A Big Fat Crisis – Let’s talk about Obesity I

It might sound counterintuitive, but despite often being associated with malnutrition, India is seeing rising obesity. Data sources indicate that more than 135 million Indians are affected by obesity. And it is not just a cosmetic concern. Being obese is a medical condition that increases the risk of other illnesses and health problems like cardiovascular diseases, diabetes, high blood pressure, and certain cancers.

But how did we get here? Experts have quoted several factors – unhealthy food habits, sedentary lifestyles, lack of healthcare services, and inadequate financial support. The Indian middle-class has expanded, which is a sign of economic progress, but more facility and abundance has meant that it has now become more important to watch what we eat and maintain activity round the clock.

It’s not all doom and gloom – there are many aspects to this complex problem, and there are solutions within reach too. Experts say that even a modest weight loss can improve or prevent health problems. To shed light on the matter, we spoke to renowned dietician Dr. Swathi Sreekanta, who joined us on World Obesity Day. Here’s an insightful Q&A with the expert to show us a way out of this prevalent crisis.

The word ‘obesity’ is commonly used, and we are increasingly seeing it being used trivially. However, it is a serious medical condition. Can you please explain what obesity is in medical terms?

‘Fat’ is probably the layman’s way of putting it, but obesity is a non-communicable disease and is clinically diagnosed. Every person has what we call in medical terms a Body Mass Index or BMI – this is a ratio found by using the person’s weight and height. Anyone who ranges between 19.9 – 24.9 is considered normal. Over 25-30 is overweight and beyond 30 is classified as obese. Furthermore, there are grades 1, 2, and 3 to measure its severity.

But considering the Asian body type, the measure might be a bit different from the rest of the world. We are not greatly tall, to begin with, compared with Europeans. Off late, 23 is considered normal and over 23 is categorised as overweight. Coming back to the term ‘obesity’ – it is a clinical term we use on diagnosing someone overweight but needs a lot more attention than someone who is just overweight.

Apart from the BMI, the other indices would be the waist-to-hip ratio which can give us a deeper idea of where exactly one is faltering. It also helps to assess the type of body and the shape of one’s body. For example, if somebody is heavier around the middle, they would have a lot more health risk than someone who is heavier on the legs – the terminology we use for these body types are ‘apple-shaped’ and ‘pear-shaped’. But primarily, it is BMI that gives us an accurate idea.

It is often assumed that only putting on weight is an early sign, but what are the early signs of obesity?

Pain in the knees or in your back: Sometimes, the smallest weight gain would show by way of pain in the knees or back. The immediate sign is that you would feel a lot heavier.

Clothes don’t fit anymore: Even though the whole concept of having the right size of jeans or blouse might seem very cosmetic at the outset, it is something that we should monitor every couple of months. Also, keep looking at whether your clothes are fitting the right way or becoming tight or loose.

Changes in the pattern of sleep or skin: Other signs may include finding it hard to fall asleep, snoring, or changes in the color of the skin. If there is folding of the skin, you might find some fungal infection there. At the nape of your neck, there might be some darkening of the skin – when you’re gaining a lot of weight, there is some insulin resistance, hence the changes in the complexion of your skin.

Apart from that, changes in blood pressure, varicose veins, are also signs of gaining weight, but those appear later.

One’s body weight depends on many factors including genes, existing diseases, and lifestyle. What are some of the risk factors for obesity?

When somebody is on the heavier side, they tend to blame it on their genes. While genetic factors definitely come into play, weight is something we can have control on much more than we admit. Once we see visible signs of becoming overweight, we should take action to stop it in its tracks. There are definitely some conditions that can cause you to gain weight without your involvement, like if you’re taking medications like steroids, or if you’ve had surgery and your movement is limited. Women put on weight after pregnancy, and a thyroid imbalance or PCOS can cause weight gain as well.

But unless you have a condition, it is often a function of how proactive you are – you are your best judge, so look and act accordingly.

Obesity has proven to be fatal in many Western countries. In India, we too are moving towards an increasingly sedentary lifestyle. How will increased cases of obesity in the country affect our population?

Obesity can be both a symptom of and a cause for many non-communicable diseases. It can’t be spread in a community by means of physical contact and hence invokes less fear than communicable diseases. But despite that, this non-communicable malady has shown itself to be in need of more urgent attention, as it afflicts populations at large and is the leading cause behind developing diabetes, hypertension, CVD, some forms of cancers.

There are many other reasons why obesity is worrying. It is, for starters, self-limiting – when you gain weight, you find it difficult to get around and stop doing things you’d normally do. On gaining weight, one may not be able to do a certain sport because it has an impact on their knees or back. These changes take place far before obesity starts causing serious diseases and gaining weight is a slow, incremental process, which gets difficult to get rid of with time. Awareness is necessary – obesity is just a sign and it is like a wake-up call. People need to act on weight gain and not let it lead to obesity.

We might also need to question our attitude around bodyweight – in India, looking healthy has always been a sign of prosperity whether it be an adult or a child. Like you see people when they see a child, say, “why isn’t she chubby?”. We must definitely challenge these deeply held beliefs because the world has changed considerably since the advent of the internet and smartphones.

I am glad there are forums like yours who are trying to make World Obesity Day popular so that people know that it is a widespread problem, but also that there is enough help out there and they should reach out. Obesity causes populations to have poor mental health, which leads to a lack of productivity and thereby affects them at large. When healthy individuals perform their best, there is growth in the country. But an obese population weighs itself down.

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