Friday, May 7, 2010

Some random thots on.... OBESITY

A common problem worldwide and locally in Malaysia.Mainly due to lifestyle change[ IT connectivity,less physical sports among the new generations, MacDonald and Fast food culture, etc and etc], increasing affluence and changing societal values to physical activities and work.

At the family level ,obesity is ubiquitous. There is obesity everywhere you go.In my very own family , two of my children are extremely obese plus plus, a product of having a wife who 'finds' pleasure in cooking! An endocrinologist colleague of mine jokingly in fact viewed 'good cooks' amongst debutants as potential risk behaviour for future family.Good news for those prospective young ladies outside there who know very little about cooking : you girls are positive 'material'. Good cooks are hazardous to not only their own health but their future children and futute husband's health!...

People talk about BMI [ weight in Kg divided by square of surface area of body in metres ]when they want to classify obesity. Anything above 21 is already "yellow" in term of increasing predisposition to chronic medical problem and a shorter lifespan.25 and above is overweight. A BMI of 30 and above is OBESE.

I have a simple working rule in my clinic.Your height in centimetres minus 100. That is your ideal body weight. Say you are 170 cm in height, then your ideal body weight is 70 kg plus minus 3 to 4 kg both side. Beyond that narrow confine, consider yourselves overweight.If you are 170 cm in height and you weight is 10 kg excess, you are creeping into the obesity zone.15 to 20 kg above your ideal weight, you are in deep 'shit'.Beyond 20 kg from your ideal 70, you are most probably doomed to a shorter lifespan, 'averagely and statistically' speaking. How much shorter you may ask?

Recent studies showed as much as 12 to 15 years shorter....and mind you this is 'statistically' speaking.You might die of a fatal myocardial infarct at the ripe old age of 39!..Or a diabetic complication at 45.

What are the factors working against obese people? :

1.Increased propensity to Metabolic Syndrome: High blood cholesterol with low HDL cholesterol[ double whammy,'Too much garbage that is choleterol, with no garbage lorries, that is HDL choleterol or good cholesterol, as i used to simplify for my patients ], high triglyceride, borderline high blood pressure, and borderline high fasting blood sugar. All this impact on the circulatory system to give premature incidence of diabetes, hypertension , stroke and heart attack. The bottomline is : premature death or chronic ill health!

2.Musculo-skeletal effect on the joints especially the knees , ankles , hips and spines.The 'shock absorbers'.

3.Certain cancers occur more in obese people, example are colonic,endometrial cancers and increasingly now , hepatomas, ie malignant liver cancers.

4.Sleep apnea..impacts on quality of life or lack of it.

5.Liver cirrhosis: Usually present early as a major cause for 'fatty liver' usually diagnosed on ultrasound examination of the abdomen. Progress to complete scarring in the liver resulting in complete disruption of healthy liver cells being replaced initially by fat cells from the abdomen creeping in and finally total scarring of the whole liver....A potential epidemics of liver cirrhosis in Asia due to metabolic syndrome arising from creeping obesity in the future.

7.Obesity Related Congestive Cardiomyopathy
In the morbidly obese,carrying excess 30 to 50 kg above their ideal body weight, we cardiologist often times see this condition in our practice. Not difficult to imagine from the 'layman's perspective. However massive your size, your heart is only the size of your palm. Imagine that 'pump' pumping around the blood needed for 1 1/2 persons for years. Firstly, as a result of overwork, the muscle thickened. Subsequently the chambers dilate or enlarge. On the routine chest Xray, the heart silhoute showed a bigger heart.When the heart dilates further it become less efficient as a pump. You get shortness of breath and easy fatiguability. Over time you get pump failure. Luckily it not a common problem but with an explosion of obesity amongst the young people nowadays, we increasingly see this condition often in as young as their early forties and late thirties.Their problem are compounded further by diabetes , hypertension and primary lung hypoventilation and ischaemic heart disease, commonly related to obesity via the Metabolic Syndrome pathway as earlier discussed.

When I see a very fat guy in my clinic, I see 'future' headaches for us doctors, and despite what you guys may think of us, unlike lawyers, we do not like future 'Headaches'...
A fat guy with poor heart function with diabetes and borderline kidney function, with poor lung function, breathing heavily even at rest in bed,and on top of that has a perforated appendix awaiting a cardiological review prior to an emergency appendicectomy, constitute a big headache for plumbers like me.If he does not go for surgery, he could progress to 'septicaemia' ie overwhelming infection in the blood. If he does go to surgery,he has a higher probability of dying on the table due to an anaesthetic accident. If he survived surgery , he may may end up having a 'coronary incident' or pulmonary embolism in the immediate post procedure period. These are the type of patients that keep us plumbers awake at night...Hobson's choice!.....How do you tell that to a patient [ and his or her relatives ] who is in need of emergency surgery?

8.Ventilation/breathing failure due to increased incidence of 'under-filled' lungs alveoli, initially leading to increasing pressure in the lung tissues and finally respiratory failure. This we frequently see in extremely obese individuals....Do not feel that you need to be only candidates for Asia's Biggest Losers before you are there...If you are already 30 kg excess beyond your ideal range, you are already half way there!

