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!

Getting Enough Rest Can Promote Weight Loss

A young woman measuring her waist. (Photodisc)
A young woman measuring her waist. (Photodisc)

One month has gone by. How are you doing with your weight loss program? For those who continue to struggle, here is some good news.

A study published in Psychoneuroendocrinology says that getting enough rest promotes weight loss. Without enough deep sleep, fat accumulates.

Two hormones in our body, ghrelin and leptin, control our appetite. Ghrelin increases hunger and leptin promotes feelings of fullness. Researchers found that in chronic insomniacs there is a significant disruption of night time ghrelin levels and this increases their appetite during the day.

In addition, in chronic insomniacs, there is increase in the levels of stress hormone cortisol which increases cravings for high-carb, high-calorie foods. Furthermore, the brain secretes growth hormone during the deep-sleep phase, helping the body convert fat to fuel, says a report in the Scientific American Mind.

It is estimated that 10 to 40 per cent of people suffer from some sort of insomnia. This is only an estimate as nobody has yet defined what constitutes normal sleep.

Most adults sleep seven to eight hours a night. Newborns and children may sleep up to 16 hours a day. Older people may sleep only six hours a night. There is no magic number. If you are tired the next day or are yawning all the time then you need more sleep.

The quality of sleep you get is also important. The quality and quantity of sleep depend on many factors like your health, your lifestyle and your environment.

In a survey done in the United States, it was found that many patients with insomnia have other medical problems. Thirty per cent of the patients have depression, 20 per cent have other mental disorders, and 19 per cent have other illnesses. But 31 per cent of the patients have primary insomnia (i.e. they have no medical condition contributing to insomnia).

“The prevalence of insomnia has also been reported to be higher in women, women in minority groups, people who are unemployed or separated, lower socioeconomic groups and in those with medical or psychiatric (particularly substance abuse) disorders,” says an article in the Canadian Medical Association Journal.

Workaholics spend many sleepless nights to accomplish their tasks. They ask, “Why do we need to sleep?” Experts say we need sleep to rest. Sleep allows the brain and the body to recover and restore itself. So we can be fresh for the next task. Now we know we can lose weight as well.

It is very important that you consult your doctor if you have trouble falling asleep or cannot remain asleep for an adequate length of time. The cause of your insomnia could be stress, depression, anxiety, panic attacks, spastic bladder, arthritis, hyperthyroidism, congestive heart failure, obstructive sleep apnea, restless leg syndrome or lung disease. You may be overindulging in caffeine or alcohol. Or there may some other cause.

Your physician can help you sort some of these problems by recommending regular daytime exercise, avoiding large meals at night, avoiding caffeine, tobacco and alcohol; reducing evening fluid intake; maintaining a consistent wake-up time; avoiding or limiting daytime napping and avoiding bright lights (including television), noise and temperature extremes. In some circumstances he may recommend medications.

Remember, there are three things required to lose weight: a low calorie healthy diet, regular exercise and enough sleep.

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

What is the role of exercise in a weight loss program?

Did you know that less than 25 per cent of people who attempt weight loss, on their own, incorporate exercise into their weight loss plans? Are you one of them?

If yes, then remember, exercise is more strongly associated with weight loss than any other factor, including diet. Combine exercise and weight loss diet and you will see effective and sustained weight loss. Evidence shows that even if you do not lose weight, you will find exercise improves your cardiovascular system.

Evidence also shows that increased exercise intensity increased the magnitude of weight loss. The question is: besides being on a diet, how much exercise do we need to lose weight?

A study published in the Journal of the American Medical Association found that if you can get people to reduce how much food they eat by about 25 per cent, and you get them to do a least
30 to 40 minutes of exercise five days a week, you can achieve a weight loss of nine per cent. This means a 200-pound person could lose about 20 pounds and successfully maintain it for at least a year (Globe and Mail October 1, 2003).

A study from Duke University, published in 2004, in the Archives of Internal Medicine, showed that study participants who got no exercise during the eight-month study gained an average of almost 2.5 pounds. But 73 per cent of those who briskly walked 17 kilometers a week or about 30 minutes a day were able to maintain their weight or even lose a few pounds. Those who did more vigorous exercise, like jogging 27 km weekly, had the most noticeable weight loss.

