According to WHO (World Health Organisation), obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. It is one of the major risk factors for a number of diseases, including Non-Communicable Diseases (NCDs) such as Type-2-diabetes, cancer, hypertension and stroke as well as Atherosclerotic Cardiovascular Disease (ASCVD).
The COVID-19 pandemic has made the dangers of obesity even more pronounced as the World Health Organisation has reported that obesity increases the risk of death and serious illness in persons suffering from COVID-19 by seven times compared to healthy people.
On the occasion of World Obesity Day on March 4 of every year, Dr Tanupol Virunhagarun, or Dr Amp, President of Bangkok Association of Regenerative Health and The Study of Obesity (BARSO), and Chief Executive Officer of BDMS Wellness Clinic, has given his insights into obesity with the intention of creating awareness and achieving the goal of stopping the rate of increase in obesity by 2025.
“Obesity is considered a serious health problem for Thailand. According to the latest report conducted by the Department of Health, Ministry of Public Health, in 2022, the prevalence of being overweight and obese among adults was 47.8%, increasing from 34.75% in 2016. This is in line with the report by the Bureau of Nutrition in 2020 which revealed that obesity in females was 46.4% and 37.8% in males compared to the rates in 2014 of 41.8% and 32.9% respectively. Bangkok has the highest prevalence of obesity.”
Another group which should not be overlooked is children. From the Bureau of Nutrition’s report, 13.3% of children aged 6-14 years and 9.07% of children under the age of five are obese.
Dr. Amp shares five important aspects to provide correct knowledge and understanding of obesity as a guideline to promoting good health.
1: Obesity is a disease
“Some might not know that obesity is considered a chronic disease just like type 2 diabetes and hypertension,” Dr. Amp said.
Obesity is the condition when there is accumulation of abnormal or excessive fat in our body which impacts most body systems which can put us at risk for many other chronic illnesses such as obstructive sleep apnea, joint mobility problems, weakened immune system such as metabolic disorders like high sugar levels and high blood pressure as well as inflammation which increases the chance of heart disease, stroke and cancer.
According to the American Association of Clinical Endocrinologists (AACE) standard, obesity can be divided into three phases: Phase 0 is when Adipose tissue is found but no complication developed; Phase 1 is when at least 1 complication related to obesity is found at low or medium level; Phase 2 is when at least 1 complication related to obesity is found at severe level.
“Obesity is not only the risk factor for diseases or the consequence of our lifestyle but a disease in itself which can create the potential for several complications,” Dr. Amp emphasises on the danger of obesity.
2: Weight alone cannot determine obesity
Generally, BMI is used as the index to determine a person’s obesity. At a BMI of 25, a person is considered to be overweight and over 30 is obesity. However BMI alone may not be an accurate tool in evaluating obesity. The index does not distinguish fat from muscle. For example, someone can have excess fat but the same BMI as a muscular athlete who has a lot of muscle.
Dr. Amp suggested that BMI alone is not enough for diagnosing obesity. A variety of tools must be used to make a diagnosis such as measuring waist circumference or using the DEXA (Dual-Energy X-ray Absorptiometry) to measure the whole body fat. In the middle age group (20-50 years) excessive fat should not be over 32% in females and 28% in males.
3: Factors that cause obesity – it isn’t only down to over-eating
People tend to understand that taking too much food is the cause of being overweight and that calories depend on the quantity of food you consume. But don’t forget that the same amount of food may provide different calories. For example, 100g of apple has 50 kcal, while 100g of chocolate has 400 kcal. This depends on the energy density of the food according to the ratio of nutrients: carbohydrates, proteins and fats. Carbohydrates and protein provide 4 kcal of energy per gram while fat is 9 kcal per gram.
Therefore, eating to prevent and treat obesity is not just about limiting quantity: it must take into account the quality as well as the right amount. Foods that are high in fibre such as vegetables, fruits, or whole grains often provide less energy than foods that are high in fat and sugar. Also we must include other nutrients that are essential to the body such as vitamins, minerals, including various antioxidants for the body to function normally.
There are other factors which can negatively contribute to your metabolism and risk of obesity. These include low physical activity, insufficient sleep, hormonal changes, as well as genetic code, so lifestyle modification must be taken into account at the same time.
4: The fatter you are, the more difficult it is to control your eating habit
Obesity is caused by an imbalance in the body's control over hunger and satiety which is controlled by the Neuroendocrine. The endocrine glands produce hormones that can send signals to the brain to tell whether we should continue eating or not.
The most important hormone is Leptin which helps regulate the long-term balance between your body’s food intake and energy use. The amount of Leptin is proportional to the amount of fat cells in your body. If you don’t have enough sleep, leptin levels decrease, which signals that our body thinks it’s starving. This stimulates intense hunger and leads to increased food consumption.
“In an obese person, a decreased sensitivity to leptin occurs causing ‘leptin resistance’, a condition which results in an inability to detect satiety and causes persistent hunger,” Dr. Amp explains.
Another related hormone is Ghrelin known as the “hunger hormone”. Ghrelin signals your brain when your stomach is empty and it’s time to eat. Ghrelin levels increase between mealtimes and decrease when your stomach is full. People who have obesity often have abnormal ghrelin levels, so that even when the stomach is full, the ghrelin level doesn’t decrease and hence nor does the appetite.
So obesity is not simply the result of a lack of willpower to stop eating; it is also related to hormonal imbalance in the body.
5: Genetic and environmental factors related to obesity
Nowadays, many understand that obesity is related to genetic factors. It has been found that families with obese family members can pass on obesity to younger generations through genes such as Fat Mass and Obesity-Associated Gene (FTO). However genes are not the only cause; the more important factor is lifestyle.
Dr. Amp explained that consumption behaviours, such as choosing to buy foods that are high in sugar or fat as well as processed foods, family culture, and social and environmental factors, also play important roles.
Although internal factors such as heredity and genes are with us from birth and cannot be changed, there are many other external factors that cause obesity which we can control. Behavioural changes and taking good care of your health can prevent you becoming obese.
Listed below are seven weight-management tips from Dr. Tanupol that can help you to avoid obesity.
1. Choose nutrient-dense foods. In one dish, there should be 50% varieties of vegetables and 25% good protein like fish, beans and whole grains. The remaining 25% can be whole grains such as brown rice.
2. Avoid high fat foods or only consume them in small amounts. This especially applies to trans fats and saturated fats such as fatty meats, animal skin, offal, cakes, fast food, pearl milk tea, processed meats such as bacon, ham, sausages, and others.
3. Avoid bakery products and foods and drinks containing a high proportion of sugar, especially beverages and snacks with high Fructose Corn Syrup (HFCS) like soft drinks, syrup, fruit juice, jam, cookies, ice cream, cakes and pies.
4. Exercise regularly for at least 150 minutes a week or about 30 mins 5 days a week.
5. Get enough sleep – at least 8-9 hours daily. Go to bed no later than 10pm.
6. Avoid smoking and excessive alcohol drinking.
7. Try to relieve stress by meditation, mindfulness or relaxing activities.
Nowadays, there seems to be an increasing tendency towards obesity in both adults and children. It is something that everyone should be aware of and pay attention to because obesity is the main cause which can lead to various diseases that eventually affect the quality of life. Dr. Amp would like to take the opportunity on World Obesity Day to raise awareness among the public to fight obesity in order to create a healthy society together.
“Good Health cannot be bought; you must work for it,” Dr. Tanupol concluded.
