14 August 2006

Slipping down the obesity slide?

If you're five to ten percent over your ideal weight, or your waist circumference is over 90cm, you stand a good chance of slipping into obesity, according to an obesity expert.

If you're five to ten percent over your ideal weight, or your waist circumference is over 90cm, you stand a good chance of slipping into obesity.

That's the message from a top international authority on obesity at the South African Gastroenterology Congress, attended by 580 doctors, specialists, surgeons and physicians in Port Elizabeth last week.

"Lose that weight now by eating what is beneficial for your body," said Professor Tessa van der Merwe of the International Society for the Study of Obesity. "As you grow older, your weight will increase and it will be harder to lose it. It is no fun being obese, so be aware that prevention right now is far better than cure.

One out of two South African women and one out of three South African men are overweight. That is 45% of the population – just 20% less than the world's fattest country: the United States.

While 25% of South Africans fall into the overweight category with a body mass index of between 25 and 30, another 20% are in the obese category with a BMI of over 30.

"Losing weight is not the main reason for losing weight," Van der Merwe said. "Research shows us that being overweight causes other health problems."

Different races, different profiles
Thirty percent of black women are obese, followed closely by white women (26%), coloured women (25%), and Indian women (21%).

Twenty percent of white men are obese, with coloured men at 10%, black men at 9% and Indian men at 8,6%.

More alarming is the fact that 20% of children under the age of six are overweight and highly likely to grow into overweight adults with related illnesses. Doctors are starting to see type II diabetes in children. In the past, it was only found in adults.

"Obesity is one of the modern world's biggest killers," said Van der Merwe, who also heads South Africa's first obesity clinic, situated in Pretoria.

"We assume it is a United States problem, but South Africans have been growing steadily larger over the last century. This is thanks to a confounding genetic predisposition towards energy conservation, lack of our ability to sense fullness, and a decrease in the amount of energy we use at the workplace.

A complicated condition
"Obesity is far more complicated than a simple lifestyle disease and its treatment is not cosmetic," she said.

"Patients often have other health complaints such as heart disease or cancer, hypertension or diabetes. They are candidates for strokes and asthma attacks and also can suffer from back strain, incontinence, depression, eating disorders, bad self image and sleep apnoea.

"Obese people become prisoners of their own bodies – too embarrassed to swim in public and visit cinemas or restaurants as the seats are too small. Teased and ridiculed, most become introverted," Van der Merwe said.

The personal and economic consequences of obesity are costly. However, the treatment of the condition is hugely cost-effective in terms of health economics.

Gastric bypass surgery an option
For the morbidly obese (BMI above 40), gastric bypass surgery is recommended, according to experts attending the congress. The Roux-en-Y gastric bypass will reduce the size of the stomach to limit the amount of food it can take. This can cause some calorie wasting without threatening health.

With this operation, patients can lose 35-70% of their body weight in a year or two, depending on their starting weight. The adjustable gastric band will restrict portion size only and can be offered to patients above a BMI of 30 who have failed numerous previous attempts at conservative weight loss.

A weight loss of 25% can be expected with the band over 18 months.

But be warned: this is a serious operation that must only be used in morbidly obese cases.

High healthcare expense
Obesity and related illnesses carry a healthcare expense of between 5 to 8% of the health budget in most developed countries and the impact on indirect cost is considerable.

Long-term sick leave for obese workers is up to 2,4 times higher than their thinner counterparts.

It is predicted that, in the year 2020, heart disease and depression caused by obesity will be the world's greatest disability.

"The best way to stop the slide down the obesity highway is to educate children at school and people who are about 5 to 10 percent overweight with a BMI of between 25 and 30 before they reach the path of difficult return.

"Unfortunately, there is no magic bullet in the pipeline from the pharmaceutical point of view to help obesity, but surgery is highly effective in the morbidly obese," Van der Merwe says.

- (Bay Public Relations, August 2006)


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