Understanding Obesity Paradox


Individual can be said to have excess weight if his weight is more than ideal weight for his/her height and person can be classified according degree of excess weight. For this categorization, we use Body Mass Index that adjusts your weight for your height and is calculated as:

BMI = Weight/Height( kg/m2 )

Category BMI (kg/m2)
Underweight <18
Normal 18-23
Overweight 23-30
Obese >30
Super-obese >40

Why do we gain weight at all?

Our ancestors were hunters and gatherers. They had no guarantee of future availability of food. This made ability to store fat i.e. gaining weight an evolutionary advantage. This trait has persisted till date and human body perceives gaining fat as survival instinct. But, when exploited beyond a limit everything becomes harmful and same is true for fat also.

What is the extent of obesity in world today?

Two third of people living in USA are either obese or overweight. Situation is little better in India, but people from middle and higher socioeconomic strata are almost as obese as our western counterparts. More disturbing fact is increased prevalence of obesity in childhood. Obese children are common sight in schools now days.

What are the treatment options for tackling obesity?

Lifestyle changes are cornerstones of obesity treatment. Doing enough physical activity and restricting calories can not be replaced by any other means including medications and surgery.

Now, we also have some reliable medications which can make you lose weight when used judiciously with lifestyle changes. But, selecting right people for these medications is crucial to avoid side-effects.

Bariatric surgery is now a matter of fashion in our society. Bariatric surgery is definitely a good option in selected patients especially in super-obese people. But, being an irreversible in nature in most cases, long term complications and implications need to be looked into. Moreover, people opting for bariatric surgery should realize that lifestyle changes would still be required after surgery. In short, there is no short-cut to lose weight.

Persistent hard work along with ethical medical guidance would be needed for long term care.

What are recent trends in management of obesity?

There has always been a paradox while understanding obesity: If obesity is so harmful then does human body still perceives it as survival advantage?   Well there are two aspects this statement.

Firstly, that evolutionary cycle is actually longer than our lifespans and harmful obesity is relatively recent phenomenon. Secondly, it now seems that actual harmful effects of weight are due also to inactivity associated with obesity along with per se increased fat mass.

So, we as doctors, now place more emphasis on overall fitness of person irrespective of their actual weight!!

Author: Dr. Rajiv Singla

A leading endocrinologist and diabetologist from New Delhi. An alumnus of University College of Medical Sciences, Dr. Singla completed his MD (Medicine) from Maulana Azad Medical College (MAMC). He went on to pursue DM (Endocrinology & Diabetes) from reputed AIIMS, Delhi.

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