Obesity is a term signifying excessive fat accumulated to an extent that it starts having deleterious effects on health. As a measure of obesity the most accepted definition is the product of body weight in Kgs / square of height. This value is called body mass index (BMI). BMI more than 30 kg/m2 is called obesity and values in the range of 25–30 kg/m2 is termed overweight. In the South and East Asian countries lower values of 23 kg/m2are used the cut offs for over weight .
In a recently published study from USA in the JAMA Cardiology in April 2018, it has been clearly shown adults between ages 40 and 59, who are overweight or obese have a significantly higher risk of developing cardiovascular disease as compared to their normal counterparts. This higher risk is of the order of 21 to 85%. These figures are very alarming in the context of obesity becoming a pandemic all over the world, Jammu and Kashmir being no exception where more than 29 per cent of women and over 20 per cent of men are either overweight or obese. This is the major reason for the increasing incidence of high blood pressure, Diabetes, heart attacks and obstructive sleep apnoea being seen in our population. These problems very often occur together in the same individual. A very noteworthy fact is that only one decade ago the prevalence of overweight and obesity was only 6.2 per cent in 2006 as compared to 29.5 per cent in 2016 as per the National Family Health Survey (NFHS) in our state. The prevalence in school children as per a survey of 9000 school children done by Prof Masoodi from SKIMS was 34.5 in boys and 38.4 pc in girls. This tells us that the problem often starts in childhood.
Obesity is mostly caused by a combination of excessive food intake especially of carbohydrates and fats in combination with lack of physical activity and often also a genetic susceptibility. The view held by some obese people that they eat very little yet gain weight due to slow metabolism is not supported by any scientific evidence. Obese people have greater energy expenditure than their normal counterparts due to the energy required maintaining an increased body mass but in spite of that the increased consumption of food far outweighs the expenditure. Most obese people are very sedentary and as their weight increases it becomes a vicious circle.
Obesity is stigmatized in most of the western world as a serious disease though in the earlier days it was seen as a symbol of wealth and fertility which in some parts of the world is still considered a sign of prosperity. We need to be aware of the fact that obesity cuts down life by 7to 10 years in general and make our family, friends and everybody aware of this fact. It is mostly preventable through social changes and personal choices. Diet quality needs to be improved by reducing the consumption of energy dense foods, such as those high in fats and sugars. Unfortunately we in Kashmir are traditionally used to these items, plenty of rice and mutton preparations. This is despite the fact that we are lucky to have plenty of fruits and seasonal vegetables almost all round the year now. In good old days winter months used to have lot of shortages. These are nearly over due to much better transportation and availability of supplies. Dried vegetables which used to be preserved in autumn months for winter are only kept as nostalgic delicacies in the urban parts of the state although still used in remoter parts. In this regard the Muslim population still has a much lower consumption of greens and vegetables as compared to their Pundit and Jammu counterparts. Increasing the dietary fibre content by the intake of unpolished rice, wheat and higher intake of lentils is highly recommended. Replacing mutton with fish, poultry with peeled off skin is a much better alternative to mutton. The cooking medium of modest amounts of mustard oil or olive oil is much better than hydrogenated vanaspati oils and ghee. The quantity of rice intake also needs to be curtailed. In a milieu where high triglycerides in the blood is rampant and genetically good cholesterol (HDLc) levels in blood are invariably low consumption of carbohydrates is recommended. Milk products and butter are again saturated fats and increase bad cholesterol levels (LDLc). The combination of obesity, high triglyceride and low HDLc in blood along with high blood pressure is named as Metabolic Syndrome. This syndrome is associated with high likelihood of getting vascular events like heart attacks and strokes etc.
On the exercise front to burn the calories by aerobic exercise is very important. It is recommended that a minimum of 30 minutes every day 5 to 6 times a week is very important. It should become a habit for every healthy person. Besides this walking and physical activities during the daily chores should be encouraged. Going to market on foot instead of a car or a 2 wheeler is preferable. Taking a bicycle is much better. Walk up and down the stairs as often as possible. Winter time which takes around 4 months in the valley should again not make you sedentary. Wear proper attire and spend at least 30 minutes for a brisk walk or a jog. Make sure a warm up is done before going out for 5 to 10 minutes and timings could be altered. It is better to have a companion to encourage each other. Wear bright clothes which are visible in fog and dim light.
Besides this it is a good habit to check your weight once in a few months to know which side you are leaning to. A gain of more than 1 or 2 kilos should caution you.
There is enough proof that these steps can make a distinct difference to your heart health. In a scientific study it has been shown that in adults these measures can reduce the BMI from 25 – 40 kg/m2 by at least 5 kg/m2. Losing weight will reduce the risk of cardiovascular disease significantly because it brings down the blood pressure, triglyceride levels and insulin sensitivity, which go a long way to reduce cardio vascular events, make you live longer and have a more purposeful life.
Prof Upendra Kaul is Chairman and Dean Academics and Research, Batra Heart Center & Batra Hospital and Medical Research Center, New Delhi.
kaul.upendra@gmail.com