Dr Segun Ogunwale is an endocrinologist. In this interview with TOLUWALOPE KAREEM, he talks about obesity, causes and some of its risk factors
What is obesity?
Obesity is an abnormal or excessive accumulation of fat in the body that may impair the health factors of the individual.
What are the causes of obesity?
Generally, there are many causes of obesity, but I will talk about the common causes. It is becoming an epidemic because we now see people (children and adults) being affected; also, unhealthy eating habits, in terms of quantity and quality of food, as well as the timing of eating. There is also a lack of physical activities and sedentary lifestyles that we find nowadays. From all the statistics, we find this more in the urban areas, than in the villages and semi-urban areas. People there are more physically active. They get to do a lot of work like farming, they also work long distances. Not so many people have vehicles; people do house chores and children play outside. Unlike the urban areas, where children are mostly indoors and lots of people have their vehicles.
In terms of unhealthy eating, we have fast food, too much carbohydrate and sugars, even soft drinks, beverages and many more. In quantity, people sometimes have too much to eat. And most of us tend to eat at the wrong time. Many of us don’t even have breakfast at all, rather we have brunch, combining breakfast and lunch, and at night, when we do not really need the food. But because we have starved ourselves for a long time, we eat heavily and go to sleep and then the food is converted to fat.
How is obesity diagnosed?
There are many methods used, but the commonest one is called the body mass index, using your weight in kilogrammes and your height in metres. When you use your weight, it will be weight/height in metre square, so that is weight/height multiplied by height. And if your body mass index is equal to or greater than 25, then you say the person is overweight. People talk about obesity but don’t talk about being overweight because if you don’t watch it, when you are overweight, then you’ll soon become obese. Those who are 30 to 34.9 are under class one obesity, and class two is from 35 to 39.9. We also have what is called morbid obesity: those who are 40 and above, and there are severe cases of obesity of people from 50 and above.
Children are also not spared. The paediatricians have a way of calculating for children using graphs.
The easiest way to know if someone has a healthy weight or not is to find their height in centimetres. If my height is 108cm and I subtract 100 from it, what I have is 80kg. If I am less than 80kg, I can boldly say I have a healthy weight for my height and that says taller people have more room to gain weight, compared to shorter people.
Are genes responsible for obesity?
There are some people who have fast metabolisms and some have slow metabolisms. Their body breaks down food easily and they are very active people, so no matter what they eat, it won’t really show. For some people, even the little they eat, the body stores so much because it takes a little for them to gain weight. Even then, I don’t want them to hide in such things saying it is just their body and that’s the way they are. Some people even claim that it’s hereditary because that is how they all are in their family, which is not true. You need to look at the person’s lifestyle.
Are you eating healthy? Are you eating at the right time? Are you keeping fit? These are the questions to be asked; find out well, and if that family eats a lot. Statistics show that women are more obese than men, but in terms of being overweight, they are almost the same ratio. However, when it comes to obesity, women are more, especially in underdeveloped and developing countries, where most women are married and sit at home as full housewives and having babies.
Most men have truncal obesity, which is a result of unhealthy events in the body. I don’t want people to hide under genes. There might be some genetic defects such as hypothyroidism, but I don’t want people to hide under it. Those are the exceptions that you’ll have, but the most common causes of obesity are still tied to unhealthy eating and small or no physical activities. I have not seen a person who eats healthy, moderately and is physically active that we would say is obese, except they have some disease.
There are people with different bodies. People like sumo wrestlers in Japan hardly drink water; they drink milk. Your life is what you eat and it’s true to an extent, what comes into you affects you.
What complications are obese people prone to?
There is what we call Type 2 diabetes. In the United States, we talk about juvenile diabetes and it is in Nigeria also because I have seen one or two cases. Of the two common predisposing factors, there’s one you cannot do anything about. But the one you can do something about was found to be the second most consistent predisposing factor in developing Type 2 diabetes. You also see people who are obese developing arthritis, especially of the knee; it is a common complication of obesity. I remember a woman who was supposed to go for an operation in January and someone said, ‘Why not lose weight?’ She lost weight and didn’t have to go for the surgery and her knee healed from arthritis.
Also, heart disease and stroke have been associated with obesity, especially heart attack. Of course, there are also psychological complications, such as depression as a result of bullying, which can even lead to them eating more and make it worse.
Why are obese people prone to heart attacks?
High cholesterol is common with obese people and cholesterol blocks the inner lining of blood vessels that supplies blood to the heart. Anywhere blood does not flow, oxygen does not go. Once oxygen is cut off from the heart, then there is a heart attack. The heart bears more burdens to work with and heart failure comes in.
What are the preventive measures against obesity?
It starts from childhood. You see people say they have once suffered and they need to enjoy, and also do not want their kids to go through the same thing they went through, hence ‘my children must enjoy and live a good life.’ We think we are enjoying ourselves but we don’t realise we are only harming ourselves. As a result of this thinking, we end up eating too much.
Let children move around and burn fat and energy. They shouldn’t just be allowed to sit indoors and just watch television or play with an iPad alone. Take the family for a workout and eat healthily. Our children don’t eat healthy most of the time because we are in a hurry to go to work, we would rather give them junk food, synthetic foods, no fruits or vegetables. Obesity used to be a problem of the West, but now it is our problem.
Preventing obesity starts early in healthy living, in terms of quantity, quality and timing. Also, exercise and go for medical check-ups. There is nothing wrong with adults and children doing exercise. Adults should learn to take walks, and it can be done as a family. This also helps with bonding with the family. If you have a spouse or friends, you can ask them to go together with you. I believe more in outdoor exercise because if you have a treadmill at home, you can always decide to do it another time, but when you go out, you know you are going to come back home. You can just take a walk around your neighbourhood. If you are one who has to go to work, you should wake up early and do your exercise. Studies have shown that it takes 21 uninterrupted days of consistently doing something to form a habit. Create time, walk or exercise for 30 minutes, be consistent and as time goes on, your body adjusts to it and you get used to it. Then gradually, you increase your time.
The more you do it, the more your brain is fixed and you know when or not you haven’t exercised for a day; that way, it becomes a habit. People need to do physical activities, even a little walk is really helpful. Some people drive to every single place, even when it is a short distance, which is not good. Join a group of people that can challenge you and let it become a habit; set goals on the number of calories you want to lose. When you meet with a dietician, they would let you know what food to eat and what not to eat.
Does obesity affect a person’s sex life?
Yes, it can indirectly affect one’s sex life. For instance, men have been found to have low testosterone because of suppression of the hypothalamus in the higher centres of the brain, which controls sex organs. So, you find obese men with low sex drive, low testosterone, and low libido. It also affects women’s oestrogen levels. When a woman is obese, she is depressed, the drive for sex and even in life generally goes down, because they feel ashamed of their body. It affects both men and women.
What type of lifestyles should obese people cultivate?
They should stop the sedentary lifestyle that they have been living and increase physical activity. Register with a gym, meet with a nutrition therapist to guide you through your meals to reduce your weight. Get help on your diet; go to support groups where people set targets and help to motivate one another. Family and friends can also stand as support groups, instead of bullying and making fun of them.
Does regular alcohol intake increase the risk of obesity?
Yes, it does. Most people who drink alcohol indulge in other things, and they eat a lot. An alcoholic that hardly eats is always malnourished. So, most alcoholics drink heavily and eat heavily. Alcohol is an indulgence, and indulgence doesn’t go alone. Usually, it goes along with other things.
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