1.76 CME

Recognizing Obesity as a Chronic Disease

Speaker: Dr.Ramkumar Sundaraperumal

HOD and Specialist Internal Medicine, Zulekha hospital, Dubai

Summary

The presenter thanks Medar city and introduces a discussion on obesity, highlighting its increasing prevalence, even in India. The session will involve real-life case studies to explore effective management strategies. The speaker aims to go beyond the common perception of obesity as simply an energy intake vs. expenditure problem.
Obesity is commonly misunderstood as solely a result of overeating and lack of physical activity due to a lack of willpower. It is a chronic condition, similar to diabetes or hypertension, with both biological and behavioral components. Effective management requires a holistic approach rather than a simple prescription-based solution.
The focus is primarily on obesity stemming from lifestyle factors, excluding cases linked to medical conditions like hypothyroidism or genetic predispositions. Unlike past concerns of nutritional deficiencies like kwashiorkor and marasmus, the rise of obesity is connected to improved quality of life, increased access to high-calorie diets, and decreased physical activity in modern lifestyles.
Statistics show a tripling of obesity rates over the past four decades, with over half the population in developed countries being overweight or obese. Globally, nearly a billion people are overweight, and the increasing availability of high-energy foods, even in smaller cities, contributes to the problem.
Obesity is defined using the Body Mass Index (BMI), which is calculated as weight in kg divided by height in meters squared. A BMI between 25 and 29 indicates overweight, while a BMI over 30 signifies obesity. Limitations exist, such as not accurately reflecting body fat in athletes with high muscle mass. Other measures like waist circumference and waist-to-hip ratio are useful, particularly for Asian populations.
Obesity leads to various complications, including metabolic problems like diabetes, hypertension, and high cholesterol, respiratory issues such as sleep apnea, cardiovascular diseases, and gastrointestinal problems like non-alcoholic fatty liver disease. Increased cancer risk in different organs, psychological distress (anxiety, depression), and mechanical issues like osteoarthritis also plague obese individuals.
Obesity can be staged based on risk factors and severity. Stage 0: High risk factors, Stage 1: Mild complications, Stage 2: Established complications and moderate disability, Stage 3: End-organ damage, Stage 4: Severe disability. The approach of managing obesity should be tailored with different strategies for each stage.
The presentation includes case studies to show how different patients' needs require individualized attention. The root of obesity is multifaceted, involving hereditary predispositions, hormonal factors, and lifestyle choices. Also, set point theory, weight cycling, socioeconomic status, and psychological conditions should be considered.
Dietary recommendations include reducing refined carbohydrates and increasing protein intake, substituting saturated fats with unsaturated fats, and incorporating fiber-rich foods. Portion control and limiting packaged drinks and sweets are essential, with a focus on reducing calorie intake by 500 calories daily through various diet plans like low-carb, high-protein, or plant-based options.
Regular physical activity, including at least 150 minutes of aerobic exercise per week, is crucial, with a long-term goal of 200-300 minutes per week for weight maintenance. Resistance training helps maintain muscle mass while reducing fat. Medications may be considered in some cases, particularly those that aid in both weight reduction and diabetes control.
Bariatric surgery, such as gastric bypass, sleeve gastrectomy, or gastric banding, can be an option for patients with a BMI over 40 or a BMI over 35 with obesity-related complications. Managing obesity requires a long-term commitment and frequent follow-ups to help patients sustain lifestyle changes and manage co-morbidities such as diabetes, hypertension, and cholesterol.
In conclusion, effective obesity management demands a holistic, individualized approach, considering biological and behavioral factors, co-morbidities, and long-term sustainability. Focus on adequate nutrition, preservation of muscle mass, regular monitoring, and personalized treatment plans are essential for successful patient outcomes.