By: Nutrition expert- Vidula Kozarekar, Mumbai.
Email id: firstname.lastname@example.org
Obesity is an excess of body fat, resulting in adverse health effects. Obesity has emerged as a major public health problem. The prevalence of obesity is increasing in almost all parts of the world.The prevalence of overweight and obesity among population aged 30 years and above was 42% and 12% globally, respectively. Obesity is much more than cosmetic problems, as its associated health problems are increasing. According to some estimates, it is responsible for greater health-care costs than is either smoking or drinking. The development of overweight and obesity is extremely complex and multi factorial. Ultimately, it is the imbalance of energy intake being greater than the energy expenditure that contributes to weight gain.
Research studies over the last decade showed that regular activity and appropriate energy intake can play critical roles in preventing and managing the negative health consequences of obesity, diabetes and other cardiovascular diseases. Weight loss programs focused on restricting energy intake, but sharp reductions in energy intake have been shown to result in fat-free mass reductions and negatively impact metabolic rate. In addition, a growing body of evidence demonstrates that in comparison with a dietary restriction intervention alone, exercise, accompanied with or without weight loss, can lead to favorable changes in body composition including a reduction in abdominal adiposity.
Exercise has been found to be associated with better results in dieting subject. Furthermore, improvement of diet as well as regular physical activity of at least 60 min/d may also protect obese individuals of cardiovascular disease.
- Diet and exercise in obesity: A case report
- Patient Info: A rural mother aged 58 years at the time of appointment, with complaints of breathlessness while doing normal day-to-day activities. Excessive sleepiness was observed during the day hours as she dosed off performing normal daily chores. Her sleeping behavior included loud snoring. The breathlessness was not associated with postural variation, nor did it disturb her sleep.
She was morbidly obese as she weighed around 150.9 kg against a height of 157 cm [body mass index (BMI) 61.2 kg/m2]. She was diagnosed with morbid obesity, chronic type II respiratory failure, and obstructive sleep apnea. Her clinical history and examination along with lab investigations ruled out the possibility of hypothyroidism and Cushing’s syndrome. She was not on any steroids nor was she on any antidepressants. She was a nonalcoholic and a nonsmoker.
- Goal setting: The goal setting was planned on a weekly basis. The first week was planned for behavioral modification, followed by minor changes in diet and mild physical activity. As the weeks progressed, her diet was gradually changed to a low carbohydrate, low fat and low protein diet. Similarly, increased the physical activity from indoor activity to outdoor physical activity. The goals were specific, measurable, and achievable.
- Physical activity: Increased energy expenditure is the other half of the energy balance equation that affects body weight, the other being food intake. Daily activities were planned and modified. Motivational counseling on following a healthy lifestyle was given at least twice on a daily basis.
The goal from the point of view of physical activity was to achieve a minimum 3 h of moderately vigorous physical activity on most days of the week. Initially, started with hand cycling for 10 min at four occasions on a single day. Along with this, she was asked to walk 150 steps indoors. The frequency as well as duration of hand cycling was also increased to 3-4 times/day, and the duration from 15 min to 20 min. Breathing exercises were also started from the third day. The patient did it regularly at an interval of 2 h during the day hours. The duration of breathing exercises varied from 5 min to 15 min. By the middle of second week, she was able to walk outdoors. Initially, she was able to cover 500 m in 90 min. But by the end, she was able to cover 1.5 km in 60 min on two occasions (morning and evening). This activity was undertaken along with hand cycling and breathing exercises.
- Dietary modifications: Includes decreasing calorie intake and promoting low-calorie diet. Limiting the consumption of high-calorie foods by limiting the portion size and the number of servings was the principle followed in all her meals. Included more of fruits, vegetables, legumes, and whole grain cereals in her diet. Between the servings, there would be a minimum of 4 h, which was the time given for the food to be digested. In between, no supplementary meals were given. Only fruit or vegetable juices and drinking water were provided between meals. Lemon juice with honey was the first drink that she had soon after waking up. Breakfast would be sumptuous, followed by a lighter lunch, then an even lighter dinner. Milk was replaced with curd, which was gradually reduced and stopped during the subsequent weeks. She was asked to move from rice-based meal to wheat-based meals with more of fresh vegetable salads, fresh fruits, legumes, peas, nuts, and fruit and vegetable juices. Fruit juices and vegetable juices were provided at an interval of 2 hour. Gradually, reduced the amount of rice served. The final goal was to make her diet free of rice and make it a plant-based, whole-food diet over the period of 7 days.
Sedentary lifestyle is a type of lifestyle with no or irregular physical activity. A person who lives a sedentary lifestyle may colloquially be known as a couch potato. A similar study done in rural South India showed that leisure-time physical activity had a significant negative relation to waist circumference. Because of the impact on energy balance, physical activity contributes to the prevention and control of weight gain. Hagan et al. reported reductions in weight losses of 7.5%, 5.5%, and 0.6% in women participating in 12 weeks of diet plus exercise, diet alone, or exercise alone, respectively. The solution to losing weight is a whole food, plant-based diet, coupled with a reasonable amount of exercise. Studies from across the world have shown that vegans are anywhere from 1.8 kg to 13.59 kg slimmer than their meat-eating counterparts. By feeding on a plant-based diet along with exercise, several intervention studies have shown to decrease the weight by 4-7% of their body weight over 3 weeks. All of these results show that consuming a whole-food, plant-based diet will reduce weight quickly over a period of 3-4 weeks. Losing body weight while on a plant-based diet is much less likely to occur if the diet includes too many refined carbohydrates. Sweets, cakes, pastries, and pastas also do not help. As long as one eats the right type of food, one will be able to achieve the desired weight.
- Weight reduction: Over a period of 1 week, with gradual modification of diet and exercise, she lost only 1.8 kg. During the course of the intervention, after 9 days she weighed 146.2 kg (lost 4.7 kg) while fully on diet modification but still picking up on physical activities.
- Breathlessness: Her breathlessness gradually reduced from breathlessness even while doing normal activities to only during the performance of strenuous activities
- Snoring: By the end of the second week, the patient’s relatives observed that her loud snoring behavior had reduced.
- Blood pressure: She presented with a blood pressure of 150/100 mmHg. End of the program her reading was 130/90 mmHg.
Obesity is the most ominous harbinger of poor health. With necessary lifestyle modifications, the trend can be reversed. Weight control has been the subject of extensive study and writing. The simple conclusion of weight control research is the need for dietary modification and increased physical activity. Treating professionals should devote time to counsel the patient and bring him/her back to a diet-and-physical activity regime that will solve this issue.