The Big Picture on Obesity

This is the era of the expanding waistline. Why is obesity such a big problem? Is it just a personal matter? What do the doctors have to say on this topic? We got our panel of experts to share on the health-risks and management of obesity for people across the different age groups. 

Obesity in Kids

Kids these days are spending more time in front of the TV and computer and less time exercising or pursuing outdoor activities. Parents also have fewer free moments to prepare nutritious, home-cooked meals.

From fast food to electronics, having everything quick and easy is the reality for many people today. Is it any surprise that the younger generation is battling weight issues earlier in life?

“Genetics, lifestyle habits, or a combination of both may be involved. In some instances, endocrine problems, genetic syndromes, and medications can be associated with excessive weight gain,” says Dr Wendy Sinnathamby, Specialist in Paediatrics at Raffles Children’s Centre.

What are some health risks that overweight and obese kids face?

Overweight and obese kids are at risk for developing medical problems that affect their present and future health and quality of life, including:

• High blood pressure, high cholesterol and abnormal blood lipid levels, insulin resistance, and type 2 diabetes
• Bone and joint problems
• Shortness of breath that makes exercise, sports, or any physical activity more difficult and may aggravate the symptoms
• Restless or disordered sleep patterns, such as obstructive sleep apnoea
• Tendency to mature earlier (overweight kids may be taller and more sexually mature than their peers, raising expectations that they should act as old as they look; overweight girls may have irregular menstrual cycles and fertility problems in adulthood)
• Liver and gall bladder disease
• Depression

“Cardiovascular risk factors (such as high blood pressure, high cholesterol, and diabetes) present in childhood can lead to serious medical problems like heart disease, heart failure, and stroke as adults. Preventing or treating overweight and obesity in kids may reduce the risk of developing cardiovascular disease as they get older,” says Dr Wendy.

Obese kids are also more prone to low self-esteem that stems from being teased, bullied, or rejected by peers.

Studies have shown that a child’s risk of obesity greatly increases if one or more parent is overweight or obese While the role of genetics is undeniable, people in the same family tend to have similar eating patterns, maintain the same levels of physical activity, and adopt the same attitudes toward being overweight.

Preventing kids from becoming overweight means adapting the way your family eats and exercises, and how you spend time together. Helping kids lead healthy lifestyles begins with parents who lead by example.

Tips from Dr Wendy to help your child achieve a healthy weight:

• Inculcate good habits early. Children who are exposed to healthy foods such as fruits and vegetables from a young age are more likely to continue eating these foods as they grow older. One of the keys is to introduce these foods early, even as early as when solids are first introduced, and to continue to encourage the child to eat these even if they initially seem to reject the food. These foods should be presented in a fun and interesting way to children.
• Encourage your child to have at least five servings of fruits and vegetables a day and avoid giving children junk food which is food that is high in calories, saturated fats, salt and sugar but with limited or no nutritional value. Foods such as crisps, chocolates, and soft drinks tend to taste good and can be addictive. Children given these foods will have a higher tendency of shunning healthy foods that are rich in nutritional value.
• Encourage your child to be physically active every day through activities like walking games and sports.
• Cut down on TV, computer, and video game time and discourage eating while watching TV.

Parents should seek help for their kids if they notice that their kids will only eat unhealthy foods and/ or if they are putting on weight quickly.

Obesity in Adults

As you age and your metabolism slows down, the amount of fat in your body slowly increases. Adults are more prone to central obesity (or ‘apple-shaped’ or ‘masculine’ obesity), where the main deposits of body fat are localised around the abdomen and the upper body. Central obesity is correlated with overeating and a sedentary lifestyle.

“A healthy woman’s Waist to Hip Ratio (WHR) should not be over 0.85 and a man’s should not be over 0.9. Ratio numbers above these may indicate central obesity which puts you at higher risk for chronic diseases,” says Dr Stanley Liew, Specialist in Endocrinology at Raffles Internal Medicine Centre.

To measure your waist and hip circumference, position the measuring tape mid-way between the top of your hip bone and the bottom of the rib cage, and the widest area around your hips respectively. To calculate WHR, divide your waist by your hip circumference (waist / hip).

What are the health risks of putting on weight?

