A Review on Obesity – Life Style Disorder

DEFINITION:

The word ‗Obesity‘ came from Latin word; where the verb ‗obedere‘ means ‗over eat‘ and ‗obesitas‘ means ‗being very fat‘.

Obesity is a health condition in which the natural energy stored, reserved in the fatty tissue of human beings, is increased to that point where it is linked with certain health issues. It can be defined in relative or absolute terms. Practically, it is evaluated in absolute terms by measuring BMI (body mass index), but also in terms of its distribution through waist circumference or waist-hip circumference ratio measurements. The normal amount of body fat (expressed as percentage of body fat) is between 26-30% in female and 19-24% in male. Female with over 30% body fat and male with over 25% body fat are considered as obese.

Women of reproductive age have higher rates of overweight and obesity and are more adversely affected by obesity-related complications than men. This gender difference is mainly due to general weight gain during childbearing years, gestational weight gain and weight retention, adverse lifestyle, or risk factors associated with pregnancy and the postpartum period. Maternal obesity increases the risk of numerous complications including pregnancy, labour and birth for both the mother and the child, diabetes and hypertensive disorders etc. Compared with normal weight, maternal overweight is associated with a higher risk of caesarean delivery and a higher incidence of anaesthetic and postoperative complications. Low Apgar scores, macrosomia and neural tube defects are also more frequent in infants of obese mothers compared with infants of normal-weight mothers.

Obesity may be caused by a number of social, cultural, behavioral, physiological, metabolic, and genetic factors that are beyond the person’s control. Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness. It is associated with increased risk of medical illness, disability, and death. It is a metabolic disorder that is primarily induced and sustained by an over consumption and underutilization of caloric substrate.

Base on Waist/Hip Ratio– Waist/hip ratio rises above 1.0 in male, and in females when it rises above 0.8.

Base on Body fat Distribution –

• Central (Abdominal /visceral/ android / apple shaped) – Collection of fat in abdomen. Common in males. Causes risk of -D.M.-2, Hypertension, Hyperlipidaemia
• Generalized (Gynoid/pear shaped) – Collection of fat on hips and buttocks. Common in females.

BMI – Body mass index is the most simple and useful index to estimate body fat. It is calculated as follows:

BMI = Weight in Kilograms / Square of height in meters.

So BMI = Kg / sq ms

BMI is indexed as follows for reference:

BMI- Type

< 18.5 Underweight

18.5-24.9 Normal weight

25.0-29.9 Over weight

30.0 – 34.9 Class 1 Obesity

35.0 -39.9 Class II Obesity

40.0- above Class III Obesity

CAUSATIVE FACTORS:

For each individual, body weight is the result of a combination of genetic, metabolic, behavioural, environmental, cultural and socioeconomic influences. Behavioural and environmental factors are large contributors to obesity in females.

Fundamental or the miasmatic causes:

• Heredity: determines how susceptible an individual is to become overweight or obese.
• Genetically a person is influenced by how the body uses calories for energy and how the body stores fat.
• Familial obesity is an established risk factor, which exposes an individual to develop obesity.

Exciting and maintaining factors:

• Eating habits: contribute to the development of overweight and obese states specially in individuals consuming food rich in animal fats, vegetable oils and sugar/syrups and less of vegetables, fruits and other high fibre starchy foods.
• Lack of exercise and workout.
• Increasing industrialization, better transportation facilities, more mechanization at home and workplace.

Some factors that are leading causes of obesity in females

• Genetics
• Junk Foods – Some processed foods that are hard to resist.
• Insulin – High insulin levels and insulin resistance are directl linked to the development of obesity.
• Certain Medications – Some medications may promote weight gain by reducing the number of calories burned or increasing appetite.
  
