Obesity - A Chronic Disease

Waist circumference should ideally not exceed not exceed 94 cm for men or 80 cm for women. Above these levels health problems are likely to develop. If the waist circumference of a man reaches 102 cm, or that of women 88 cm, then there is a serious problem and weight loss should be recommended.

Health Risks of Obesity

Obesity is an important health problem which contributes significantly to morbidity as well as being the world’s second most important risk for premature mortality (after smoking). Mortality risk increases in direct proportion to excess weight.

Obesity is a risk factor for a wide range of diseases and is associated with a considerable number of co-morbid conditions.

An important aspect is the correlation between obesity and diabetes. Obesity causes peripheral insulin resistance and plays a key role in the genesis of type 2 diabetes as well as the frequently metabolic syndrome.

The number of newly diagnosed diabetic patients has increased dramatically over the past few years. The WHO estimated that over 100 million people will suffer from type 2 diabetes by the year 2000 correlating with the increase in obesity (who Technical Report series No. 844, 1994; Prevention of diabetes mellitus). In practice, weight loss has proven to be the most important casuals measure to prevent type 2 diabetes.

Benefits of Sustained Moderate Weight loss

A weight loss 5 -10 kg brings very definite health benefits, and most of the benefits that are potentially achievable by weight loss are achieved with the first 5 -10 kg loss.

In patients with type 2 diabetes, weight loss under physician supervision is clearly linked to increased survival. A retrospective analysis by Lean et al2 found that each kilogram of weight loss increased life expectancy for the average diabetic patient with BMI > 25 kg / m2 by 3-4 months.

Integrated Weight Management

Recent weight management guidelines from health organizations, e.g. the National Institutes of Health (NIH, USA)1 and the World Health Organisation (WHO)4, all recommend that drug therapy should be used as one element within an integrated weight management programme of diet, physical activity, life-style modification and pharmacotherapy.

Calorie-Restrictive Diets are at the centre of most weight management programmes and are often effective in producing short-term weight loss. Unfortunately, weight is normally regained once the patient has stopped dieting and returns to prior eating habits. Therefore, healthier lifelong eating habits are recommended to help maintain weight loss long-term.

Physical Activity is also a key element of many weight management programmes. It has favourable effects on a wide range of physiological parameters and is useful for preventing the adaptive decrease in the basal metabolic rate which occurs in response to energy restriction. Physical activity is thus a very useful component of any weight management programme.

Life-Style Modification, defined as methods or tools for changing behaviour, is an important factor in successful long-term weight management. The exact life style modifications required will vary from patient to patient, but there are several basic principles which the physician should consider.

The patient should be encouraged to undertake an ongoing process of self-monitoring and identify reasonable, achievable goals. He/she should ideally receive advice on topics such as food preparation, eating patterns, how to increase his/her level of physical activity and coping with relapses.

The overall aims is to help patients to identify, achieve and maintain reasonable long-term changes to their life-style, as part of their overall weight management programme.

Pharmacotherapy with an anti-obesity agent is the fourth component of a weight management programme. Its weight reducing efficacy and good safety profile make it highly suited as an adjuvant to non-pharmacological therapy in obese patients for whom diet and physical activity alone have proved ineffective or inadequate.

References