Excess body weight has adverse effects on health and life expectancy. It is associated with conditions that cause early disability and premature death such as type 2 diabetes, high blood pressure, heart disease, stroke, high cholesterol, gout, breathing problems, cancer, gallstones, heartburn, arthritis, skin infections and rashes, sex hormone problems (including a decreased ability to have children) and colon, kidney and endometrial cancer. Weight loss reduces the risk of these conditions.

Many people wrongly look on obesity as a sign of well being, affluence and beauty. Some individuals even self-medicate with drugs like prednisolone and cyproheptadine just to gain weight. Contrary to a commonly held notion, most cases of obesity are not ‘genetically determined’. Obesity runs in families mainly because people from a similar family background generally tend to have similar eating and lifestyle practices.

The main factor in obesity is an energy imbalance. People gain weight when they take in more energy (measured in calories) from food and drinks than they use through their physical activity and basal metabolism. The excess energy is stored as fat.

Excess body weight is easily assessed by the Body Mass Index (BMI), which is calculated by taking the patient’s weight (kilograms) and dividing it by the square of the height (metres).

Body weight is generally classified according to the BMI as follows:

COMMON CAUSES

Excess intake of food and other calories coupled with a lack of regular physical activity.

SYMPTOMS AND SIGNS

There are no specific symptoms or physical signs associated with obesity.

• Obesity that predominantly affects the upper part of the body or results in excessive abdominal fat, described as truncal obesity, is more commonly associated with one or more of the cardiovascular risk factors listed above. In general a woman's waist measurement should fall below 35 inches and a man's should be less than 40 inches.

• Dark, thickened folds of skin around the back of the neck and in the axilla (pseudoacanthosis nigricans) seen in some overweight or obese individuals is associated with the metabolic syndrome comprising type 2 diabetes, hypertension, hyperlipidaemia and obesity among others.

INVESTIGATIONS

Measurement of blood pressure and the following tests are helpful in excluding possible associated medical conditions and directing the treatment of overweight or obese individuals.

• Blood Glucose
• Blood Uric acid
• Blood Lipid profile
• ECG

TREATMENT

Treatment objective

The objective of treatment is to ensure an initial loss of about 10% of the current weight, at a rate of 2 - 4 kg per month.

Non-Pharmacological Treatment

A weight reducing diet under the supervision of a dietician is important. Any underlying or associated disorders must be treated. Weight reduction often corrects, or helps to control, these associated conditions. Regular physical activity plays a major role in ensuring weight reduction. Occasionally psychological counselling is required.

Pharmacological Treatment

Over-the-counter ‘slimming’ pills are rarely useful and may have harmful long-term effects. Special approved anti-obesity treatments are available but should only be given under expert guidance.

REFER

Obese individuals, especially those with severe and morbid obesity, and those with accompanying medical conditions must be referred for appropriate follow up by a physician or a metabolic and endocrine specialist.