• Leptin Resistance – Leptin, an appetite-reducing hormone, doesn‘t work in many obese individuals.
• Poor diet – eating large amounts of processed or fast food – that’s high in fat
• and sugar, drinking too much alcohol, eating out a lot, drinking too many
• sugary drinks – including soft drinks and fruit juice.
• Lack of physical activity
• Stress, Emotional Factors, and Poor Sleep
• Sugar – Scientists believe that excessive sugar intake may be one of the main causes of obesity.
• Misinformation – People are being misinformed about health and nutrition. Misinformation may contribute to weight gain in some people. It can also make weight loss more difficult.
• Calorie consumption- In India, a changing environment has broadened food options and eating habits. Some foods are marketed as healthy, low fat, or fat- free, but may contain more calories than the fat containing food they are designed to replace. It is important to read food labels for nutritional information and to eat in moderation.
• Portion size has also increased- People may be eating more during a meal or snack because of larger portion sizes. This results in increased calorie consumption. If the body does not burn off the extra calories consumed from larger portions, fast food, or soft drinks, weight gain can occur.
• Calories Used- Bodies need calories for daily functions such as breathing, digestion, and daily activities. Weight gain occurs when calories consumed exceed this need. Physical activity plays a key role in energy balance because it uses up calories consumed.
• Environment– People may make decisions based on their environment or community. For example, a person may choose not to walk to the store or to work because of a lack of sidewalks
• Health Conditions – Sometimes hormone problems cause overweight and obesity. These problems include:
• Underactive thyroid (also called hypothyroidism).
• Cushing‘s syndrome.
• Polycystic ovarian syndrome (PCOS).
• Medicines – Certain medicines such as corticosteroids, antidepressants, and medicines for seizures may cause you to gain weight.
• Emotional Factors – Some females eat more than usual when they are bored, angry, or stressed.
• Smoking – Some females gain weight when they stop smoking. One reason is that food often tastes and smells better. Another reason is because nicotine raises the rate at which body burns calories, so burn fewer calories when stop smoking.
• Age- As we get older, we tend to lose muscle, especially if we‘re less active. Muscle loss can slow down the rate at which body burns calories.
• Pregnancy– During pregnancy, women gain weight so that the baby gets proper nourishment and develops normally. After giving birth, some women find it hard to lose the weight.
• Lack of Sleep- Females who don‘t get enough sleep on a regular basis seem to have high levels of a hormone called ghrelin (which causes hunger) and low levels of a hormone called leptin (which normally helps to curb hunger).

ASSESSMENT OF OBESITY

Body fat percentage is total body fat expressed as a percentage of total body weight. It is defined that men with more than 25% body fat and women with more than 33% body fat are obese. A certain amount of fat is necessary for body to function properly as it is the key factor for storing energy, heat insulation, shock absorption, and other functions. It is stored in the form of adipose tissue in body. Although not a direct measure of adiposity, the most widely used method to gauge obesity is the body mass index (BMI), which is equal to weight/height² (in kg/m²). The reference range used to categorize individuals is:

Along with BMI certain other measures may also be taken into consideration to assess an individual in terms of nutrition. These are:

• Waist circumference
• Hip circumference
• Waist to hip ratio: a ratio of >0.9 in women and >1. 0 in men is considered abnormal
• Markers of nutrition e.g. mid arm circumference, skin fold thickness, etc.

Obesity is diagnosed when body mass index (BMI) is 30 or higher. However, BMI doesn’t directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don’t have excess body fat.

