A Fat Challenge

Once a diabetic, always a diabetic. This may not be a cheerful thought, but it is a truth that over 61 million Indians are coming to terms with. Hope lies in managing the condition to the best of our capability, or preventing Type 2 Diabetes before it is too late. Research is forever on the quest to understand Diabetes better, to find possible clues on how to best manage or prevent the disease.

One of the questions that have intrigued researchers for long is how obesity impacts Diabetes. Obesity, a condition marked by excess body fat, is known to cause insulin resistance, which impairs the action of insulin in the body, resulting in high blood glucose levels. However, defining obesity only by the amount of body fat may not give the complete picture. In fact, before you start looking at fat as a mortal enemy, let us first munch on one often-overlooked fact: fat serves a function in the body, and too little fat, below a certain level, would also affect physical and physiological health.

The essential and the extra

Body fat, biologically known as Adipose Tissue, is made up of a special kind of cells known as, what else, but fat cells. These cells are created in the body for the express purpose of storing energy in the form of fat. Once your body has taken the calories that it needs from food, the excess calories are converted to fat and stored in the adipose tissue. This is a sort of temporary storage for energy, which may later be used at a time of energy shortage

No matter how lean and athletic you like to be, some percentage of your body weight should still comprise of fat. The minimum level of fat required to keep the body in a healthy state, is known as essential fat. Typically, essential fat is about 3 to 5 per cent for men, and 8 to 12 per cent for women. Women need that extra fat in the body due to the demands of childbearing and other hormonal functions. Problems start when the relative amount of body fat compared to the total body weight exceeds these recommendations.

Then again, it is not just how much fat you have in your body, but also where it is located, that decides its actual impact.

Types of body fat

Based on where fat is located in the body, body fat can be defined as:

• Visceral fat1) Visceral fat which surrounds the organs such as liver, stomach, intestines, kidneys, etc. Since most of these organs are located in or near the abdominal region, high amount of visceral fat usually results in central obesity, or belly fat. Hence it is also referred to as abdominal fat. Men tend to have more visceral fat.

• Epicardial fatwhich is a specific type of visceral fat, found on the outer layer of the heart. It is considered to be 'good fat'. (Read more about fat deposit and the heart in the next article).

• Subcutaneous fatwhich is found below the skin. Women tend to have more of subcutaneous fat, around their hips, thighs and buttocks. The difference between fat deposit patterns in men and women is because of their hormonal differences.

In the recent International Symposium on Diabetes in Mumbai, Dr Shaukat Sadikot presented the case for visceral fat being perhaps the main culprit in Diabetes and cardiovascular disease (CVD). Attaining and maintaining an acceptable body weight, he explained, improves insulin sensitivity, thus helping to regulate blood glucose levels.

Remember, this information is to help you understand and know what to expect – your physician is the best person to prescribe the proper course for you. Follow their advise very carefully. With the right kind of care and advice, your diabetes should not affect the safety and outcome of surgery.

Check the bulge

In India, we are traditionally taught to consider a bulging belly as a sign of prosperity – things are now changing, and a lean body is the new desirable image. What better ornament to match your spunky new clothes than a slim waist to wrap them around? What most people don't realise however, is that the fat in your abdominal region does more than prevent you from wearing your favourite pair of jeans. Abdominal fat is actively secreting hormones, called adipokines, which may interfere with glucose metabolism in the body.

This might explain, at least in part, the infamous alliance between obesity and Diabetes. The hormones secreted by visceral fat in the abdomen can cause insulin resistance. This means that while the pancreas is still producing insulin in response to the body's requirement, the cells are unable to use this insulin effectively. And when insulin does not function correctly, the cells cannot break down glucose efficiently for the energy they need. The glucose obtained from food, and carried by blood to all organs, remains in the blood, and your doctor tells you that you have high blood glucose.

