The other day, a 45-year-old man came to the emergency room with complaints of breathlessness. Though it was not a heart attack, we ran all tests and found he had diabetes, very high cholesterol, and uric acid levels. He also said he urinated frequently and felt thirsty. And there was the overarching factor: obesity. He weighed 98 kg.
This is what we call morbid obesity, when the body weight itself poses a health threat as it increases the risk of heart disease, stroke, fatty liver, and type 2 diabetes. Usually, such people suffer from metabolic syndrome, or a cluster of conditions, including high blood pressure, high blood sugar, too much fat around the waist, and high cholesterol or triglyceride levels. Having even one of the conditions increases the risk of serious disease. Five out of 10 patients of mine are morbidly obese. But they do not realise it unless they face complications.
So what is morbid obesity?
When your body mass index (BMI), which is a measure of body fat based on height and weight, is over 40, you are in this category of severe obesity. But BMI does not reflect the percentage of muscle mass compared to that of body fat. So, you have to check for visceral or belly fat. When the waist circumference is more than 35 inches in women and 40 inches in men, the patient is considered to be morbidly obese. The waist-to-hip ratio of such patients is greater than 0.9 for men and greater than 0.85 for women.
What causes morbid obesity?
Lifestyle mismanagement is a key trigger, which means lack of exercise, consumption of high-sugar, high-fat, and processed foods, prolonged sedentary behavior, excess screen time and lack of sleep. Obesity-specific genes react to stress hormones like cortisol.
How to treat morbid obesity?
The first intervention was lifestyle management. For my patient, I suggested gradual movement exercises because putting a person with a high BMI suddenly on an extreme regime could put them at greater risk of injury or health complications. Besides, we chose activities that he would stick with rather than give up. Low-impact water aerobics worked for our patient.
The food chart approach usually works. With the help of our dietician, we first calorie counted and recorded what our patient ate daily. Replacing carbs with more fiber and protein, we took care of hunger pangs and lowered calorie intake. We completely eliminated processed foods, packaged meals, artificial beverages and saturated fats.
We increased his water intake. He limited alcohol and avoided taking it with dinner, getting rid of the habit gradually. Decreasing calorie intake by 500 to 600 calories and gradually by 1000-1,100 calories per day via exercise and diet can lead to sustained weight loss and help you shed up to a kg per week. Once our patient saw that he had agency in sustaining a weight loss, he stayed motivated and on course.
His weight loss medication, which we put him on, worked better. Let your doctor decide when you need such drugs or bariatric surgery.
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