Obesity

Introduction

Obesity is a chronic condition that has now becomes an epidemic. The prevalence has risen significantly over the years including Malaysia. Ten years ago obesity was only a health risk factor for cardiovascular disease. Howeverbased on scientific findings for the paast five years, obesity is an independent risk factor for cardiovascular disease and a disease on its own1,2. Obesity is now known as a chronic disease that has detrimental effect to health and significantly contribute to mortality and morbidity especially for cardiovascular disease and diabetes1,2. The United States of America documented obesity prevalence of 32.2% in the year 2003 – 2004 amongst adult population3. Meanwhile, the National Health Morbidity Survey (NHMS) in 2011 documented a prevalence of obesity 27.2% (4.4 million) population of 18 years and above11 an increase of 14% from NHMS 2006. The Lancet in 2014 quoted Malaysia’s population to be 45.3% obese and this is the highest among other South East Asia countries4,10. Due to the very high prevalence rate of obesity in Malaysia and its contribution to health mortality and morbidity, Ministry of Health Malaysia has made screening for obesity a mandatory procedure in government health clinics and hospitals. Every patient who visit the health premise regardless of reason, will receive an obesity screening procedure.

Definition

Obesity is a complex condition where an individual has an excess of fat leading to metabolic changes in the body. It is a chronic condition that needs medical attention and specific therapy by a specialist and other medical personnel. A male individual is obese when he has 25% excess fat5. Meanwhile, a female individual with 35% excess fat is defined as obese5. Obesity is calculated based on weight appropriate for a given height using the formula : BMI = Weight (kg) / Height2 (m) 2 Obesity screening measures weight in kilogram (kg) and height is meter (m).

Calculate your BMI
Height : (Centimeter, cm)
Weight : (Kilogram, kg)
  
BMI

World Health Organization (WHO) defines BMI of 30 kg/m2 and above as obese6 and BMI of 25 – 29.5 kg/m2 is overweight6. However risk factors for cardiovascular disease among the Asian population occurs at a lower BMI compared to the above BMI scale mentioned. Asian population has higher fat rate per body compared to Caucasian for the same BMI.

Classification of Obesity

WHO Obesity Classification for Asian Population7

Classification BMI (kg/m2) Health Risk
Under weight <18.5 Low
Normal 18.5 - 22.9 Risk increased but mild and acceptable
Overweight > 23 Increased
Pre-Obese 23.0 - 27.4 Significant risk
Obese class 1 27.5 - 34.9 High risk
Obese class II 35.0 - 39.9 Very high risk
Obese class III > 40.0 Extremely high risk

Risk factors for obesity

Why do people become obese? What are the contributing factors? Risk factors for obesity are5:

  • AGE. Increased age will reduce the basal metabolic rate. Therefore weight will start to increase even though the amount of food taken, type of food and frequency of eating remains the same.
  • GENDER. Female tends to become obese relatively easier compared to male gender. This is because female has a lower basal metabolic rate compared to male. Weight becomes a major issue when a woman reaches menopause8.
  • GENETIC / FAMILIAL. Some people has a genetic factor that makes them easily put on weight and becoming obese. However environmental factors play a vital role in the expression of obese genes8.
  • PHYSICAL ACTIVITIES AND DIET. Sedentary lifestyle and infrequent physical activities in addition to unhealthy eating are major contributors to obesity.
  • PSYCHOLOGICAL FACTOR. Many individuals tend to eat more under stress due to emotional instability. Stress management is essential in order to avoid over eating.
  • MEDICAL CONDITION. Certain medical conditions lead to obesity although it is rare. Examples of medical condition contributing to obesity are hypothyroidism, depression and selected brain lesions that may cause patients to eat more than needed.
  • MEDICATIONS. Steroid-based medication and anti-depressive agents may lead to obesity.

Obesity Implication

Obesity is a risk factors for many chronic diseases and contribute to significant mortality. Apart from this, obesity also reduces the quality of life. Examples of chronic diseases contributed by obesity are :

  • Diabetes Mellitus
  • Fatty liver (liver disease)
  • Dyslipidaemia (high cholesterol)
  • Metabolic Syndrome
  • Sleep apnoea
  • Coronary Heart Disease
  • Cerebrovascular disease
  • Heart Failure
  • Hypertension
  • Osteoarthritis
  • Gouty arthritis

Why must we screen for obesity?