While putting on weight in general can have negative effects on your health, intra-abdominal fat gain is particularly unhealthy. Too much belly fat increases your risk of:

• Heart disease
• Certain cancers such as breast and colorectal cancer
• Type 2 Diabetes
• Metabolic syndrome
• Gallbladder problems
• High blood pressure
• Sleep Apnoea

Weight Loss Management

Whether you’re trying to lose belly fat or trim fat from another part of your body, weight-loss basics remain the same:

• Reduce calories and your portion sizes. Replace your usual fare with healthy foods that contain fewer calories.
• Increase physical activity. The general recommendations for adults are to get two hours and 30 minutes of moderate aerobic activity a week or one hour and 15 minutes of vigorous aerobic activity, in addition to strength training. You may need to do more to lose weight and keep it off.

“After you shed excess pounds, it is important that you maintain your weight loss with a healthy diet and regular physical activity,” adds Dr Liew.

How can people with severe obesity achieve long-term weight loss?

In severe obesity the only methods shown to result in long-term weight loss with over 90% effectiveness are surgical in nature (e.g. keyhole surgery or lapband). Bariatric surgery like the lapband has been shown to prevent, improve or cure co-morbidities of obesity like diabetes. It has also been shown to improve life expectancy.

“With a band on the stomach, you will find that a small meal would fill you up quickly, reducing your calorie intake significantly,” explains Dr HG Baladas, Specialist in General Surgery at Raffles Surgery Centre. “This is a major procedure and is recommended only for the severely obese. My patients who opt for this procedure lose about 20kg to 70kg gradually.”

As a leading expert in bariatric surgery (lapband) in the region, Dr Baladas, has helped hundreds of obese patients uncover a normal and healthier body.  The criteria for bariatric surgery is a Body Mass Index (BMI) from 32 – 37 with co-morbidities, or > 37 without co-morbidities.

Obesity in The Elderly

Obesity is a prevalent health problem among seniors in developed and emerging countries. As the aging population increases in number, so too will the number of chronic illnesses which often accompany aging.

Chronic conditions, such as arthritis, diabetes, hypertension, and heart disease, are among some of the most common, debilitating and costly chronic conditions in older adults. These conditions are frequently  associated with and worsened with obesity

What are the health risks associated with obesity in the elderly?

“ In addition to the health-risks usually associated with obesity such as high blood pressure, high cholesterol and type 2 diabetes, obesity in elderly also puts one at higher risk of falls, reduced mobility, gait and muscle weakness.” shares Dr Carol Tan-Goh, Specialist in Geriatric Medicine at Raffles Internal Medicine Centre.

In addition, it is found that the relative risk of arthritis in people who are obese increases over time. Obesity means that the load placed on joints, especially the knee and hip joints, are heavier. The pain and stiffness caused by arthritis leads to decreased mobility, thereby increasing stress, pain, and depression. One’s quality of life will thus be affected.

Weight loss management for the elderly

Older persons present special challenges when making changes in diet and activity levels. In patients over 65, the increase in chronic diseases associated with aging reduces physical activity and exercise capacity. This makes it more difficult for elderly persons to lose weight.

Research suggests weight gain in older age is not caused by eating more or consuming energy-dense foods, but usually by a decline in physical activity. A weight loss program that minimises muscle and bone loss is recommended for the older adult. 

Several studies have shown benefits from progressive resistance training, which helps conserve lean body mass, strengthen bone, and increase energy expenditure.

Says Dr Tan- Goh, “To avoid musculoskeletal injuries and encourage adherence, exercise should be started at a low intensity. The individual can then gradually progress over several weeks or months to a more vigorous level.  Don’t forget to check with your doctor if you have heart disease and other medical conditions that may affect your ability to exercise ”

Tips for the elderly who need to lose weight:

• Eat small meals four to six times a day. The metabolism slows down when the body only gets three large meals a day. By eating small meals more frequently, the metabolic rate remains high. 
• It is also important to look at the nutritional value of the meals and not just the amount. Many older persons have concurrent diabetes and high blood pressure. They may also have difficult with their teeth, and have trouble eating certain types of food. In general, aim for a higher fibre intake, foods high in nutritional value- including vitamins B12, Iron, Calcium, Vitamin D. Avoid high cholesterol foods. 
• Exercise as often as you can. There are low-impact exercise classes available that are designed just for senior citizens, and some exercises can be done while sitting in a chair. Walking is always good while water aerobics reduces strain on the joints. If you have not exercised in a long time or have medical conditions, consult with your doctor before starting an exercise program. 
• Do exercises that improve your balance, strengthen your bones as well.