OBESITY - Full extract 

Phil is one of my favourite patients. He is always ready for a laugh with the reception staff, and anyone else in the waiting room. 

He is 38 years old and tips the scales at 104 kg. Much of his weight is around his abdomen, which hangs rather impressively over his belt. I have been trying for some time to get Phil into better shape, especially since he developed high blood pressure last year. We have not had much success. 

" I have to admit I have got a bit bigger around the middle," said Phil. " Although, I'm the same weight as when I played footy." I tried to explain that this just meant he had been overweight for a long time. He replied by saying that all men in his family have been this size. 

" Phil, that just means that there have been a lot of other overweight men in your family." I waited for his response. 

" Who's going to win at the football on Saturday? " he asked." 

There is no single reason why people become overweight. Usually it is due to a combination of excessive food intake and not enough physical activity. However, the way this happens is often complex, with psychological, social and cultural factors involved. Genetic factors are also important; many people are predisposed to become overweight as they get older. 

There are several ways of measuring obesity. Skin-fold thicknesses are sometimes used. Waist-hip ratios can also be helpful, especially in identifying abdominal obesity. The most relied upon figure these days is the BMI (Body Mass Index). This is the weight in kilograms divided by the height in metres squared. A figure of 20-25 is in the healthy range, 25-30 is overweight and greater than 30 is regarded as obese. 

Interestingly, Australian men are more likely to be overweight than women. Current figures suggest that 44% of men are either overweight or obese, compared to about 30% women. When men put on weight, it nearly always goes to the abdomen. Call it what you like, many men develop a paunch, belly, or beergut by the time they reach middle age. For some, it is almost a badge of maturity. 

Abdominal obesity is more likely to be associated with problems like gout, high blood pressure, elevated blood cholesterol and adult-onset diabetes. It is not the extra weight that causes problems, but the excess body fat. When women put on weight it tends to go on around the hips, thighs and buttocks. However, it is not linked with other illnesses to the same degree as male obesity. Yet women are far more likely to seek medical advice about their weight. 

Being overweight is also associated with conditions like gallstones, osteoarthritis, breathing disorders, sleep problems, postoperative complications and even pedestrian accidents. It is no coincidence that life insurance companies take a good look at a person's weight. Actuarial tables have always shown that being overweight often means a reduced lifespan. 

Obesity has only become a health issue in Western countries in the last few decades. There is more food around and more money to buy it with. We are also far more sedentary than ever. The only hunting and gathering most of us do is driving to the local supermarket or convenience store. 

The body is remarkably efficient at conserving fat stores. When we go into diet mode, our bodies conserve energy by altering the metabolic rate. As dieting continues we also tend to focus on food and seek it out. These natural defence mechanisms make it really hard to lose weight. Although things do seem to be stacked against easily losing weight, here are a few suggestions:- 

A general medical check is a good place to start. It is worthwhile having a blood sugar and cholesterol level at the same time. 

We all have different reasons for being overweight, and we need personalized health advice. An individual exercise program is important if effective weight loss is going to be achieved. Factors like low self-esteem may also be significant and may need to be discussed. Those who are very overweight may benefit from specialized dietary advice and counselling. 

Up till recently there were no prescription medications being currently recommended for weight reduction. Xenical is a new medication that works by reducing the absorption of fat from the gut, and may be helpful for some people. However, lifestyle and dietary changes remain the basis of any weight reduction program.

For extreme cases of obesity, resistant to all other approaches, a surgical opinion may be considered. In some cases, procedures such as gastric banding may be a suitable option.

Food is meant to be enjoyed. Weight-reduction does not mean being sentenced to a life of rabbit-food. A healthy and interesting diet can be recommended, with the emphasis on fruit, vegetables and cereals, and less fat, red meats, and refined sugars...the same diet we should all be eating anyway. Occasional treats are a good idea and should be allowed for. 

Some people get too focused on their diet and find it hard to think or talk about anything else. Forget counting calories, and only bring out the bathroom scales every couple of weeks. (see also Weight management & eating behaviour) 

Health Tips:
* There is no need to feel guilty or inferior about being overweight. When you feel good about yourself you are more likely to succeed in improving your health. 

* Despite what anyone says, there are no quick-fix solutions. It is important to have a reasonable goal and to regard weight reduction as a longer term plan. 

Weblinks: www.nevdgo.org.au/info/std_misc/WeightManagement.html
               www.nevdgp.org.au/info/std_misc/obesity_surgery.htm

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: December 11, 2004