Obesity screening is done by measuring weight (kg) and height (m) and using these 2 measurement to calculate BMI. By measuring BMI, a patient will be able to know their health status and its risk factors pertaining to the BMI. Patients can go to the nearest health clinics to get their BMI measured and health risk factors calculated. High risk patients will be referred to the appropriate health personnel for intervention7. Interventions include referral to dietitian for healthy eating, physiotherapist for empowerment of physical activities and specialist for medical therapy7. If needed, the patients will be referred to counsellors for behavioural modification. Patients are encouraged to measure their BMI every 3-4 months or each time they visit a health clinic. Weight reduction will decrease their health risk factors and morbidities leading to a better quality of life and longevity. The possibility of chronic diseases emergence in an individual is markedly reduce with weight reduction7.

Screening Modality

Weight and height are measured using scales that have been calibrated and validated. The scales are calibrated and validated every year by a certified company.

Management and treatment of obesity

Patients with obesity must see a doctor for proper consultation and management. There are certified therapy for obesity endorsed by Ministry of Health Malaysia under the care of an endocrinologist. However, surgical intervention can also be considered in severe cases when medical therapy failed.

How to prevent obesity?

Behavioural modification is essential in obesity management because it is closely related to eating habits and sedentary lifestyle. Medical and surgical interventions help in weight reduction but behavioural modifications will maintain and sustain the weight loss. Obesity can relapse after therapy if unhealthy habits persist. It is vital to prevent obesity because prevention is better than cure. Medical and surgical therapy are expensive and not without any complications. Education and self-control are important elements in obesity prevention and relapse. A certified counsellor is engaged to assist in psychological and emotional management8. Empowerment will help behavioural changes and yield successful outcome. Healthy eating habits and moderation in food choice are steps to be taken to ensure obesity is prevented. Dietician can assist in making appropriate diet choices. General recommendations are high fibre intake, low calorie diet and low fat diet8. However, a more specified medical nutritional therapy is the best recommendation for complicated cases in order to treat obesity. Adapting an active lifestyle along with medical nutritional therapy help in preventing obesity9. The recommended duration of moderate physical activity per day is 60 – 90 minutes and this will result in BMI reduction among obese patients. For patients with normal BMI, the recommended duration of moderate physical activity will help to prevent obesity. This recommendation is only possible if the patients have good diet control9. Poor dietary habits

Exercise can prevent obesity

 

Reference

  1. http://www.mayoclinic.com/health/obesity/DS00314/DSECTION=complications (visited 25 April 2013)
  2. Complications Of Obesity George A. Bray, M.D. Ann Intern Med. 1985;103(6_Part_2):1052-1062. Doi:10.7326/0003-4819-103-6-1052
  3. Prevalence of Overweight and Obesity in the United States, 1999-2004 Cynthia L. Ogden, PhD; Margaret D. Carroll, MSPH; Lester R. Curtin, PhD; Margaret A. McDowell, MPH, RD; Carolyn J. Tabak, MD, MPH; Katherine M. Flegal, PhD. JAMA. 2006;295(13):1549-1555. doi:10.1001/jama.295.13.1549.
  4. http://thestar.com.my/news/story.asp?file=/2013/1/18/nation/12591415&sec=nation (visited 25 April 2013)
  5. Clinical Practice Guidelines Obesity and Management Malaysia 2004
  6. WHO Obesity: Preventing and Managing the Global Epidemic. Report on a WHO Consultation on Obesity, Geneva, 3-5 June 1997. Geneva: World Health Organization 1998
  7. WHO expert consultation. Appropriate Body Mass Index
  8. Dengel JL katzel LI, Godberg AP. Effect of an American Heart Association Diet with or without weight loss in lipids in obese middle aged and older men. American Journal of Clinical Nutrition 1995; 62: 715-721
  9. National Institute of Health. Clinical Guidelines on the Identification, evaluation and treatment of overweight and obesity in adults. The evidence report Bethesda. National Institutes of Health September 1998. Report No: 98-4083

 

Last Reviewed : 14 April 2015
Writer/Translator : Dr. Sri Wahyu bt. Taher
Accreditor : Dr. Fuziah bt Paimin