Let us look at the study published in 2008, “Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women,” in the Archives of Internal Medicine. For two years the authors of the article studied 201 overweight and obese women with body mass index of 27 to 40, with age range of 21 to 45 years.

They found that by the end of the 24-month intervention, the women who managed to lose at least 10 per cent of their starting body weight and managed to keep it off were exercising twice as long as and burning more than twice as many calories through exercise as women who had no change in body weight. More they exercised, more they lost weight. Women who lost the most weight exercised 68 minutes a day, five days a week.

Every day we read about the epidemic of obesity. Is it because we eat too much or we are not exercising enough? Well, you will be surprised to read that our calorie intake over the last 100 years has not increased. What has happened is there has been a sharp drop in caloric expenditure secondary to changes at the workplace and in the home.

The Archives article defines the duration and intensity of physical activity necessary to maintain weight loss. Your happy hour of physical activity should have 68 minutes. The challenge is to sustain intense exercise for 68 minutes per day about five times a week and keep it interesting.

The Archives article suggests that increased daily activity should be encouraged via formal exercise, a modified work and school environment that allows for movement while working and learning. A modified home environment with less television and more movement would go a long way in achieving the happy hour of activity. So, let us keep moving.

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

Good Sleep is Necessary for Losing Weight

A study published in the May issue of Psychoneuroendocrinology says that getting enough rest promotes weight loss. Without enough deep sleep, fat accumulates. Ok, this is not a joke. Read on….

Two hormones in our body, ghrelin and leptin, control our appetite. Ghrelin increases hunger and leptin promotes feelings of fullness. Researchers found that in chronic insomniacs there is a significant disruption of night time ghrelin levels and this increases their appetite during the day.

In addition, in chronic insomniacs, there is increase in the levels of stress hormone cortisol which increases cravings for high-carb, high-calorie foods. Furthermore, the brain secretes growth hormone during the deep-sleep phase, helping the body convert fat to fuel, according to a report in the Scientific American Mind.

It is estimated that 10 to 40 per cent of people suffer from some sort of insomnia. This is only an estimate as nobody has yet defined what constitutes normal sleep.

Most adults sleep seven to eight hours a night. Newborns and children may sleep up to 16 hours a day. Older people may sleep only six hours a night. There is no magic number. If you are tired the next day or are yawning all the time then you need more sleep.

The quality of sleep you get is also important. The quality and quantity of sleep depend on many factors like your health, your lifestyle and your environment.

In a survey done in the United States, it was found that many patients with insomnia have other medical problems. Thirty per cent of the patients have depression, 20 per cent have other mental disorders, and 19 per cent have other illnesses. But 31 per cent of the patients have primary insomnia (i.e. they have no medical condition contributing to insomnia).

“The prevalence of insomnia has also been reported to be higher in women, women in minority groups, people who are unemployed or separated, lower socioeconomic groups and in those with medical or psychiatric (particularly substance abuse) disorders,” says an article in the Canadian Medical Association Journal.

Workaholics spend many sleepless nights to accomplish their tasks. They ask, “Why do we need to sleep?” Experts say we need sleep to rest. Sleep allows the brain and the body to recover and restore itself. So we can be fresh for the next task. Now we know we can lose weight as well.

It is very important that you consult your doctor if you have trouble falling asleep or cannot remain asleep for an adequate length of time. The cause of your insomnia could be stress, depression, anxiety, panic attacks, spastic bladder, arthritis, hyperthyroidism, congestive heart failure, obstructive sleep apnea, restless leg syndrome or lung disease. You may be overindulging in caffeine or alcohol. Or there may some other cause.

Your physician can help you sort some of these problems by recommending regular daytime exercise, avoiding large meals at night, avoiding caffeine, tobacco and alcohol; reducing evening fluid intake; maintaining a consistent wake-up time; avoiding or limiting daytime napping and avoiding bright lights (including television), noise and temperature extremes. In some circumstances he may recommend medications.

Remember, there are three things required to lose weight: a low calorie healthy diet, regular exercise and enough sleep. Now you know, I wasn’t joking.

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