CLINICAL FEATURES

Obesity is diagnosed when body mass index (BMI) is 30 or higher. However, BMI doesn’t directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don’t have excess body fat

Symptoms and Signs Are Associated With Obesity in females

Obesity in females is caused by multiple factors, and although the principle of decreased caloric intake and increase in exercise is a relatively simple concept, there are many underlying reasons that lead to obesity in an individual. Obesity increases risk of many other diseases and health problems, including the following:

• Heart disease
• Diabetes
• High blood pressure
• Insomnia from sleep apnea (snoring)
• Stroke
• Osteoarthritis (especially knee and hip joint pain, and lower back pain)
• Gout
• Depression
• Dementia
• Gallstones
• Lung disease
• Fungal rashes in skin folds
• Colon cancer
• Endometrial cancer
• Thyroid disorder
• PCOS
• PID
• DUB
• Menstrual disturbances
• Infrequent or no ovulation
• Gestational diabetes and hypertension

Depression is the one of the most common effects of obesity in females. Many obese females suffer emotional distress. Because of the emphasis on physical appearance in our culture, which equates slimness with beauty, obese females may feel unattractive.

Types of Obesity in Females

The obesity in females is identified by two types android & gynoid.

Android: – Android type of obesity is like as a shape of an apple. The face, shoulders, neck, chest, arms, & upper portion of the abdomen are bloated. The lower portion of the body — the hips, thighs and legs are thinner in comparison with the upper part. This type of obesity is having major risk for heart damage and heart disease due to high cholesterol. Females, who are under hormone treatment for their menstrual irregularities or after childbirth, are more prone to android obesity. It occurs in females around menopause too due to thyroid gland functional disturbance.

Gynoid: – In this type of obesity the lower part of the body having extra flesh. It is also common to both sexes though females are more prone. This type of obesity is similar to pears. The flesh is more flabby in the abdomen, thighs, buttocks and legs. The face and neck mostly give a normal appearance. In this, vital organs affected mostly are the kidneys, uterus, intestines, bladder & bowels.

The third type: – Except android and gynoid, there is one more type of obesity. Some females do not belong to any of the above type of obesity. Their whole body from head to toe looks like a barrel.

Complications – Obesity in females are more likely to develop a number of serious health issues, including:

• Type 2 diabetes

• Heart disease and strokes

• Certain cancers- Obesity in females may increase risk of cancer of the uterus, cervix, endometrium, ovary, breast..
• Sleep apnea- Females with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
• Osteoarthritis .

• Digestive problems- Obesity increases the likelihood that will develop heartburn, gallbladder disease and liver problems.
• Gynecological and sexual problems- Obesity may cause infertility and irregular periods in women.
• Cardiology- Ischemic heart disease, Myocardial infarction, Angina, High blood pressure, Congestive heart failure
• Orthopedics And Rheumatology- Gout, osteoarthritis, poor low back pain

• Neurology- Migraine, Stroke, carpal tunnel syndrome, idiopathic intracranial hypertension, dementia, multiple sclerosis
• Reproductive System and Endocrinology- Menstrual disorders, Polycystic ovarian syndrome, Birth defects , Infertility, Intrauterine fetal death, Diabetes mellitus.
• Respiratory- Asthma, Obstructive sleep apnea

• Psychiatry- Depression in women, social stigmatization.

RISK FACTORS FOR OBESITY IN FEMALES

1. Cardiology-  coronary heart disease, angina, myocardial infarction, congestive heart failure, high blood pressure, abnormal cholesterol levels, deep vein thrombosis and pulmonary embolism.
2. Endocrinology and Reproductive system- diabetes mellitus, polycystic ovarian syndrome, menstrual disorders, infertility, complications during pregnancy, birth defects and intrauterine fetal death.
3. Neurology- stroke, migraine, carpal tunnel syndrome^], dementia, idiopathic intracranial hypertension and multiple sclerosis.
4. Psychiatry depression in women and social stigmatization
5. Rheumatology and Orthopedics gout, poor mobility, osteoarthritis and low back pain.

DIAGNOSIS:

Usually diagnosis is based on clinical features.

