Sunday, February 17, 2013

Obesity treatment – why does it fail?

Obesity has been described as an epidemic of modern times – an outcome of junk food, poor exercise and unhealthy lifestyle. Though Obesity, as a disease, was initially considered a rich man’s disease, affecting the population of the developed Western world, it was soon realized that countries like India, that have a rising population of prosperous individuals, was competing with the West for the total number of people suffering from Obesity. Unfortunately, the authorities are yet to realize this fact and hence attention to this health problem is highly inadequate.

Enough has been written about the severity of the possible problems that develop due to Obesity, the need to correct the problem, and the potentially life threatening issues that may develop. Thus once the given person/their doctor conclude that there is a problem that needs treatment, the person is usually asked to reduce food intake, do exercise and lose weight! That’s it. As if everyone knows how to rule out underlying problems that may have caused the fat accumulation, revamp their diet OR identify problems or limitations related to physical exercise! It is now easy to see why ‘asking someone to loose weight and control intake is doomed to fail’

So, how does one go about to ensure that these efforts to tackle the problem will move in the right direction?
Identify if any underlying diseases have caused the weight gain: For people with Morbid Obesity – BMI > 36-37 In Indians – a clinical and hormonal screening is needed for this purpose. Trying to reduce intake or doing exercise in this scenario is utterly useless.

Have a discussion with a dietician: Once background problems are ruled out, people with mild to moderate Obesity – BMI between 27 – 37 – need a discussion with a dietician decide details about a diet that cuts down on the caloric intake, without loss in the nutrition or satiety value. Calories can be reduced without decreasing the quantity of food, which is needed to ensure the person does not get fed up with the diet and give up his efforts. Simply trying to cut down the food intake cannot be continued for long.

Identify problems in exercising: before exercise is recommended, it is essential to see if the deformity due to the obesity permits the person to exercise at all! There have been people with huge ‘pot bellies’ who cannot be expected to begin exercising at all – unless they are able to bend and move about with reasonable comfort. Another person, a lady with normal body weight, but excess fat in just the arms, had a very awkward feeling of heaviness just below the shoulders – she was unable to lift even the lightest variety of dumbbells at the gym. Obviously, both these groups of people need something else.

Generalized measures for local obesity: options such as diet control, exercise or even the medicines to loose weight work by shedding excess fat from the entire body. Neither of these can work on one specific area – as in someone with local fat excess – say tummy, hips, arms or thighs (called local Obesity) – OR with General Obesity by disproportionate fat excess in some areas. Such cases need reliable measures to tackle local fat. This is what the Body Reshaping procedures can offer, once approved by a competent Plastic Surgeon. Depending on whether the local fat excess is super added to Generalized obesity, these Cosmetic surgery procedures may be done alone or in coordination tin Bariatric Surgery.

Thus simple measures can be effective when used in the right situation – if not, treatment failure is very likely,  and and bad name resulting to the physicians involved, the person using it and even the treatment itself!

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