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by Dr Praveen Raj


Lets first try understanding each of our mindset towards obesity.Historically , we have been made to believe obesity is a state of affluence and any intention to weightless is only to look good. Even jogging in a park has been considered a sign of affluence…

We have been gradually fed with the thought that obesity is self created by someone who's not bothered at how they look for the outside world and all those who lost weight , did so only to look good for the same world.Lets look at it like this .Why would someone want to look fat and not be bothered … Will you be ? Any normal human tendency is look good … But when someone is unable to … it may not be their fault always.

We all have a great deal of knowledge about type 2(adult onset) diabetes.So would you believe if I say diabetes is related to eating more sugars.Think again …..The answer should be a big NO.isnt it ?Its a internal change in function , called insulin resistance which reduces the efficiency of the insulin produced.Likewise , obesity is a disease related to altered energy homeostasis(regulation of energy intake and energy expenditure) and not merely related to the quality or quantity of food intake.Yes, food intake does contribute , but its only a complimentary factor and not a causative factor. Thats the reason , why if two different individuals eat the same kind of food with similar activity levels , their weights would still be different .

Understanding energy homeostasis is complex .It involves a multitude of factors , including environmental factors,hormonal  and lifestyle factors.Weight regulation is a physiological process wherein the food we eat gets metabolised by a complex interact of neural signals from brain,hormonal signals from the intestines and pancreas and how its stored in the adipose tissue(fat cells).This regulation varies between individuals and is closely related to different factors as mentioned above.These factors could include stressful conditions ,drugs , altered sleep pattern ,timings of food intake , associated medical conditions , sedentary lifestyle etc.

This state of altered metabolism leading onto increased accumulation of fat is refereed to as obesity.Read the last line again …’ increased accumulation of fat ‘ , and not weight.This refers to a state where a heavyweight champion with large amounts of muscle and weight , may not be considered obese , as he has only less fat .On the contrary , someone with almost normal weight with high amounts of fat , may be considered obese.This state is common in Asians , who by genetic factors tend to have higher fat content , predisposing each of them to increase risk of obesity related comorbidities like diabetes , hypertension , polycystic ovarian disease , non-alcoholic fatty liver disease etc.This entity is called ‘thin fat Indians’.Although its grammatically wrong to have thin and fat together , it refers to higher fat content in the bodi in even thin individuals.

The increased fat accumulation has a condition called ‘low grade chronic inflammation ‘ which is the causative factor for insulin resistance as described above , which predisposes to the comorbidities mentioned above.Hence , any treatment should be intended at losing this fat and not merely weight.

Hence , obesity by its ability to precipitate the conditions mentioned above ,is and should be referred to as a disease and desired treatment to be initiated before it could eventually lead on to life threatening conditions.This is why the American Diabetology association and World Health Organisation have aptly defined obesity as a disease and not merely a cosmetic entity.

© 2017 GEM Obesity & Diabetes Surgery Centre - Updated by GEM Hospital IT Department