Maintaining proper bodyweight throughout life is a difficult proposition. Obesity or sudden loss of weight is a cause of concern. Most people do not take this seriously though it may indicate serious illness.
Workout at fitness centres without medical supervision is common but not desirable.
Physical activity for at least 150 minutes a week is recommended, though diet has an equally important role in maintaining bodyweight. For normal individuals, physical exercise may not be for weight loss only, but to maintain health.
Many social media influencers update common people regarding weight loss and diseases without having adequate medical background. Some people are desperate to lose weight and maintain an attractive figure, but unfortunately fall prey to improper advice and subsequently, financial loss. Even today, brisk walking is the commonest exercise for many.
Doctors with postgraduate qualifications in physical or sports medicine can provide the best opinion regarding weight and physical exercise. Individual assessment and requirements should be given due importance.
Usually, Body Mass Index (BMI) and waist circumference are considered important. BMI is calculated by the height and weight of an individual as follows:
- Underweight: Less than 18.5
- Normal: 18.5 to 24.9
- Overweight: 25 to 29.9
- Obese: 30 or beyond
Weight loss
Even a 5 per cent weight loss in a year can be significant. It can indicate illness. Various terms are used regarding weight loss:
- Involuntary or unintended: Not intended by the person and not a consequence of treatment of a known condition. Usually a cause can be found after workup.
- Unexplained: Though weight loss is not intended, the cause is not found after a routine workup.
- Sacropenia: A syndrome of low muscle mass. Occurs usually in older people.
- Cachexia: Loss of muscle mass because of illness. Can happen in advanced cancer (malignant cachexia)
Weight loss in obese persons with comorbidities is recommended.
However, in the healthy obese it is not considered mandatory by many. Losing weight definitely helps all obese people to reduce backache and knee pain.
Intentional weight loss by controlling diet and physical exercise can be a personal choice to improve the quality of life. However, slow and steady weight loss is easier to maintain long term.
Common causes of weight loss may be malabsorption, prolonged diarrhoea, chronic infections like tuberculosis, hyperthyroidism, psychological disorders or undiagnosed malignancies. Medical opinion is mandatory.
Weight gain
Significant weight gain or obesity can increase mortality and reduce life expectancy by 5 to 10 years. Since 1975, obesity has increased more than three times in the population. Once considered as a problem of the high income group, obesity has now become common.
The change in dietary habits, such as intake of high-fat diet regularly, is a contributing factor.
Obesity is associated with major risk factors:
- Cardiovascular diseases like heart attack, hypertension and stroke.
- Type 2 diabetes
- Osteoarthritis
- Sleep apnoea
- Depression or anxiety
- Sexual function problems
- Cancers like breast, uterine or ovarian in females and prostate, gall bladder or colorectal in males. Intermittent fasting is done to control obesity but long-term sustainability is questionable.
However, many obese people have benefitted from bariatric surgery. According to a report, attempts of weight loss may be successful in about 20 per cent of obese adults who can maintain it only for one year. Repeated episodes of weight gain and loss
is referred to as weight cycling. It has a negative health outcome.
Obese persons are often ridiculed and discriminated by many in society. It lowers self-esteem.
Fitness centres
Physical activity is an essential requirement of health and should be an integral part of lifestyle. Thus regular workout at home or fitness centres is welcome. However, the absence of doctors at most fitness centres is a cause for concern as the safety of the people are compromised.
Also, the qualifications and training of the fitness experts have been questioned by many. Unfortunate events have also been reported which could have been avoided in many cases.
Some fitness centres have tie-ups with hospitals or physicians on call. However, during strenuous physical exercise, adverse events may be sudden, requiring immediate medical help. That may not be always available. Though employing postgraduate doctors in physical or sports medicine may be costly, it does increase the safety profile.
Pushing people beyond endurance levels is not recommended. Over-exertion leads
to muscle breakdown and release of a protein called myoglobin. This is called rhabdomyolysis.
Large quantities of myoglobin can cause kidney failure, which can be disastrous. Usually, after heavy exercise, body ache subsides in a day or two. However, if it persists for a week or more, medical advice is mandatory.
A trust gap exists between physicians and fitness experts. They should not compete but complement each other to provide the best service. Unfortunately, in corporate hospitals, fitness centres are not available for the use of common people. The hospitals have all facilities,
including intensive care, that can be utilised in acute emergencies. Physicians and fitness experts can be made available at an extra cost to increase safety.
If space is a constraint on the hospital campus, it can be located close to the hospital. This will be a great service to society, where huge public participation can be expected. But is this feasible!
Maintain your style but control your weight.