‘How’, ‘why’, and the Deep Blue Sea

Variety of vegetables, seeds, nuts, eg, berries, fish and chocolate on green wooden table.
Variety of vegetables, seeds, nuts, eg, berries, fish and chocolate on green wooden table.

John: Dear Jane, why are you obese? You need to control your diet and exercise more.

Jane: Ok John. But why are you asthmatic? You need to breathe harder and take in more air!

Just as bronchial asthma is not due to breathing less air, it is flawed to think of obesity as being a simple problem of over-eating and under-exercising.

It is true that when energy intake (food consumption) exceeds energy expenditure (physical activity), weight gain can occur. But to see obesity as only a problem of diet and exercise is too simplistic. Excess junk food consumption and a sedentary lifestyle may explain HOW obesity occurs. Focusing on HOW obesity occurs, and to see obesity as a diet-exercise problem leads us to make judgemental remarks like John did. Such a judgemental approach may also lead to fat-shaming, body-shaming and snack-shaming.

Therefore, it is important to move away from the 'HOW' to focus on 'WHY' obesity occurs.

WHY, then, does obesity occur? Obesity is due to a complex interplay of behavior, society, environment and biology. Let me try to explain with an example.

Imagine for a moment that you have just come home from work. And imagine that you find your close relative sitting on the sofa with a box of doughnuts, which is later offered to you. The aroma of freshly prepared bread and the sweet fragrance of glazed sugar waft into your nose tempting you. The nerves carry the smell to areas of the brain that regulate appetite. Your senses are aroused and your stomach growls. Tired, stressed and hungry, you reach out for the doughnuts.

A few minutes later, you have an empty box of doughnuts and a mind full of guilt.

Several factors have conspired here to give you a calorie bomb – one, your hunger and stress as you have come home from work. Second, the environment prompting obesity, that is, the easy availability of sugary foods in your society/family. Third, the influence of the brain hormones that patrol your appetite-regulating centre.

Thus, all obesity-affirming activity is a complex interplay of biology and environment. Newer research is just beginning to unravel the complexities of weight control by the body. This has helped in designing new dietary measures, novel exercise regimens and other innovative therapies.

Yet, today, people with obesity continue to suffer between the devil and the deep blue sea. On one side, they grapple with health problems such as knee arthritis, snoring, and Diabetes. And on the other side, they have to live with the psychosocial burden of obesity, and the judgmental approach of society.

It is time to approach obesity from a fresh perspective.

The world, society, family, the healthcare provider and the individual – all should work together to tackle obesity holistically, rather than seeing it as a problem of will power and blame the individual. People with obesity need more empathy and encouragement, in addition to lifestyle changes and other treatments.

As they say, a long journey begins with a single step. Here is a small step by us – from the banks of the deep blue sea, we bring you the Mediterranean diet as our latest cover story. Celebrated as one of the best diets for weight management and Diabetes, this diet seems so far from India, both geographically and culturally.

Hence, we have worked on this diet from an Indian perspective. While retaining the core philosophy of this diet, we have tried to show that one can follow this nutritious diet despite living in India, and with locally sourced foods. Hope you enjoy reading this issue of Diabetes Health.

Dr Unnikrishnan AG


Diabetes Health Magazine