9.Low self esteem...May seem least of all the problem enumerated but actually very real. Less job opportunity,less 'marriageability' quotient, depression etc and etc.

How then can one get out of this vicious cycle of ill health leading to more ill health?

First and foremost and rule number ONE: There is no short cut.....can forget about gastric bypass, stomach balloons and worst of all lipo-suctions.While gastric bypass and balloons work for the extremely obese ,it is not without risk and cost plus plus and it is still hard work with respect to diet ,diet and diet. There is no escaping that even with bypass....Lipo suction is only for the 'looneys'. It does not change anything. Risk of fat embolism and instant peri- procedure death or irreversible brain damage due to hypoxia is real and significant.Remember the celebrated 'datin' case in Pantai sometime ago!.

What do we have then?....hard work my dear, hard work.....

Just 4 words:Cut intake, burn more !...

Cut Intake:
.Do not add calories in your drinks...drink plain water
.Try eating slower than your usual pace. Use fork and spoon if this help.
.Factor in salad, vege soup or fruits before actual dessert 1st before meal.
.Try just fruits as your working day lunch. Fruits and veges and salad are fibre rich with reduced calories.
.Cut down on 'deep fries', santan and fats. Apart from 'stimulating your very own liver to produce your own 'endogenous' cholesterol, fats,oil and santan are 'packed with calories.
.If you have to have rice, just one 'cupful' at each meal..
. Fruits, fruits ,fruits and fruits
. Small not try missing your meals but go for small meals and plenty of fluids before during and after meals.

Burn More:
.Factor in physical activities in your daily life. If you can take the staircase rather than the elevator, take the staircase. If you can park your car one kilometre away from your work place and FOC rather than park near your office and pay, park one kilometre away FOC. If your work means you come back only at 730 pm at night, and if you are a Muslim, choose a surau one or two kilometres away from your house and walk there daily for Isyak prayer. What I mean is , you do not need to be in the gym to exercise, just activate and plan your life ACTIVELY.
.Exercise everyday of your life. Half an hour a day will do.
.Enrol in a gym near your office. Go to the gym at lunch break or after office rather than be contributing to the jam.
.Do your 'home work' while exercise.Ie keep your mind busy thinking about solutions to work problems, zikir, music or something so that your 'exercise time' will be a pleasure to you.

What is the dividend in keeping to an ideal weight:
Even if by a twist of fate you do not get chosen to 'live longer', you live a healthier and more vital life. Your sex life will be 100 % better, your attitude to life will be more 'tolerable' to your life partners.In short , you will be less of an ..rsehole to yourselves![ pardon the pun! ]

Take care......

Dr Nik Howk

Related Articles:
. Angina and the Coronary Patient (Click Here)
. Exercise: Mixing the Profane and the Sublime (Click Here)
. The 4 Jokers.(Click Here)
. Letter to a prospective Son-in-Law(Click Here)
. Some random thots on Longevity..[1,2,3 ](Click Here, Here & Here)
. Longevity: A Muslim's Perspective.(Click Here)


RahmatHarounHashim said...

Dear Dr Nik,

In my novels, I used to call the mothers who prepare hazardous meals for their families: a "Kitchen's Killer". Just watch kitchen's basin/sink, if clogged every six months, likely you have clogged arteries in the house and members of Metabolic Syndrome Club.

Pearls and Gem said...

Yes Rachmat, future mother-in-laws should be looking for SYT's who cannot cook!

Quite unrelated to our present thread but I wish to put in here is this 2 ayats which I read from my early morning 'lepaking' in between Surah Al Anaam[letter 6] and Al Araf[letter 7 ], which in a way has a bearing to our lives today: We have a choice to be healthy or sick, to be happy or sad,and finally to be in the 'Garden' or in the 'dump':

"Listen to this ayat from Surah Al Anaam in your internet at ,

preferably with the haunting voice of Qari Abdul Baasit rendering it. Put yourselves some millenium or perhaps several centuries ahead in time, then the full meaning of the ayat would come to bear :

O ye assembly of the jinn and humankind! Came there not unto you messengers of your own who recounted unto you My tokens and warned you of the meeting of this your Day? They will say: We testify against ourselves. And the life of the world beguiled them. And they testify against themselves that they were disbelievers. (130
Al Anaam , 6 : 130

Fast backward a couple of millenium into the realm of 'time before time:

And We created you, then fashioned you, then told the angels: Fall ye prostrate before Adam! And they fell prostrate, all save Iblis, who was not of those who make prostration. (11) He said: What hindered thee that thou didst not fall prostrate when I bade thee? (Iblis) said: I am better than him. Thou createdst me of fire while him Thou didst create of mud. (12)
Al A'raf , 7 : 11-12

Then one can understand George Bernard Shaws' assertion that indeed 'life is a stage, and we ,just the actors'.

That begs the perennial question of 'free will and fate'. Are we really free? Are we doomed by fate,already decided long time ago? The obvious answer lies in the existence of heaven and hell. It is only an irrational God that made heaven and hell but takes away the choice of free will!

At the end of time It all boils down to our choice."


Dr Nik Howk