At its most common, obesity is caused by eating too much and moving too little. If you consume high amounts of energy, particularly fat and sugars, but don’t burn off the energy through physical activity, much of the surplus energy will be stored by your body as fat. Obesity doesn’t happen overnight. It develops gradually over time, as a result of poor diet and lifestyle choices. This also means that the problem of obesity is not solved overnight. Losing weight requires slow and controlled changes that can be maintained and even enjoyed. One of the greatest tools for a weight loss journey is the patience to understand that no lifestyle change is effective immediately, it takes time and commitment.
The increasing prevalence of obesity can make it harder for people to recognise that they or their children are (or are at risk of becoming) overweight or obese. It is important to stay informed about portion sizes, recommended rates of exercise, and how to live a healthy lifestyle.
Figures from the NI Public Health and Information Research Department show that in 2010/11 23% of the male population in Northern Ireland were recorded as obese. This figure has increased to 28% in 2016/2017. A study from the European Society of cardiology ranks British men as the most obese across 47 countries.
Obesity reduces life expectancy by an average of 3 to 10 years, depending on how severe it is. Shockingly, it’s estimated that obesity and being overweight contribute to at least 1 in every 13 deaths in Europe.
Obesity has both a day-to-day and long term impact upon health.
Day to day problems associated with obesity includes:
- Difficulty doing physical activities
- Increased sweating
- Back pain and joint pain
- Low self esteem and feeling isolated
More serious and long term health conditions developed as a result of being obese can include:
- High blood pressure
- Osteoarthritis- pain or stiffness in the joints
- Sleep apnoea
- High cholesterol
- Gastro – Oesophageal Reflux Disease (GORD) – where stomach acid leaks out of the stomach and into the oesophagus
- Gallstones– small stones, usually made of cholesterol, that form in the gallbladder
- Reduced fertility
- Liver and kidney disease
Am I Obese?
One of the most common ways to know whether you are healthy, overweight, or obese is by calculating your BMI. BMI or Body Mass Index is a measure of whether you are a healthy weight for your height. The scale that is used is:
- 5 – 24.9 = healthy weight
- 25 -29.9 = overweight
- 30 – 39.9 = obese
- 40 or above = severely obese
Calculation of BMI is often done as part of registration with a GP or at hospital/community outpatient appointment for related conditions such as type 2 diabetes, cardiovascular disease or osteoarthritis. You can calculate your BMI on the NHS website by providing your personal details such as age, gender, height, and weight. Here’s a link: https://www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx
BMI is not used as a definitive calculation of healthy weight as some people who are muscular have a high BMI without excess fat. Measuring waist circumference is often used as an additional measure. For men, waist circumference of less than 94 cm is low, 94–102 cm is high and more than 102 cm is very high. Your ethnic background may also influence your BMI. The parameters mentioned above are generally applied to those with a white Caucasian background. The threshold for those with other ethnic minority backgrounds may be lower.
The Causes of Obesity
What we put into our body is one of the greatest contributors to weight gain or weight loss. Therefore, reviewing what you eat and drink is one of the first steps in identifying potentially problematic behaviour. For example:
- Eating large amounts of processed, fast food, or food high in fat and sugar
- Eating larger portions than you need
- Eating out frequently
- Drinking too much alcohol (drinking the upper limit of 3-4 units per day adds 200-325 extra calories per day)
- Drinking too many sugary drinks- this is thought to be the biggest contributor to obesity and prompted the introduction of the sugar tax in April 2018
Lack of Physical activity
What we do with our bodies is another one of the greatest contributors to weight gain or weight loss. Our lifestyles have changed drastically over the last two decades, relaxation is now found in watching TV, playing computer games, or browsing the internet. This has seen a rapid decline in the amount of time we spend engaged in physical activity.
The Department of Health recommends adults do two and a half hours of aerobic activity each week in addition to strength exercise. This does not have to be completed in one session and is recommended to be divided for example 30 minutes of exercise per day x 5 days a week. Examples of aerobic activities include; cycling, walking fast, tennis, water aerobics or even pushing a lawnmower. Examples of strength activity include; lifting weights, yoga, sit-ups, push ups and heavy gardening such as digging or shovelling.
There is no single rule that applies to everyone, but to lose weight at a safe and sustainable rate of 0.5 to 1kg (1lb to 2lbs) a week, most people are advised to reduce their energy intake by 600 calories a day. For most men, this will mean consuming no more than 1,900 calories per day. The best way to achieve this is to swap unhealthy and high-energy food choices – such as fast food, processed food, alcohol and sugary drinks for healthier choices. A helpful way to track your daily calorific intake is by noting down your meals or using an app to log what you have eaten. Alongside this it is important to monitor associated food behaviours e.g., do you eat out of boredom or at a particular time of the evening, if so what is the trigger? This assessment of your behaviour allows you to become more informed and therefore more in control of making changes.
In conjunction with diet changes exercise is an essential part of any weight loss program. There are many additional benefits to exercise other than weight loss, such as improving your appearance, reducing depression, and improvements in sleep patterns. Start small by setting achievable exercise goals and allowing them to become part of your daily or weekly routine. Remember, even small amounts of low impact exercise are better than nothing so don’t try to run a marathon before you can walk a mile. Be proud of any progress you make and keep reminding yourself to be patient with your weight loss journey. Finding a friend to exercise with or taking part in an exercise class can give you group motivation and keep you committed. As with food, it can be helpful to use a pedometer, app, or device (Fit Bit or Apple Watch) to track your physical activity. It is often motivational to see what you have achieved or be reminded of targets you should reach.
Orlistat is the only medication for obesity that has been proven safe and effective in clinical trials. It is a prescription only medicine and will only be recommended if you have made significant effort to lose weight by adjusting your lifestyle. Treatment with orlistat must be combined with a balanced low-fat diet and weight loss strategies, such as doing more exercise. Benefits and side effects of this product will be discussed with you by your GP.
Bariatric surgery is sometimes used to treat people who are severely obese. It is only available on the NHS to treat people with severe obesity who fulfil certain criteria. Bariatric surgery may also be considered as a possible treatment option for people with a BMI of 30 to 35 who have recently (in the last 10 years) been diagnosed with type 2 diabetes. In rare cases, surgery may be recommended as the first treatment (instead of lifestyle treatments and medication) if a person’s BMI is 50 or above.
A major study has found promising results for the safety of a weight-loss drug available in the US but NOT in the UK . 28/08/2018
A study published in the New England Journal of Medicine says that adults using a drug called Lorcaserin lost an average of 8.8lb over 40 months. It says the drug, which works by suppressing appetite, does not put people at greater risk of heart issues. But experts emphasise the importance of long-term lifestyle changes in achieving effective weight loss. The drug has been available in the US for several years under the name Belviq, but it does not have a European licence. The pill is taken twice a day and costs about (£155-225) per month. It would have to be approved by NICE (National Institute of Clinical Excellence before it could be prescribed in the UK.
Are you clinically obese? Have you tried to change your lifestyle in an effort to lose weight? Do you have an inspiring story of your weight loss to share or are you simply looking some support and inspiration? Join or start the conversation below.