INVESTIGATION:

These exams and tests generally include:

• Health history –Weight history, weight-loss efforts, physical activity and exercise habits, eating patterns and appetite control.
• General physical exam This includes measuring height; checking vital signs, such as heart rate, respiratory rate, blood pressure and temperature.
• BMI Calculation
• Measuring waist circumference
• Checking for other health problems –Other possible health problems, such as high blood pressure, thyroid disorders and diabetes.
• Blood tests- Blood tests may include a cholesterol test, liver function tests, a fasting glucose, a thyroid test and others.
• Body fat also can be calculated by using skin calipers. Calipers are an instrument that measures the thickness of skin.
• Body shape is also important. People who carry most of their weight around the waist (apple shaped) have a greater risk of heart disease and diabetes than do people with big hips and thighs (pear shaped).

MANAGEMENT OF OBESITY IN FEMALES

Dr. C.F.S.Hahnemann in aphorism 261 has rightly stressed on the importance of proper diet and exercise. ―The most appropriate regimen during the employment of medicine in chronic diseases consists in the removal of such obstacles to recovery, and in supplying where necessary the reverse: innocent moral and intellectual recreation, active exercise in the open air in almost all kinds of weather (daily walks, slight manual labor), suitable, nutritious, unmedicinal food and drink, etc.‖

Management is one of the most important key factors in dealing with obesity in long- term. It is a chronic disease that requires long-term intervention and judicial employment of medication, if necessary. The intervention in obesity can be from any of the following listed strategies, single or in combination:

• Dietary
• Life style related physical exercise, behavior modification etc.
• Medicinal
• Surgical

Physical exercise – Reduction in weight is not the mathematical calculation and reduction in calories. Exercise depends upon lifestyle, average daily workout, age, gender and other circumstances like nutrition, weight etc.

Surgical treatment: surgery is indicated for the treatment of morbid obesity which includes co-morbid conditions which are life-threatening. It is only advised for those with

very high BMI of 40 or more. Bariatric surgery changes the anatomy of the digestive system.

Behavioral therapy: Strategies include self-monitoring techniques (e.g. weighing, and measuring food and activity); stress management; stimulus control (e.g., using smaller plates, not eating in front of the television or in the car).

There are ways can change behavior and lifestyle that will help maintain weight loss:

• Learning about nutrition
• Changing eating habits
• Increasing physical activity
• Changing attitudes about eating
• Joining a weight loss program
• Developing support systems
• Management of diet- The calorie intake is usually reduced for obese individuals along with increased physical activity. Adults should usually be advised to follow a low-fat diet
• Eat well by choosing nutritious foods like fruits, vegetables, whole grains, and lean protein. Eat high-fat, high-calorie foods in moderation.
• Exercise regularly moderate-intensity activity a week to prevent weight gain. Moderately intense physical activities include fast walking and swimming.
• Follow a healthy-eating plan, focus on low-calorie, nutrient-dense foods, such as fruits, vegetables and whole grains. Avoid saturated fat and limit sweets and alcohol. Eat three regular meals a day with limited snacking.
• Know and avoid the food traps that cause to eat Identify situations that trigger out-of-control eating.
• Monitor weight regularly

HOMOEOPATHIC MANAGEMENT-

The homoeopathic approach towards obesity in females should be scientific and feasible. Many times, remedies alone are not able to benefit a patient fully, here comes the concept of obstacles to cure and exciting and maintaining causes. So motivate the patient to follow others management factors like diet control, controlled exercise, changes in life style pattern etc. Homoeopathy has wide scope to offer individuals suffering from obesity or related disorders. Like other systems of medicine, Homoeopathy also has its own scopes and limitations. A basic knowledge of disease and sound knowledge of homoeopathic philosophy is the key to deal any case.

In aphorism 5 of Organon of Medicine, Hahnemann has described the constitutional approach towards state of the patient. By constitutional approach one means “An individual”, her moral and intellectual character, her occupation, mode of living and habits, her social and domestic relations, her age, sexual functions etc. An individual is the basic unit which is affected by interior (mental generals) and exterior (environmental) factor, thus the approach to rectify it should be holistic. For internal phenomenon and obstacles we may give the best similimum remedy, this will make one individual strengthen from inside so that the vital force can preserve the state to health whereas the exterior phenomenon deal with various management tools (e.g. exercise, weight reduction, diet etc).

