Obesity is everyone’s business |13 October 2023

Obesity is a largely preventable problem affecting millions of people worldwide, with the numbers nearly tripling in the last 50 years. Even here we have seen a marked increase in the number of people living with the condition in all age groups.

On the surface, all that everyone sees is the person’s body size but the problems linked with obesity is far more complex than a person’s appearance. And while some individuals feel comfortable with their body size and we should embrace body diversity, obesity has both physical and mental health implications.

Even with continued education about obesity, there is a lot of stigma and discrimination faced by those with obesity. This at times stems from a lack of understanding about the condition itself with many people still believing that obesity is a ‘personal choice’. While there is an aspect of choice, there is also many other factors that influence that choice.

Obesity and its complications

Obesity is defined as an abnormal or excessive fat accumulation that poses increased risk for many other diseases or health problems. A person is classified as having obesity based on a calculation known as body mass index (BMI) whereby the individual’s weight and height is calculated and then divided as follows:

Body mass index (BMI) = weight (kg)/ (height (m) x height (m))

After doing the calculation, if BMI is above 30, then the person is within the obesity category as illustrated in the table.

Although BMI is commonly used to estimate body fatness, it is a crude measure and has certain limitations. For instance, it cannot be used in all population groups like those who are unable to stand to be measured and those who are muscular. BMI alone is also not an appropriate measure for children and adolescents. We must also consider their gender and age and preferably use a reference chart or table.

If someone has a lot of fat accumulation in their abdominal area, it may be more appropriate to use waist circumference measurement whereby the person’s waist is measured using a measuring tape. A woman is at increased health risk if her waist circumference is above 80cm and a man is at increased health risk if his waist circumference is above 94cm.

When a person has obesity they have increased risk of cardiovascular disease, diabetes, high blood pressure, abnormal blood lipid levels, liver diseases, certain cancers like breast cancer, difficulty sleeping, respiratory problems, joint and back problems, mental health problems like low self-esteem, depression and anxiety. 

Causes of obesity

When we describe the causes of obesity we simplify it by explaining that it is an energy imbalance between the amount of calories (energy) consumed and amount of calories used up by the body. But it is a bit more complex than that and we find that the environment that people find themselves in everyday has a huge influence on obesity.

When we look at how our food system has changed significantly over the years, it is unsurprising that people’s eating patterns have also changed. The heavy advertising, ready availability and accessibility of highly processed foods that are high in fat and sugars alongside larger portion sizes are key drivers of high calorie intake.

But when we delve deeper we must also consider why is it that some people eat the way they do while others eat a different way? The reasons are many but may include factors like cost of food, low income, convenience, time constraint, lack of cooking skills, taste preferences and cultural values among others.

The same can be said about the amount of energy used in activity. Physical inactivity seems to go hand in hand with improved infrastructure, technological advancement and urbanisation. As more people get desk jobs with prolonged sitting, there is improvement in public transport and increased private car ownership and engagement in sedentary activities for leisure such as watching television, the more inactive that people become.

Despite popular beliefs that genetics significantly contributes to obesity, only rare genetic disorders like Prader-Willi syndrome directly causes obesity. Our environment however has a more important role in influencing our genes and make us more susceptible to obesity.

Individually managing obesity

At an individual level there is a lot we can do in preventing obesity for ourselves and family members based on our lifestyle choices. Choosing to eat a diverse and nutritious diet on most days; remaining active several times per week; abstaining or keeping your alcohol consumption low; abstaining from smoking; getting adequate rest and sleep and managing stress are all great ways of reducing your risk of obesity.

If you are already in the obesity category, then we should look at how we can manage your condition by focusing on lifestyle changes. The first thing that we need to look at however is your level of motivation and what kind of expectations you may have. Lifestyle change really is behaviour change and changing habits which have taken years to form. It is expected therefore that making changes will take time and a lot of hard work from your end. The results may not always come as quickly as you hope and you may even have instances when the weight does not move despite all the effort you are putting in.

It is normal to feel discouraged and feel like giving up. But the reality is that most people don’t actually realise the number of behavioural changes they make in their effort to lose weight. This should actually be your focus. Focus on optimising your health, with less focus on what the number on the scale is telling you.

Dietary change remains one of the most important parts of obesity management. Overall recommendations include consuming a diverse diet rich in fruits, vegetables, wholegrains, local starches, eggs, fish, chicken, lean meat, milk products, nuts, seeds, lentils, beans and healthy fats. Opt for more natural and minimally processed foods and reduce your intake of highly processed foods. You should also be mindful of portion sizes, cooking methods and eating mindfully.

Getting adequate physical activity is an important addition to your journey to better health. Try not to overdo it when you get started especially if you have been inactive for a long time. The best exercise to start with is walking or swimming. Start slow and gradually build up until you can do at least 30 minutes every day. As you improve you can include other activities like cycling, hiking, dancing or other sports that you enjoy. It is important to also include some resistance or strength training exercise to strengthen your muscles such as lifting weights.

Traditionally, obesity is seen as a ‘Health problem’. We would like to shift this mind-set and make everyone realise that it is a societal problem. While the health sector deals with the treatment of symptoms or comorbidities as a consequence of obesity, society has to deal with absenteeism from work, premature disability and inability to work, reduced work productivity and high economic cost at individual, family and societal levels.

The approach we take to address obesity therefore should be an ‘all-of-society’ approach involving the government, private sector, civil society and organisations. No one should be pointing fingers but rather we should be coming together to look at ways to make it better.

On Sunday October 15, 2023 members of the public are being invited to witness the launch of the obesity campaign at Gordon Square starting from 9am. The aim of the campaign is to bring everyone on board whether you are from government, private or civil society for us to find innovative ways of preventing obesity and also help those already living with this condition. You shouldn’t be asking “what is the government going to be doing” but rather “what can I do or contribute in this journey”. It is only through collaborative work that we can really succeed in achieving our goal in tackling obesity.

Even if you think obesity is not your problem because you are slim, think about how you can help others around you, be it friends, colleagues or family members. Besides, one of the best ways to tackle obesity is by preventing it in the first place.

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Please get in touch by emailing eat4ourhealth@gmail.com and let us know how you’re doing with these ideas, or better still, let us know how we can help you.

Yours in health

The E4OH team