OBESITY is defined as abnormal or excessive fat accumulation that may impair health.
Worldwide, at least 2.8 million people die each year as a result of being overweight or obese.
As at 2008, the World Health Organization (WHO) claimed that 1.5 billion adults, 20 years and older, were overweight and of this number, more than 200 million men and nearly 300 million women were obese. The rate of obesity also increases with age — at least up to 50 or 60 years old.
Locally, 20 percent of Jamaican adults are categorized as obese, with 32 percent classified as overweight. In the Jamaican Healthy Lifestyle Survey (JHLS), 25 percent of the population was categorised as obese, with a female preponderance (38 percent vs 12 percent).
Interestingly, in a paper by Ichinohe et al., 19.2 percent of obese and 42.2 percent of overweight women in Jamaica felt their weight was acceptable, while 20.5 percent of obese males and 60.0 percent of overweight men in Jamaica felt their weight was acceptable.
These gender differences in prevalence of obesity in Jamaica may be due to:
1. Lack of exercise in women, but not in men (Ichinohe et al);
2. Cultural association of overweight with maternity and nurturing;
3. Cultural association of increased sexual appeal.
CHILDHOOD OBESITY
Childhood obesity is similarly reaching epidemic proportions. In Jamaica, over 11 percent of 10 –15 year-olds and 35 percent of teenagers 15–18 years old are categorised as overweight and obese. Furthermore, 80 percent of overweight children from 10–15 years become overweight adults at age 25.
Overweight and obesity result from an energy imbalance. This involves ingestion of too many calories and a lack of adequate physical activity.
Body weight is also the result of genes, metabolism, behaviour, environment, culture, and socio-economic status.
Finally, behaviour and environment play a large role in causing people to be overweight or obese.
The medical complications of obesity are well established and include:
• Diabetes;
• Hypertension;
• Dyslipidemia;
• Cerebrovascular accidents;
. Cataracts;
• Idiopathic intracranial hypertension;
• Obstructive sleep apnoea;
• Osteoarthritis;
• Gout;
• Polycystic ovarian syndrome;
• Gallstones;
• Fatty Liver;
• Phlebitis;
• Severe pancreatitis;
• Cancer (breast, uterus, cervix, colon, oesophagus, pancreas, kidney, prostate).
There are also important quality-of-life implications as a result of being obese or overweight. These include low social status, low employment, low self-esteem, low physical fitness, high rates of personality disorder, high rates of depression, high rates of psychosis, and high rates of physical sequelae from medical complications.
OBESITY MANAGEMENT
Management of obesity should be focused on prevention and treatment.
Prevention strategies should be implemented from childhood. Behavioural, knowledge and environmental elements are important in implementing change.
It is important to note that the benefits of weight loss far exceed the preservation, restoration, or enhancement of physical appearance. In fact, losing five to 10 per cent of your current weight is enough to obtain the medical benefits.
Successful weight loss treatments include setting goals and making lifestyle changes, such as eating fewer calories and being physically active. Medicines and weight-loss surgery are other options, where indicated.
Next week we will explore the patient-doctor encounter and what to expect.
Dr Karen Phillips is a consultant physician and endocrinologist at the Kingston Public Hospital and associate lecturer at the University of the West Indies. She is also an obesity practitioner at Weighless Ja — the first interdisciplinary weight loss programme in Jamaica, aimed at promoting a healthy lifestyle and successful weight management. She may be contacted at 634-5142-3 or weighlessja@gmail.com
