The
vast majority of people who are over weight or obese are over
weight or obese because they eat too much. That is to say, they
eat more than they require and the excess calories they take
in are turned into fat. Often, these days, particularly in children,
the excess calories can be in the form of sweet drinks and,
in adults, in the form of alcohol. It is one of the great unfairnesses
of life that some people, for constitutional or genetic reasons,
or whatever, have a much lower calorific requirement than others
and put on weight very easily. Those who are relatively immobile,
arthritics for example, can come into that category. Obesity
is said to be present when the person's BMI (Body Mass Index)
is 30 or more. The BMI, a figure calculated from the height
and weight, is said to be normal between 18.5 and 25. A person
with a BMI between 25 and 30 is considered overweight. Does
obesity matter? Yes. Obesity is associated with an increased
risk of heart attack, hypertension and stroke, and diabetes,
all of which can result in premature death. Sleeping problems
such as sleep apnoea are much more common in the obese. Some
cancers, such as those of breast, uterus and ovaries in women,
and prostate in men, are more common in obese people. Arthritis
of the lower limbs, particularly, or worsening of arthritis
already present, is common in obesity. The distribution pattern
of fat is important, particularly abdominal fat. People with
a high abdominal girth to hip girth ratio are at an increased
risk of heart disease.
Every fad or fancy diet only works if it involves a person taking into the body less calories than he or she requires. To lose weight deliberately, requires a degree of self-denial and discomfort that many feel unable to tolerate in modern society, surrounded, as we all are, by plentiful, tempting food. For this reason, dietary advice and mutual support such as occurs in "Weight Watchers" etc. can be most useful. Losing weight should be done gradually and steadily, not more than 1 kilogram per week. This can often be achieved by eating the same things as usual, but less so, using a smaller dinner plate, for example. Fatty foods, refined high calorie carbohydrates can be replaced by more fruit and vegetables, high fibre foods etc. Paradoxically, very fat people often have quite a high metabolic rate and can lose weight on a surprisingly generous calorie allowance. Regular exercise is essential, but the most important factor is management of the diet. Generally speaking, people who say that they are not losing weight on a calorie intake below their requirement are kidding themselves. "However little I eat!". There are few obese people in a famine. It has been estimated that, by the year 2005, if present trends continue, in the UK nearly 20% of men and 25% of women will be obese and there are, already, large numbers, particularly of young women, with gross obesity. Doctors do not like giving the traditional amphetamine-like "slimming pills". Most are very addictive and weight comes back on rapidly once they are stopped. A newer product, orlestat, will reduce the amount of fat absorbed from the gut, but it is only prescribable when a patients have shown themselves able, by conventional dieting, to lose 2.5 KGs over a period of 4 consecutive weeks. It is only prescribable to those with true, clinical obesity. |
