association Journal (CMAJ March 17, 2015), dieting programs and books are a $66-billion industry. Now you know where all your money goes.

We all have different ideas on what is right and what is wrong. When it comes to eating, it will be hard to find two people following the same dietary regimen to lose weight. If you want to be a permanent loser (I mean losing weight) then eat less.

Obesity has been officially recognized as a disease by the American Medical Association. Obesity gives you grief with multiple medical problems. In Western countries, people are considered obese when their body mass index (BMI) exceeds 30 kg/m2. They are considered overweight if the BMI is 25-30 kg/m2. In simple terms you are either of normal weight, overweight (25-30 kg/m2) or obese (over 30 kg/m2).

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level. There is no simple solution. It is determination and hard work.

So the secret is out – to lose weight you have to eat smart and eat less for life.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Obesity is a Disease that Reduces Life Expectancy

People jogging. (Dr. Noorali Bharwani)
People jogging. (Dr. Noorali Bharwani)

Obesity has been officially recognized as a disease by the American Medical Association. Obesity gives you grief with multiple medical problems. In Western countries, people are considered obese when their body mass index (BMI) exceeds 30 kg/m2. They are considered overweight if the BMI is 25-30 kg/m2. In simple terms you are either of normal weight, overweight (25-30 kg/m2) or obese (over 30 kg/m2). Ask your doctor where you stand.

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off. Habits that have been ingrained in your system since childhood.

Obesity is most commonly caused by a combination of excessive eating, lack of physical activity, and genetic susceptibility with hormonal or psychiatric disorders. Obesity increases the likelihood of various diseases, particularly heart disease, type-2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

What is the solution? Is there a way to stop this epidemic of obesity, which is a disease, a medical condition?

A political solution is needed, just like the laws against smoking, says an article in the Canadian Medical Association Journal (CMAJ November 18, 2014) titled, “A political prescription is needed to treat obesity” by Fletcher and Patrick.

Last year, World Health Organization (WHO) member states declared a target to stop the rise in obesity by 2025. A report from the Global Burden of Disease Study on global, regional and national trends in overweight and obesity has shown that obesity is still increasing worldwide, including in Canada, particularly among young people.

Governments must recognize that individual-level interventions, nutritional advice and activity guidance are not working, says the CMAJ editorial. Obesity will only be curbed by population-level measures supported by legislation. There is no disagreement among experts that physical activity is not enough to prevent or treat obesity, unless it is combined with some kind of dietary intervention.

The editorial says family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy.

Bariatric surgery (surgery for obesity) has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort.

Drugs to suppress your appetite may work to some extent, but may have nasty adverse effects.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level, says the editorial.

Experts agree there is no single solution to the problem of obesity. We should help people make better choices. People are addicted to sweet and high-fat foods that are inexpensive and easily available. We need to change our approach, says the article.

We should encourage school-based nutrition and activity, incentives for active commuting, restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products.

The editorial concludes by saying, “Our government needs to act to restrict the sale of high-calorie and nutrient-poor food products or reduce the incentive to buy them through increasing their prices via taxation.”

Can you think of a law that will make us exercise more, eat less and eat healthy? If yes, then a Nobel Prize may be waiting for you.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!