The increasing occurrence of Obesity in Indians is a matter of concern and especially so because obesity can lead to Diabetes and heart disease. The Diabetes Health team looks at how best obesity in adults can be managed to enhance health parameters and improve the quality of life.Obesity explainedObesity is a condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Excess body weight is implicated as a risk factor for many disorders including Diabetes, heart disease, cancer, female infertility etc.Indians have more abdominal fat. This abdominal obesity makes them more prone to develop Type 2 Diabetes. 55 per cent of people with Type 2 Diabetes are obese at diagnosis. Abdominal fat excess makes the body resistant to insulin, which is a hormone that can lower blood glucose.Insulin is an important hormone that delivers glucose (sugar) to our cells. When a person is overweight, the cells in the body become less sensitive to the insulin that is released from the pancreas. There is evidence that fat cells are more resistant to insulin than muscle cells. If a person has more fat cells than muscle cells, then the insulin becomes less effective overall, and glucose remains circulating in the blood instead of being taken in to the cells to be used as energy. Insulin resistance causes high blood glucose levels i.e. Diabetes mellitus. Left untreated Diabetes leads to heart attacks, kidney failure, foot amputations and blindness. What causes obesity?When you eat more calories than you burn off, you gain weight. How you eat, your activity level and other things affect how your body uses calories and whether you gain weight. If your family members are obese, you may have inherited a tendency to gain weight. And your family also helps form your eating and lifestyle habits, which can lead to obesity.Obese youngsters become overweight or obese adults. This facilitates the onset of diseases like Diabetes in later life. Increased prosperity has transformed India's dietary patterns to include Western foods leading to a rapid increase in obesity. Indians are genetically more prone to Diabetes. On top of this, a rapid shift in our dietary habits and lifestyles is resulting in a rapid rise in obesity. The incidence of Type 2 Diabetes in our country is increasing in correlation with the rise in obesity. Determining obesityObesity can be determined by a number of ways, ranging from very high-tech machines that can precisely quantify the amount of fat and lean tissue in the body to the simple weight scale that you find at home. The two most common ways of detecting obesity in your doctor's office is by obtaining a height and weight to calculate body mass index (BMI) and using a measuring tape to determine waist circumference.Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 and 30 kg/m2, and obese when it is greater than 30 kg/m2.Weight in KgsBMI =Height in Metre2It's not just how much people weigh, but also where they carry the weight, that put them at greater risk for health problems. People who carry more weight around their waist - an 'apple-shape' - are more likely to suffer from obesity related problems than someone who is 'pear-shaped', or carries more weight in their hips and thighs.Health risks associated with obesityObesity harms nearly every aspect of health. The resulting complications affect not only heart, lungs, muscles, bones, kidneys, digestive tract as well as the hormones controlling blood sugar and puberty but also affect an individual's emotional wellbeing. Disrupted sleep cycle (changing work shifts, limited sleeping time) and obstructive sleep apnoea have also become identified as contributing to worsened weight gain, poor Diabetes control and an increased rate of cardiovascular events.In addition to the comorbid conditions mentioned above, obesity is commonly associated with oesophageal reflux, degenerative arthritis of weight bearing joints, infertility and recent studies have confirmed its importance in increased cancer risk. This is primarily for cancers in women, such as breast and endometrial cancers.Psychologically, people who are obese are more likely to be depressed, to earn less in the market place, to experience discrimination and are less likely to be married.In addition, obesity may also have an adverse impact on other diseases such as multiple sclerosis and worsens the outcome in patients who are undergoing transplants. Cardiovascular riskObesity increases the risk of coronary heart diseases as it affects blood glucose, blood pressure and HDL, LDL and cholesterol levels. Comorbidities relating to obesity like coronary artery disease increase as BMI increases.Studies indicate that obesity can cause heart attacks in both men and women with minimal increases in BMI. Hypertension is approximately three times more common in obese than normal-weight persons. This relationship may be cause-and-effect in that when weight increases, so does blood pressure, whereas when weight decreases, blood pressure falls. In a 14-year prospective study, middle-aged women with a BMI >23 but <25 had a 50 per cent increase in risk of nonfatal or fatal coronary heart disease. Men aged 40 to 65 years with a BMI >25 but <29 had a 72 per cent increased risk.People from South and Southeast Asia manifest Type 2 Diabetes and cardiovascular risk at lower body weights than European populations. The World Health Organization has attempted to identify appropriate parameters of obesity in Asian populations, data citing that risk for chronic diseases increases past a BMI threshold of 25 kg/m². Probably more important for South Asians is the waist circumference, indicative of central obesity. Current consensuses hold that central obesity is present in an Asian woman with a waist circumference greater than 80 cm (or 90 cm in an Asian man).Managing obesityDietAn important consideration is to choose foods sources that have not been processed but instead are 'whole foods', mainly those that you would use to cook at home with. Processed foods that are characteristic of a number of 'convenience' food choices contain extra amounts of added sugars, salt, and fat that make them more desirable to eat but ultimately have been found to promote unwanted weight gain, hypertension and heart diseases.It is also important to consume foods that have demonstrated to prevent weight gain and are associated with the lowest population risk