This is a sad situation – the body needs insulin to maintain the blood glucose level, but in this case, blood glucose may go too high even though the pancreas is producing insulin. Over a period of time, the constant pressure on the pancreas may also have a negative impact, and it may not always keep producing enough insulin. It is easy to see how the problems may spiral out of control with time. Your best insurance against this damage, therefore, is to act much before any of this happens – lose the excess abdominal weight.

Measuring body fat

Usually, healthy weight for an individual is calculated through body mass index (BMI). BMI within the range of 18.5 to 25 is generally considered healthy. The definition of 'healthy' BMI however, varies with ethnicity, gender and many other factors.

Dr H B Chandalia explains that BMI takes only the weight and height into consideration, which may not show how much of that mass is owing to fat. "Some athletes might weigh more, so their BMI will be high," he cites, explaining that in some cases, the higher weight could be because of muscle mass. Using methods such as electrical resistance or underwater weight measurement can help determine the body fat percentage, he explains, though a much simpler idea would be to simply measure the waist circumference.

Dr Sadikot concurs that waist measurement is the simplest way to detect excess body fat. "Anybody can measure their waist circumference," he remarks, adding: "For Indian women, the recommended waist circumference is within 80 cm, while for Indian men, it should be within 90 cm".

Do Indians have it worse?

Losing weight is easier said than done, as most of us know. In our February-March 2012 issue, we pondered whether our bodies are 'programmed' to resist our attempts at weight loss. Indians, in particular have a peculiar relationship with obesity. For a country where under-nutrition is still such a big problem, we are oddly amongst the world leaders in Diabetes prevalence. Dr C S Yagnik has since many years and through many research papers, tried to address this dichotomy. One possible explanation to this paradox might be in the theory of the "thin-fat Indian".

For his paper published in the International Journal of Obesity in 2002, Dr Yajnik and his team compared babies born in rural Maharashtra with those born in a UK hospital. On an average, the Indian mothers who were generally younger, lighter and shorter than their UK counterparts, gave birth to smaller, lighter babies. This low birth weight, Dr Yajnik infers, leads to a tendency later in life to retain more fat.

This suggests that perhaps, the bodies of Indian babies are conditioned, or 'programmed' for undernourishment. Hence later in life, we develop a tendency to horde the calories from food in form of fat instead of using them up. Remember that is the primary function of fat – to preserve calories for later use. It is a smart strategy, and helps people survive periods of starvation, when these stored calories come in handy. But this very habit of your body may become a problem when it keeps storing calories even when food is available in plenty.

Maybe that is what you see happening when your friend laments how she does not seem to be losing weight even though she is eating so little. It is not about how many calories you consume, but how many calories you are actually using. Perhaps, your body is storing more calories in form of fat than it needs too, preparing for the very unlikely event of starvation. Maybe nobody told your body that you have enough food in the kitchen.

The results can be seen in practice. Dr Sadikot cites the example of an Indian man who may have the same BMI as a Caucasian, but a higher body fat percentage, and hence a higher tendency for Diabetes. The Caucasian man with the same BMI is likely to have more muscle mass.

Same old solution

None of this is to say that as an Indian, you are doomed to suffer from obesity and Diabetes. Understanding a problem does give you a better shot at the solution. In this case, the solution still lies in modifying your lifestyle to improve your metabolism. If your body is storing more calories than it is burning, the logical approach would be:

1.Control the amount of calories you consume (diet), and Push your body to use all the stored up calories (exercise) Starving yourself is clearly not a good idea. Work around your food habits and mealtimes in a way that you keep eating small amounts of low-calorie, nutritious food at regular intervals throughout the day. Erratic food habits are also a reason for higher fat storage.

Make sure to include some form of physical exercise in your routine. Whether it is walking to the grocery store or playing with the kids, pick up an activity which you enjoy and can continue.

Like any good homemaker, your body tries to use its calories with economy. You 'spend' energy on your daily activities, and you store energy for contingencies. We are gifted with an intelligent metabolism that usually knows how to keep the balance sheet healthy. When that balance goes wrong, however, you may need to take matters in your own hands and make choices that are in the best interest of your body.