What makes us gain weight? This is a million-dollar question. Even in the year 2021, we cannot answer this question with complete confidence and we are still not sure about what exactly it is that makes people fat. One of the major pitfalls in the treatment of obesity lies in the lack of understanding about its disease process. Unfortunately, current theories are often highly simplistic and often take just one single factor into account.
· Obesity is caused due to intake of excess calories or,
· Obesity is a result of inadequate physical activity or,
· Obesity is due to excess fat consumption or,
· Obesity is due to excess carbohydrate in diet
No other disease has been mired with as many myths as obesity. To be able to understand the disease better, it is important to bust a few myths that surround it. We discuss a few of these below:
Obesity equals prosperity
Traditionally, in many cultures and especially in India, fatness is perceived as a sign of prosperity and good health. Nothing could be further from the truth. Obesity is the precursor of many metabolic diseases like type 2 diabetes mellitus, hypertension, heart disease and dyslipidemia.
Obesity leads to many mechanical problems like joint issues and mobility problems. It can adversely affect the lungs, liver and reproductive health. It is also implicated in many types of cancers like uterine, breast and colon cancer. Obesity is a chronic progressive disease that affects the body from head to toe.
“Eat less, move more”
It is evident that eating too many calories can result in weight gain. Registered dietician Mariam Lakdawala says that “eat less and move more” is the most common advice that is handed out to patients with obesity. It sounds very simple that if eating more is the problem then eating less must be the solution. People who try to deliberately reduce their diet, lose weight temporarily but as soon as they revert to their normal diet, the weight comes rushing back. The failure to permanently stick to a restricted diet is conveniently pinned on the patient.
However, we are missing a very important link here. Weight loss is not just a derivative of trying to eat less. It is important to find out “why” some people cannot control their appetite. What is it that makes them eat more? We cannot have an effective weight loss solution unless we are able to understand the mechanisms behind this.
Obese people lack willpower
Blaming the disease on mental state and lack of willpower is an index of how much is not understood about the physical terrain of the disease. Obesity is a complex multifactorial disease. It has been proven in multiple studies that 70% of obesity is inherited through our genes. Complex systems regulate eating behavior to balance energy intake and expenditure.
Obesity is not a mere derivative of food intake and energy expenditure but seems to be a result of impaired brain circuits and neuroendocrine feedback associated with pathological overeating and physical activity. Obesity is probably a result of breakdown of regulation (as in cancer and heart disease) of fat tissue. We need to find out the exact defect.
Bariatric surgery is a shortcut
Presently, bariatric surgery is the only effective treatment option for people with severe obesity. Most people who have tried to lose weight know how difficult it is and repeated cycles of weight loss and weight gain can be highly demotivating. The folly lies in subjecting patient with severe obesity to ineffective weight loss measures. Obesity must be treated in a graded manner.
Just like a patient who needs to lose about 5 kg must not be advised bariatric surgery, similarly a patient who needs to lose 50 kg must not be subjected to endless weight loss diets which are ineffective. Bariatric surgery is indicated for people with a BMI more than 35 Kg/m2 or for those with a BMI ≥ 30 Kg/m2 with 2 obesity related diseases. Bariatric surgery is not an easy option and neither is it a short cut. Most people who opt for bariatric surgery have put in a lot of effort into losing weight by conservative measures before resorting to surgery.
(The writer is a Laparoscopic and bariatric surgeon, Saifee Hospital, Apollo Spectra, etc.)
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