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M. P. Ravindra Nathan

By M. P. Ravindra Nathan, MD, FACC, FACP

It may sound hackneyed and trite but let me say it one more time, �Too many calories and too little physical activity lead to overweight.� I am used to excuses from my patients such as �Gosh! I don�t eat much at all,� (the reverse is often true!) or �It is my hormones, doc� (only less than 5 percent suffer from overweight related to hormone problems) When given a target to shoot for, they say, �Oh, boy, I have never been that low since my school days.� Even the pets in USA are beginning to look obese.

Although I don�t see that many obese Indians (Body Mass Index >30), there are plenty of us around in the overweight category (BMI 25-30). Ditto with Indian children. During the Indian holiday parties recently, I noted that at least 25 percent of the guests may be in that category, especially women. With a high incidence of diabetes and heart disease among us, even a small weight gain in the wrong place can be adding insult to injury. Indians are prone to develop a �paunch,� or abdominal obesity, one component of the �Metabolic Syndrome� and a definite risk factor for heart disease. Also, remember it is easier to put on weight than to lose it.

Lalita Kaul, Joseph J Nidiry and Henry W Williams Jr. are authors of �Multidisciplinary approach to the management of obesity: Handbook for physicians and health care professionals.�
Every year, Americans spend more than $33 billion on various diet-related products and services in an effort to slim down; nevertheless, obesity rates continue to increase. Why? The food industry is one step ahead of you, spending an equal amount on advertising and other marketing tools. The proliferation of restaurants and fast food chains along with �super sizing� of meals have encouraged people to eat out. Then there is the problem of instant gratification; when I see a platter of laddus or gulab jamuns, my willpower wilts too. While the calorie consumption is increasing, the daily physical activity has been decreasing. Many of us have become couch potatoes and Chinese and Indian takeouts have gained in popularity.

Some consider obesity a disease related to interplay of genetic, psychological and environmental factors and the treatment often has to go beyond eating less and exercising more. �The mindset needs to change,� says Jennifer Marks, medical director of Weight Intervention Program at University of Miami. �Just like alcoholism, being seriously overweight is not about weakness or willpower, it is a disease.� While there may be some truth in it, I suspect that old-fashioned gluttony and laziness still play a major role.

The first step in the treatment is to go to a doctor and screen for any remediable problems such as hormone imbalance or excessive fluid retention. Then educate yourself in nutrition and draw up a practical approach, a sensible plan counting the calories. Maybe you want to enlist the help of a dietitian. It is not just the calories alone; the quality of food you eat counts too. The components in the �food pyramid� have changed and you need to eat a lot more fruits and vegetables and less of meats and rice.

Do you read the labels? When you shop in the grocery stores, it is good to look at the nutrition facts of serving sizes on the package. Specifically, you must look at the amount of saturated fats and carbs, not just the cholesterol content. I know it is a pain in the neck, as the small print is hardly readable but be an educated consumer. You will be surprised how much fat is present in those �low-fat� items.

While browsing in an Indian grocery store recently, I looked at a packet of Soan Papadi, a delicious sweet. Guess what? One serving size contains 3 grams of saturated fat, almost a third of what American Heart Association recommends for a low-fat diet regimen. And one serving of Methu Khari Biscuits contains 1 gram of saturated fat. Same with tea toasts, banana chips etc. Keep in mind the accuracy of the labels in some of the Indian food packages may not always be reliable. Some containing ghee or palm oil are labeled as �saturated fat 0�! So, look at the ingredients too.

A couple of years ago, I vacationed in Paris with my family for a week. I could hardly see an obese French person during my entire week�s stay. The legendary leanness of the French is well known � so is the much lower incidence of heart disease, in spite of eating fatty foods � the �French Paradox,� as we call it. Xavier, one of our respiratory therapists, who comes from France, told me one day, �As children, we were taught not to overeat. Only smaller portions are served and we consume a lot of bread and some wine.� And they walk a lot, too. In America, we have the �clean the plate� mentality after serving too much. However, thanks to the invasion by the fast food culture, the French waistline also is getting broader.

You don�t see many obese vegetarians. Dr. Dean Ornish of California has shown that a low-fat vegetarian diet, as part of a comprehensive lifestyle program, led to measurable regression of atherosclerotic lesions in 82 percent of research subjects and interestingly, most didn�t lament this dietary change. Now, there is a tantalizing thought for you.

In regards to exercise, you have to make it a habit and not a ritual; a joy, not a job. In my hospital, I try to climb the stairs frequently rather than take the elevators. Some days there is quite a traffic on those steps. One Harvard study noted that participants who averaged 55 flights of stairs per week had a 30 percent lower death rate during the study period. My wife has installed a treadmill in the family room and does some low-level walking while watching TV or reading newspapers. Or you can go hiking or play tennis with your friends, something enjoyable and hence less monotonous. My father had a habit of walking for 20 minutes in the front porch after his supper and now I know why he remained healthy till 75.

There are no dearth for diet books but there is one I would like you to read: �Multidisciplinary approach to the management of obesity: Handbook for physicians and health care professionals,� by Lalita Kaul, PhD, RD, LD, LN; Joseph J Nidiry, MD; Henry W Williams Jr., MD, MPH ($25 + S&H, ISBN: 978-1-930636-04-0 Published by: Medical and Engineering Publishers Inc; P.O. Box 74, Sunshine, MD 20833-0074 or visit ) The book answers some of the questions we always ask, �Why we eat what we eat, what happens to all that we eat and what can we do to end this epidemic and more.� Kaul is a spokesperson for American Dietetic Association, the largest organization of food and nutrition professionals in U.S. and recommends that you visit their Web site for information.

Cardiologist Dr. M. P. Ravindra Nathan lives in Brooksville.

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