M. P. Ravindra Nathan

A couple of years ago, Elaine, a 50-year-old patient of mine was admitted with nausea, vomiting, abdominal pain and distension. She had a classic case of �acute cholecystitis,� an inflammation of the gall bladder. She promptly underwent a laparoscopic gall bladder surgery by an experienced surgeon. Normally, it would be a happy-ending story.

But this turned out to be different. Why?

The day after surgery, she went into shock because of intra abdominal bleeding which needed a full exploratory surgery. A tie which closed one of the deep arteries had come loose. A wound infection followed and then a touch of pneumonia. She ended up staying nearly a month in the hospital but survived. It was a narrow escape indeed.

�It would have been so much easier if she wasn�t so obese,� the surgeon commented. Elaine, only 5� 5� tall, weighed 302 pounds! Post-operative complications are well known in people who are obese.

By this time, you have read several articles and news items on obesity. American Medical Association estimates that more than 300,000 people die in USA each year because of obesity, second only to smoking-related deaths. Nearly two thirds of the adult American population can be classified as overweight or obese and about 15 percent of children up to age 19 are also in that category. And the numbers are increasing. Dr. Claude L�Enfant, National Health, Lung, and Blood Institute director, said recently, �Obesity has reached pandemic proportions in USA and there is no end in sight.�

Now that the holiday season is over and we are getting a jump start on the New Year with all kinds of difficult-to-keep resolutions, can I ask you how much weight you gained? �Why are you fretting about this so much?� you ask. After all, it is only food we are talking about, not drugs or alcohol. But unfortunately, excess food can do just as much damage since obesity is directly liked to the nation�s No.1 killer, heart disease and many other diseases such as diabetes, arthritis, infections and cancer. Sad to say that obesity may soon replace smoking as the No. 1 cause of preventable illnesses in USA.

Asian Americans, including Indians, used to enjoy a very low prevalence in obesity. But that is changing with the prosperity enjoyed by all of us. Which is the reason obesity is now considered a global phenomenon. Many Indian children are overweight too since we have a tendency to coax our children to eat more and clean their plates.

How do you calculate your optimal body weight? The standard way to calculate is: Women: 100 lbs for 5� of height + 5 lb/ inch, for every inch thereafter. Men: 105 lbs for 5 ft of height + 6 lb/ every inch above 5 ft. So an ideal weight for a 5� 6� man would be 141 lbs. However, scientists prefer the term BMI (Body Mass Index) which is calculated as Wt in Kg/ Height in meter2. The ideal BMI, same for everybody, is easier for comparison, from new born to adult. The normal BMI is 20-25. Mild obesity, often called simply overweight, is when your BMI is 26-30. A BMI above 30 is clearly abnormal and portends future problems. Everybody should know their BMI and if you are averse to calculations, get a small handheld BMI calculator from pharmaceutical companies. The table below is self explanatory:

Clinical Classification of obesity

Class of BMI (kg/m2) Comments

Obesity

0 20 � 25 Normal range

1 26 - 30 Mild risk (overweight)

3 31 - 35 Moderate risk (mild obesity)

4 36 - 40 High risk (moderate obesity)

5 _> - 40 Very high risk (Morbid Obesity)

Medical problems start creeping in when your weight exceeds about 10 percent of your optimal weight.

Health Consequences

Many view obesity as a cosmetic rather than a health problem. Occasionally, I see letters to �Dear Abby� defending obesity with proclamations such as: �Fat is beautiful,� �Don�t discriminate against fat people,� etc. Cosmetics aside, it is time to recognize the major health hazards of excess fat. Many don�t recognize that even with a moderate excess in weight, life expectancy is noticeably decreased and this proportionately worsens with increasing obesity. Metropolitan Insurance company emphasizes on your weight while calculating your life insurance premiums! As the degree of obesity escalates, a steady, striking contraction of life span occurs. The years lost can be calculated based on existing statistics.

A high BMI is associated with many diseases, notable among them being type 2 diabetes mellitus, coronary heart disease and heart attacks, ischemic strokes and hypertension. Arthritis and gall bladder diseases are quite common. In a recent study reported in New England Journal of Medicine, obesity was recognized as an important risk factor for heart failure, according to data from Framingham Heart Study. And they say even lesser degrees of overweight poses a risk. Also, obesity significantly increases the risk of dying from several cancers. American Cancer Society warns that the more overweight a person is, the greater the risk of dying from cancer.

Kids and adults with obesity develop more respiratory problems, especially shortness of breath and respiratory infections and need more time to recover from them. Skin problems are higher in this group, too. The psychological implications, especially depression (which can be a cause and effect), are well known. One of my patients told me sadly, �The worst problem is to get up after I go to the toilet. It is a struggle.� Some may experience urinary incontinence and it is possible to regain control over the bladder simply by shedding the few extra pounds.

To be concluded in the next issue.

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