Obesity and Adiposity: Friend or Foe?

People are in denial, I am also in denial. Obesity... it is always a weighty issue. Whenever climb onto the weighing scale, the mood of day can change. If I indulge in something good previously, I will cautiously check the scale, fine-tune the '0' mark and then only weigh. If the weight just maintained, I would be very happy. On the contrary, if I add another precious kilos onto my already 'heavyweight' frame, the following days will be dreadful.

Why are people getting obese? As far as I understand, the body weight is maintained by a balance of input and output. Input is from what we take or drink. Output is the energy expenditure. Obesity occurs when the balance of input is more than output. Too much input occurs when we overeat. Too little output means we lead a sedentary life style, working 9 to 5 in front of computer and is a potato couch. Simple explanation, rite? Not so...

Our desire to eat is govern by a complex brain activities called the satiety centre and hunger centre. Long time ago a bunch of scientist did experiments onto mouse; first they destroy the part of the brain believed to be satiety centre, thus the mouse always in hunger and no end to eating. In the end, they produced a super-obese mouse (pity the mouse). Based on the concept, some slimming medications were created so to decrease our desire to eat, which are of amphetamine-based.

Genetically modified mouse that knows no satiety.

Furthermore, our eating habit is also governed by our mood. We overeat when we are happy. During festivals, we (over)eat to celebrate. When we are sad, eating sometimes help to calm the mood and sooth the nerves. When we are promoted, feast. When we are demoted, compulsive eating. Chinese New Year, bigger feast. Our life has been surrounded by this concept of live to eat instead of eat to live.

The simplest method to determine whether you are simply overweight or obese is using a body mass index (BMI) calculation. The formula is:

BMI = (Weight in kilogram)/(Height in meter x height in meter)

For Asians, the body fat is more compared to Caucasians in similar BMI value. So we adopted a lower cut-off point for BMI. Normal range would be between 18.5-22.9. Below that is underweight. Overweight is a general term to grade a BMI more than 23. For a range of 23 to 27.4 is considered pre-obese. 27.5 to 34.9 is Obese Type I which has moderate heart and diabetes risk. 35.0 to 39.9 is Obese Type II. More than 40 (Obese Type III), you are running into a very high risk for all the disease of the rich people.

Other method of measuring cardiovascular risk is by taking a waist circumference. For men, the risk is increased when WC is more than 85 cm whereas for women, it is more than 80 cm.

So, Now you know where you stand. How do we tackle the problem?

1. Determination. Do you feel like you want to have weight loss? What is your target weight? How much to lose in how long a period? What method to achieve weight loss? If you have no answer to all the questions above, you are not yet ready. Buckle up, my friends. Determination is the first step to success and to maintain weight loss.
   
2. Keep a food diary. Record what you have eaten over 24 hours. Include all the main meals and snacks. Be honest to yourself. This will ensure that you aware of what you are taking, and not to be excessive.
   
3. Regular exercise. No one can help with this except you. As mentioned above, you need to have good output, so to tip the scale to a negative balance. Exercise for about 30 minutes for most days in a week. Studies shown that exercise help to makes you feels better, not to mention healthier as well. Some mild degree of hypertension can actually be controlled by exercise alone.
4. Food intake. Although some fad diets claim to help achieve weight loss, I personally don't recommend them. Stick to what is easy to attain, cost-friendly and most importantly, palatable. Don't try out fancy fancy stuff that in the end you cannot stick to your plan and all equal to zero.
5. Drugs. There are various types of medication used, but I will only discuss a few. First type is Orlistat, which is able to decrease absorption of fat from alimentary tract. Next types are appetite suppressant such as Sibutramine and Phentermine. Sibutramine not only reduced the appetite, but also help in increasing the metabolic rate. However, the use of this medication in hypertensive person must be cautious. Phentermine is amphetamine-based medication which has side effect of increase blood pressure and insomnia. Otherwise, medications that was proven to be ineffective are cellulite treatment, dietary supplements such as chitosan, fibre capsule and herbal preparations. Laxatives like slimming tea should not be used because of ineffectiveness in treating obesity. Usage of amphetamine, dexamphetamine and thyroxine is dangerous, and should not be used at all. Please consult your doctor about the choice of treatments.
   
6. Surgery. It is reserved for severe and morbid obesity where reduction of 50 to 100kg is required. Type of surgery includes gastric reduction by doing a vertical banding of the stomach or inserts a constriction bands around the stomach. Other types includes gastric bypass, which is to shorten the gut and induced malabsorption. Liposuction is not for generalized obesity, but to help getting rid of local fat or for cosmetic reasons.
   

Always ask for help. Ask your doctor about options available. They should be able to help you. You are not alone.