Sunday, August 13, 2000		Fitness

EATING adequate and nutritious is essential during health as well illness. The body needs energy continuously and the brain itself requires nearly 5 gm of glucose every hour. Nature has, therefore, provided us with metabolic and hormonal mechanisms to store energy in the form of glycogen (for a short period) and fat (for a longer time). Our internal mechanisms do not control this on a day-to-day basis but over a longer period of time. When metabolic and hormonal mechanisms do not function properly, it can result in obesity or, conversely, anorexia. Our body can convert a wide spectrum of food into thousands of molecules required for diverse physio-chemical and mental functions. It is amazing that for such complex functions the body needs only nine essential amino acids from proteins, one essential fatty acid from fat and 13 vitamins and some minerals; the rest it can manufacture from raw materials.

The body requires energy, which is measured in terms of kilo-calories. The amount of energy required varies according to an individual’s height, weight, age, sex, physical activity and environment. Roughly 20 calories per kg of body weight are required for performing basic body functions and 30 per cent is added for a sedentary person, 50 per ent for moderate physical activities and 100 per cent for stringent physical activities. This requirement increases with fever, trauma, increased thyroid functions and even during intense stress and strain. There is a very finely tuned mechanism for controlling the nutritional balance through the brain, hormonal mechanism and psycho-social factors. Why do some people gain more weight than required for body functioning? The precise answer is not available, although there are a lot of factors known and some unknown. Why does a person feel hungry and eat when the body already has enough calories? There are genetic factors, psycho-social factors ingrained in childhood, environment conditions, lack of physical activity, apart from certain abnormal conditions like low functioning of thyroid or other hormonal imbalances. This article does not address the abnormal form of obesity resulting from diseases. Let me start by saying that all fat is not undesirable. In fact, there can be no balanced nutrition and physical well-being without fat in the diet or in the body. Somebody has described body fat in somewhat light but realistic terms. He graded body fat as beautiful, graceful, miserable and pitiable. Late Prof J.N. Berry of the PGI, Chandigarh, who was interested in the various types of body build, used to tell us: "Remember there can be no beauty without fat. It is my problem that it quickly progresses to the next stage."

It is not only for aesthetic or psycho-social reasons that overweight or obesity is undesirable. Extra weight is associated with a large number of diseases like high blood pressure, heart diseases, diabetes mellitus, gout, gall bladder diseases, joint and bone diseases, skin infections, certain kinds of cancers, including breast cancer in women and prostate in men, respiratory disorders like excessive snoring and sleep apnoea (temporary cession of breathing during sleep) which can be very disturbing, endocrine disturbances like insulin resistance, decreased growth hormone, irregular menses and early menopause, more illness in general and even higher mortality rate. It also results in a negative self image and social handicap.

When do we say that a person is overweight or obese? The relation of height and weight in both the sexes is the body mass index which means the number of kilograms/sq.mt. of body surface area. In general, it is normally up to 25, over 27 is overweight and beyond 30 is considered obesity and beyond 35 is extreme obesity. How common is obesity? Figures available from the USA show that nearly 35 per cent of the population is obese and this percentage is increasing with time. The same trend can be witnessed all over the world. There are no precise figures available from our country. But from studies conducted at the PGIamong rural and urban population show that hardly 2-3 percent of rural people are overweight or obese but the problem is much more acute in the urban areas where as many as 15 per cent of the people are obese.

There are no easy solutions to this seemingly simple problem. I often tell my patients that body fat is like a bank balance. If you put in more and draw less, it increases and vice versa. Constant discipline and efforts are required to ward off obesity or to lose those extra kilograms.

Let me start by saying that there are no drugs for obesity. Many have been tried but have not been successful. Recently a drug introduced by Roche which prevents the digestion of the fat in the intestine and the fat passes out with the stool, thus creating the problem of bulky stools, was released in Britain (Orlistart). But only time will show how successful this is. Many surgical procedures, including the shortening of stomach, by-passing the small segment of intestine where fat is digested have been devised, and they have often resulted in complications and are advised only in a very acute cases.

Exercise is very good for maintaining the body, health of muscles and joints and for ensuring physical fitness. But most of the people cannot do the amount of exercise necessary to lose weight. Yet exercise is mandatory for everybody. Balanced and judicious diet is, therefore, the key. Depending upon the degree of obesity, calories required by an individual may vary between 1200 to 1400 and a physician or dietician can devise a simple menu for this purpose. Dieting does not, however, mean starvation. In fact starvation is not advisable for dieting and whenever tried by some misguided people, it has resulted in serious complications. Take plenty of green vegetables, salads, fruits, barring mangoes, grapes, chickoos etc., milk products minus fats, keep away from sweets of all kinds, fried food, all kinds of dry fruits and nuts and alcohol. It helps to have many small meals instead of not eating for a long time and then overeating. Eating in between meals (snacks) is often the cause of obesity. A person who takes about 1300 — 1400 calories and leads a sedentary life should loose about 1 kg of weight every two weeks and thus shed about 20-24 kgs in a year. Yet many people do not achieve this success because of lack of understanding of the process, lack of perseverance and a weakness for gastronomic delights. Yet this human weakness is not trivial. Romans are said to have vomitorial sheds attached to their feasting halls so that they could eat, throw up and eat again. What pleasure indeed!

Many health clubs and clinics offer weight reduction courses. Perhaps these places can help by focussing attention and enforcing certain dietary and physical activities which become easier to follow in a group. But it is advisable is not to take any medicines because these can cause harm.

Let me end by relating a episode that took place in a international conference on heart diseases in the 60s in Delhi, when at the end somebody asked the doyen of the cardiology at that time, Dr White from Harvard, as to how he would summarise the entire proceedings of the conference. He said, "Eat less walk more". Let us follow his simple advice.