Adopt a healthy lifestyle to prevent abdominal obesity, overweight and overall obesity
Rationale : Besides overweight and general or overall obesity, abdominal obesity (increased waist circumference) that is indicative of excess fat in the peritoneum (abdominal cavity) with accumulation of fat in and around the internal organs is associated with risk of lifestyle diseases.
BMI is the ratio of weight and height, which estimates total body mass and correlates highly with the percentage of body fat. It is computed by dividing the weight in kilograms by the square of the height in meters [BMI=Weight (Kg)÷Height (M)2]. The ideal ranges of weights for a given height are provided by WHO which is useful for categorizing persons as normal (ideal), undernourished and overweight or obese. The cut-off levels for categorizing overweight and obesity in children and adolescents are different since growth spurt in boys and girls occurs in different ages. Age and gender specific BMI Z-scores of reference population are used to assess their nutritional status.
The definition of overweight and obesity is based on BMI. In general, BMI for adults, as per WHO, ranging from 18.5 to 25 Kg/M2 is considered to be normal. However, for Asians it is recommended that the BMI should be between 18.5 to 23Kg/M2, since, they tend to have higher percentage body fat even at a given BMI compared to Caucasians and Europeans, which leaves them at a higher risk of NCDs.
Fat accumulation especially the distribution of fat around the abdomen (central obesity) and internal organs is now considered to be more harmful. Central obesity, as indicated by higher waist circumference, is considered as a risk factor for lifestyle diseases such as NCDs.
BMI ranging over 23 to 27.5 Kg/M2 is defined as overweight as per Asian cut-offs. Over 31% of urban and 16% of rural adults are overweight (NNMB).
BMI above 27.5 Kg/M2 is defined as obesity as per the Asian cut-offs. Over 12% urban and 5% rural adults are obese (NNMB).
The waist circumference is useful for assessment of central obesity. Several studies have shown direct correlation of central obesity with chronic lifestyle diseases or NCDs. Waist circumference of >90cm for men and >80cm for women is associated with increased risk of several chronic lifestyle diseases. Abdominal obesity is prevalent in 53% of urban and 19% of rural adults.
It is well known that overeating along with decreased physical activity predisposes an individual to overweight/ obesity, but solely depending on highly refined grains, processed foods and high sugar intake deranges our metabolism and predisposes to obesity. Unhealthy dietary practices during infancy and childhood (such as overfeeding) play an important role in predisposing individuals to overweight/obesity in adulthood. Low and high birth weight (<2500g and >4000g), obesity during childhood and adolescence are also likely to cause overweight/obesity in adulthood. In addition, women are at higher risk of becoming overweight/ obese around pregnancy and after menopause. Genetic (familial) factors as well as complex behavioral and psychological factors that may influence eating patterns, may also contribute to overweight/obesity, but the effect of dietary and physical activity behavior is more profound than genetics.
Over-feeding during infancy, childhood and adolescence predisposes to overweight/ obesity during adulthood. The tendency of familial obesity seems to be inherited. Eating junk or unhealthy foods coupled with low physical activity is considered as a main contributor. Complex behavioral and psychological factors influence the eating patterns. In addition, metabolic errors in energy utilization may favor fat accumulation. Insulin is an important modifier of energy and fat metabolism favoring fat deposition. Low and high birth weight (<2500 g and >3500g), obesity during childhood and adolescence are likely to lead to obesity in adults. It is therefore, necessary to maintain a desirable body weight by consuming just enough calories or adjust physical activity to maintain energy balance (intake = output). Body weight must, therefore, be checked and monitored periodically.
Several studies have suggested that inadequate and improper sleeping habits, along with more hours of screen time (spent in watching television / mobile phone) is strongly associated with weight gain in childhood, adolescence and adulthood. This is mostly due to the sedentary behavior, tendency to consume unhealthy foods during unhealthy dietary practices leading to overweight/obesity. It is necessary to maintain appropriate abdominal circumference and a desirable body weight by consuming just enough calories and being physically active. Body weight must be monitored periodically.
There are several negative health consequences of obesity. Excessive body weight causes low-grade chronic inflammation and increases the risk of heart disease, hypertension, diabetes, gallstones, fatty liver disease, certain types of cancers, osteoarthritis, psycho-social problems and also impairs immunity. Obesity is often associated with increased levels of low-density lipoproteins ('bad' cholesterol), and triglycerides, apart from abnormal increase in glucose and insulin resistance. Considering the increasing trend in the prevalence of non-alcoholic fatty liver disease (NAFLD), coronary artery disease, hypertension and diabetes in India, it is important to maintain desirable body weight for height and prevent overweight and obesity.
To maintain appropriate weight and waist circumference, one must include fresh vegetables in every meal, consume whole grains, pulses and beans; and must avoid sugar, processed products, fruit juices and HFSS foods. Regular physical activity and yoga are crucial to maintain good health and weight. Weight reduction should be gradual. Weight reduction diets should not be less than 1000 Kcal/day and should provide all nutrients. A reduction of half a kilogram body weight per week is considered to be safe. Approaches of rapid weight loss and use of anti-obesity drugs should be avoided.
However, consuming higher amounts of protein (15% energy from protein) may be important during typical energy- deficient weight loss diets (i.e., 500–750 Kcal/day deficit) to preserves muscle mass. Nevertheless, the protective effect of higher-protein diets on muscle mass is compromised if the energy deficit is more than 40% of daily energy needs, and the dietary proteins are oxidized for energy production. Hence, it is advisable not to go beyond 40% energy deficit of daily energy needs to support muscle mass maintenance and protein balance.
Weight-reducing diets should be nutrient rich and nutritionally balanced. Foods containing high sugar/salt/fat/ refined cereals such as sweets, biscuits, cakes, candies, fruit juices or cool drinks (carbonated beverages) provide high calories and nil or low nutrients and hence should be avoided. Foods containing sugar or refined carbohydrates have high glycemic index (GI) and therefore promote rapid absorption of glucose, and increase glycemic load (GL). There is a sharp rise in insulin when high sugar / refined cereal foods are consumed. Regular intake of foods high in sugar at frequent intervals increases and maintains insulin at a higher than normal level. High insulin impairs metabolism, increases adipogenesis and promotes deposition of fat in and around organs, especially when physical activity is low.
Adequate intake of micronutrients and fibre-rich foods such as pulses, nuts, chia seeds, flax seeds, whole grains including millets, vegetables and fruits improves satiety and helps to maintain levels of blood glucose, insulin, cholesterol as well as triglycerides. Pulses, nuts and moderate quantity of lean meat will also help maintain weight and health. Consumption of plenty of fruits and vegetables would not only result in satiety but also help maintain adequate fibre and micronutrient intake.
Source: ICMR National Institute of Nutrition, Hyderabad - Dietary guidelines for Indians
Last Modified : 5/14/2024
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