for chronic diseases such as Diabetes and cardiovascular disease. A healthy diet is considered to primarily be plant-based, including sources of oil that are from plants that also includes fish, nuts and whole grains.For a typical Indian dinner that includes rice, the recommendation would be to choose less refined varieties than 'polished' rice. When animal products such as meat and dairy are included, they should be from lean cuts and low-fat sources.Diabetes and cardiovascular disease. A healthy diet is considered to primarily be plant-based, including sources of oil that are from plants that also includes fish, nuts and whole grains.For a typical Indian dinner that includes rice, the recommendation would be to choose less refined varieties than 'polished' rice. When animal products such as meat and dairy are included, they should be from lean cuts and low-fat sources.Physical activity\t30 minutes to an hour of moderate to high level exercise at least 5times in a week is recommended. It is important to remain active duringawake times even when you are not exercising. These are the times when your brain and body can down regulate metabolism to hold onto extra calories so as to maintain a higher body weight, predisposed to unwanted weight gain and contributes to Diabetes risk.People must also increase one's activity outside the gym. Examples include installing standing desks for people who work in call centres or taking public transportation and getting off several blocks before you get to your work or home so you can walk more, rather than taking a car from your driveway to the parking lot.Simply walking for longer every day not only helps ward off obesity but also reduces the risk of Diabetes. Physical activity is known to reduce body mass index and insulin resistance - an early stage in the development of Diabetes. A popular guideline is to do 10,000 steps every day, though a more recent recommendation is 3,000 steps, five days a week. A higher daily step count over five years was associated with a lower body mass index, lower waist to hip ratio, and better insulin sensitivity.MedicationThe original medications used for weight- loss maintenance, such as phentermine and topiramate, were originally developed for other purposes and incidentally found to have sites of action in the brain that regulate body weight.Drugs such as metformin and liraglutide help lose weight. The pharmacological drug Dapagliflozin is a tablet medication which not only reduces blood glucose levels by helping the body to expel excess glucose out of the blood, helps manage blood pressure and supports weight loss. SGLT2 proteins are responsible for reabsorbing the filtered blood glucose. Dapagliflozin, a SGLT2 inhibitor, prevents this reabsorbing and regulates blood sugar levels.Semaglutide and Tirzepatide both are ones a week subcutaneous injections which cayse weightloss in people with Type 2 Diabetes.SurgeryGuidelines from the National Institute of Health (NIH), recommend surgery for patients with morbid obesity and associated disease, who have previously failed to respond to normal line of treatment like medication and lifestyle intervention.Asia-specific guidelines define people with BMI of 32.5 and above with associatedco-morbidity as being morbidly obese.American Diabetes Association and International Diabetes Federation have added bariatric surgery as a preferred option for morbidly obese people with Type 2 Diabetes in cases where medical treatment has failed to control their Diabetes. Patients who have undergone bariatric surgery have special nutritional requirement in the follow-up. However, many physicians and patients see this as the lesser evil compared to the chronic problems that obese people have to live with.Short-term surgical complications include gastric leaks, blood clots and infection. There are also longer-term complications, many of which relate to band slippage and band erosion, which may explain the numbers of patients who convert from banding to bypass. It can also cause longer-term nutritional complications, such as deficiencies in iron, vitamin B12, folate, calcium, vitamin D and vitamin A. Weight loss can also cause excessive skin folds, particularly in older patients, whose skin elasticity has decreased.Surgical options include:Gastric banding involves laparoscopic (keyhole) surgery to place a small, doughnut-shaped silicon ring around the upper part of the stomach. The band is then filled with fluid via a port placed just under the skin. It may take up to six visits in the first 12 months after surgery to adjust the band to the correct 'tightness' and to suppress hunger. The fluid in the port can be injected or withdrawn, allowing the size of the opening to be manually adjusted between the upper and lower parts of the stomach over the band's lifetime.a longer procedure that usually leads to a greater amount of rapid weight loss. Again, via keyhole surgery, the stomach is stapled to produce a much smaller pouch. A section of the small intestine is then bypassed and the 'Roux limb' is used to link this new, smaller stomach to the small bowel, creating a shorter gastrointestinal tract, which results in an increased feeling of fullness after small meals.e Sleeve gastrectomy involves reducing the size of the stomach by about75 per cent. Unlike a gastric bypass, where food enters a small pouch and then passes straight into the small bowel, food takes the same route following a sleeve gastrectomy as it did before surgery.Most countries consider a patient eligible for bariatric surgery if their BMI is 35 kg/m² or more and they have an obesity-related e Gastric bypass (the Roux-en-Y gastric) ischronic condition (such as Diabetes, hypertension, arthritis, reflux, etc.) or if their BMI is 40 kg/m2 or greater even if they don't have any other obesity-related conditions. A person's chances of going into full Diabetes remission, meaning that their HbA1c is normal and they do not need to take any medications for their Diabetes, is when they have their bariatric surgery at the time of diagnosis or shortly thereafter.To concludeWeight loss is a crucial aspect of better managing Diabetes as it lowers blood sugar, blood pressure and improves cholesterol and energy levels. Along with pharmacological advances, a healthy diet and regular exercise helps maintain not just your weight but also your sugar levels.