Homoeopathy is very proficient in managing all the symptoms of Obesity and furthermore plays a vital role in preventing relapse of the condition. Exercise along with homeopathic medicine can accentuate the weight loss. Controlling diet is also must while using homeopathic medicines for weight loss. Homeopathic medicines work by stimulating body‘s metabolism to burn more fat. Homoeopathic treatment is based on

‖similia similibus curanter‘‘ Where constitutional medicines selected on the basis of totality of symptoms, so one can lose weight by improving digestion, elimination & metabolism. Some important homoeopathic medicines for obesity in females are as follows:

1. Calcarea carbonica: A constitutional remedy for weight loss. Calcarea patient is fatty, fair and flabby. It is great anti-psoric remedy with increased perspiration and

swelling of glands, scrofulous and rachitic diathesis. Craving of eggs with heat as well as coldness of single part of body. Females who take cold easily, grow fat, Having large bellied, with large heads and pale skin. Females with huge fat deposition in the abdomen and profuse perspiration, especially from the head. Females who have craving for eggs or consistent urge to taste clay, soil, pencil‘s graphite, lime and many more. The patient feels worse by exertion (mental /physical), cold (in every form), water, washing, moist air, wet weather, standing. The patient feels better in dry climate, lying on painful side. Females with heavy weight in the mid-section.

2. Lycopodium: It is suited to females having obesity due to malfunctioning or a weak liver. Due to a weak liver, patient may suffer from gastric problems such as constipation and flatulence. They have peculiar habits to intake hot drinks and hot food. They become angry and irritable. These patients are inclined to crave for sugar-based sweet products. They usually eat beyond their capacity which results in the bloated abdomen. This medicine focuses primarily on the extra fat on thighs and buttocks. This may be preferred in females who are suffering from Hypothyroidism.

3. Natrum mur: This medicine suited to females who have gained excess weight due to long-continued stress or depression. The females who require this medicine usually suffer from anemia. Another important symptom is the craving for extra salts in the diet. The important constitutional symptoms include excessive heat in the patient‘s body and intolerance towards the heat of the sun. A female with weeping tendencies, especially when alone, worsens when someone consoles her and reserved nature. Long-term stress and depression might lead to an excessive gain in weight. They indulge in hot food and hot drinks. Usually, these females have a tendency to eat far beyond their daily needs and gain excess fat, especially in thighs and buttocks. They are easily irritated and roused to anger.

4. Antimonium crudum: This medicine is suited to obesity in young females with excessive irritability and fretfulness together with a thickly coated white tongue. All the conditions aggravate by heat and cold bathing. Tendency to grow fat. Sensitive to the

cold. < After taking cold. Person is fretful, peevish, cannot bear to be touched or looked at, sulky, and does not wish to speak or be spoken to, angry at every little attention. Worse – After eating; cold baths, acids or sour wine; after heat of sun or fire; extremes of cold or heat. Better – In the open air; during rest; after a warm bath. Great sadness, with weeping. Longing for acids and pickles. This medicine is preferred with the younger females, who are suffering from overweight. They have craving for salty and sugar. Old females with morning diarrhea suddenly become constipated or alternate diarrhea and constipation, pulse hard and rapid. Such individuals tend to be more sensitive compared to the other people around them and are also prone to depression.

5. Graphites: This medicine is suited to premenopausal woman who fighting weight gain. Patient suffer from constipation and skin problems and feet feel cold. The patient may be pale and very sensitive to cold.

