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  • Dr Ali A Nejat

Obesity, is it your fault ?

Obesity is a complex issue. It has effects on many aspects of our life. Being overweight is a major risk factor for heart disease, diabetes, fatty liver/cirrhosis , chronic kidney disease, joint and muscles aches and pains, digestive difficulties like heartburn and some cancers. The more weight we put on we increase the chance of chronic medical conditions and it makes their management harder.

There are several videos in this post and they are open for debate. We do not agree with every points made in these videos.

Obesity medical definition :

Body mass index: weight in kilograms divided by the square of the height in meters. Calculate your BMI here. Definition of obesity is body mass index over 30. Healthy weight is BMI between 20-25 and over 25 up to 30 is overweight. If our weight is in normal range but we believe we have localised fat, click here for more information. If we do body-building exercises we should be cautious in interpreting BMI. It may not apply if we have a large bulk of muscles. There are other methods to check on body fat.

Obesity in Australia ?

In 2014–15, almost two-thirds (63%) of Australian adults were overweight or obese. 11.2 million adults were overweight or obese (ABS 2015).About 1 in 4 adults (28%) were obese. For obesity statistics click here.

Should you ever tell someone they are fat ?

Obesity in children:

In 2014–15, about 1 in 4 (26%) Australian children and adolescents aged 2–17 were overweight or obese. That’s around 1.2 million children and adolescents (ABS 2015). About 1 in 6 (18%) children and adolescents aged 2–17 were overweight but not obese, while about 1 in 13 (8%) were obese. Read more about obesity statistics in Australia here.

Psychological impact of obesity on our children: " In one study there were 212 children aged 8 to 13 years at baseline, who were participating in the Childhood Growth and Development (GAD) Study. Questionnaire and interview measures were used to assess children's self-esteem, depressive symptoms, body image, eating disorder symptoms, experiences with bullying, family satisfaction and quality of life. Linear mixed models were used to consider longitudinal changes in psycho-social variables. Overweight and obese children reported greater psycho-social distress than healthy weight children, and these differences were more pronounced for girls than boys. The results of this study suggest that psycho-social difficulties show considerable stability in childhood, for overweight/obese and healthy weight children. What is Known: • Childhood obesity tracks into adolescence and adulthood. • Physical health problems associated with childhood obesity also persist to adulthood. What is New: • Overweight and obese children are at risk of ongoing psycho-social distress from childhood into early adolescence." Link to study.In our GP practices we see more children specially young girls ( as young as 6-7 yr old) worried about their weight and suffer from anxiety because of it. While their weight is mostly in normal limits, they listen to adults talking and being worried about their weight. We should be careful about information and worries we pass to our children.

Obesity Causes and meaning:

Environment factors:

1-Increasing food supplies and consumption, specially high calorie foods that are often served in large portions, 2-Decreasing time in occupational physical activities 3-Displacement of leisure-time physical activities with Sedentary activities like electronic devices and watching television, 4- Growing use of medications that have side effect of weight gain 5- Inadequate sleep Genetic factors:

Not every one in same condition become obese which suggests existence of underlying genetic mechanisms operating at the individual level. Twin studies indicate that rate of heritability of BMI is high ranging from 40 to 70% . Eleven rare genetic forms of obesity are found.

Energy-Balance Dysregulation:

Genes and environment interact in a complex system that regulates energy balance. Two sets of nerve cells in hypothalamus in brain control energy balance by regulating food intake and energy expenditure.Short term and long term energy balance is controlled through a coordinated network of central mechanisms and peripheral signals from cells in fat tissue, stomach, pancreas and other organs. Obesity treatment: First step is measurement, monitoring and seeking more information. We need to have regular measurement of size and weight. By regular monitoring we can see if we are getting into healthy weight ( BMI 20-25) or not. Realistic treatment plan divides into two main sections: loosing weight and maintaining weight. We may loose 10 kg in one month with very strict diet and heavy exercise but we may not be able to maintain it.To maintain the healthy weight we need to have healthy life-style, balanced diet and regular exercise.

Weight loss plan should be aligned with other chronic medical conditions, functional limitations and severity of overweight. Lifestyle modification is first option. It has low cost and minimal complications. In lifestyle modification/intervention we change our eating habits and physical activities. In lifestyle intervention we learn techniques for healthy diet and physical activities. The main issues are regular recording of food intake, physical activities and weight. Most of smart phones have apps for monitoring diet, exercise and weight. If you are looking for additional apps, please click here. Diet for weight loss: Low calorie diet, typically 1200-1500 Kcal per day for women and 1500-1800 Kcal per day for men. Diet for weight loss maintenance: Reduced calorie diet according to reduced body weight. Physical activities for weight loss: More than 150 min aerobic activity per week ( Swimming, exercise bike, push bike, brisk walking, rower machine,...) Physical activities for weight loss maintenance: 200-300 min of aerobic activities per week.Please note that to maintain the healthy weight we may need more physical activities up to 2 times of weight loss program itself.

Regular counselling and encouragement needed for this weight loss plan. If delivered by trained and experienced health professional, weight loss of 5-8% (on average) can be achieved.Recommendation only from general practitioners is not enough. Nutrition counselling, activity modification Medications: Medication can be use as supplement to reduced-calorie diet and increased activity for weight management. Medications can be considered if BMI is over 30 or 25-30 but with related medical conditions. Please discuss medications with your GP. There are many aspects of weight loss medications ( like indication, contraindication, side effects , dosage ,... ) that we need to talk with our GP before starting medication. Orlistat (Xenical) : Enzyme inhibitor resulting in fat absorption and reduces energy intake. Liraglutide (Saxenda) : Delays stomach emptying to reduce food intake. Phentermine ( Duromine) : Decreases appetite to reduce food intake. Naltrexone/Bupropion (Contrave) : Has effects on brain to reduce food intake (appetite)

Bariatric surgery:

There are several techniques and procedures for weight loss surgery : gastric (stomach) stapling

gastric banding

bowel bypass

jaw wiring. To have surgery or not is a question that needs long discussion with GP and later surgeon, dietitian and plastic surgeon. We need more information about different aspects of procedure and effects on our body. For more about surgical procedures and links click here. For public hospital in QLD see these links:

Weight-loss surgery at no cost to patient

Excellent resource for Bariatric surgery in public hospital ,QLD Please see different techniques in bariatric surgery video:

Patient's experience of bariatric experience:

QLD Medical Doctors as obesity centre:

In our medical centres in Brisbane , Northcote and Doncaster we have experienced doctors ,nurses, dietitian, exercise physiologist and psychologist to investigate causes for our obesity/overweight, make a weight loss plan and monitor our progress through the weight loss plan. If needed we liaise with different specialist as well.

In preparing this post I enjoyed reading Steven B. Heymsfield MD review article ( Mechanisms, Pathophysiology and management of Obesity) in New England Journal of Medicine 2017; 376: 254-66

Please leave your comments about weight loss experience.

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