6. Nux Vomica: It is suited to females who have gained excess weight due to sedentary habits. The other symptom is intolerance to cold air. The next important symptom is the eating habit – likes spicy food, fatty food, and stimulants like coffee or alcoholic drinks. Person is chronic sufferer of the obstinate constipation. Such type of female has a continuous urge to pass stool, but only a little stool is ejected at a time. Mentally, the patient is extremely sensitive to external impressions and gets angry to an extreme degree too. Certain people gain weight due to their inactivity. They suffer from chronic constipation and other gastric issues. They are prone to anger and also suffer from chronic intestinal issues. These patients have a strong craving for spicy and oily foods. This medicine is generally given who has sedentary lifestyle faulty dietary pattern.

7. Fucus: This medicine is used with almost everyone who is suffering from obesity. Digestion is improved and flatulence diminished. Obstinate constipation. Females who have fluctuations in their appetite and generally find it increasing and decreasing to the extremes. Hyper-motility is again a very clear indication. It helps in improving of digestion and relieving of constipation. It is very good remedy for obesity and non-toxic goiter (also exophthalmic). Thyroid enlargement in obese females.
8. Phytolacca berry: It is a glandular remedy with glandular swellings –heat and inflammations. Helps to reduce fat and thus reduce weight. Intense prostration, sitting upright makes her faint and dizzy. They are very weak and usually get tired with effortless tasks. They are also found to suffer from sciatic pain and can‘t walk for longer distances. It is useful in rheumatism of syphilitic origin where the pains are wandering, shifting and shooting. Burning in throat as from coal fire and cannot swallow hot liquids. General soreness, lameness, bruised feeling over whole body.

9. Phosphorus: It is suited to tall slender female of sanguine temperament, fair skin, delicate eyelashes, find blond or red hair, quick perceptions, and very sensitive nature. Young females, who grow too rapidly, are inclined to stoop who are anemic, with morning diarrhea. It affects the nutrition and function of every tissue of body. It causes pseudo-hypertrophy of muscles. Longs for: cold food and drink; juicy, refreshing things; ice cream > gastric pains.
10. Pulsatilla: It is a female remedy with tendency to obesity in mild, gentle, yielding females who are sad, cry easily and weeps when talking. The symptoms are changeable and contradictory. Adapted to females of indecisive, slow, phlegmatic temperament; sandy hair, blue eyes, pale face, easily moved to laughter or tears; affectionate, mild, gentle, timid Yielding disposition – the woman‘s remedy. The patient seeks the open air and feels better in it. Thirstlessness and chilliness in fat females. Aversion to fatty foods, still grows obese. Weeps easily: almost impossible to detail her ailments without weeping. Women inclined to be fleshy, with scanty and protracted menstruation.

11. Sepia: This medicine is suited to obesity in females with weakness, yellow complexion and bearing down sensations. Anxiety: with fear, flushes of heat over face and head; about real or imaginary friends; with uterine troubles. Great sadness and weeping. Dread of being alone; of men; of meeting friends; with uterine troubles. Indifferent: even to one‘s family; to one‘s occupation, to those whom she loves best.

Pains extend down to back and patient chills easily. Obesity in menopausal females with hot flushes and perspiration. Particularly sensitive to cold air, ―chills so easily;‖ lack of vital heat, especially in chronic diseases.

So the primary goal of management of obesity should be improvement of obesity- related health conditions and reduce the risk of developing future health issues. It involves balance of three essential elements of lifestyle: dietary habits, behavior modification and physical activity along with Homoeopathic intervention. We should know the things that derange health and cause disease and how to remove them from persons in health‖.

PREVENTION AND CONTROL

To reduce the risk of developing obesity

• Limit energy intake from total fats and sugars;
• Engage in regular physical activity (60 minutes a day for children and 150 minutes spread through the week for adults).
• Increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts.
• Restricting marketing of foods high in sugars, salt and fats, especially those foods aimed at children and teenagers.
• Reducing the fat, sugar and salt content of processed foods.
• Ensuring that healthy and nutritious choices are available and affordable to all consumers.
• Ensuring the availability of healthy food choices and supporting regular physical activity practice in the workplace.