Unveiling the Truth: The Complexities and Myths of Obesity

By Suvro Sanyal.

Obesity is a complex disease that occurs when an individual’s weight is higher than what is considered healthy for his or her height.

While discussing on the subject matter, it is very important to differentiate the two characteristics: overweight, and obese which has been considered appose. Overweight and obesity are both the determining labels for ranges of weight that are greater than what is generally considered healthy for a given height of an individual.

For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the “body mass index” (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

• An adult who has a BMI between 25 and 29.9 is considered overweight.
• An adult who has a BMI of 30 or higher is considered obese.
• A child of the same age of either sex, who has a BMI between 85% to 95% defined on CDC growth charts is considered overweight.
• A child whose BMI is 95% as per the CDC growth charts is defined to be obese.

Many factors attribute to excess weight gain including eating patterns, physical activity levels, and sleep routines. Social determinants of health; genetics; illness & consumption of certain medications; sleep; disabilities.

Social Determinants of Health (SDOH) – The conditions in which we live, learn, work, and play are called social determinants of health (SDOH). It can be difficult to make healthy food choices and get enough physical activity if these conditions do not support health. Differences in SDOH affect chronic disease outcomes and risks, including obesity, among racial, ethnic, and socioeconomic groups as well as in different geographies and among people with different physical abilities.

Genetics – Genetical changes in human populations occur too slowly to be responsible for the obesity epidemic. Yet variants in several genes may contribute to obesity by increasing hunger and food intake. Rarely, a specific variant of a single gene (monogenic obesity) causes a clear pattern of inherited obesity within a family.

Illness & Medications – Some illnesses, such as Cushing’s disease, may lead to obesity or weight gain. Drugs such as steroids and some antidepressants may also cause weight gain. Research continues on the role of other factors such as chemical exposures and the role of the microbiome.

Sleep – New-borns need 14 to 17 hours of sleep per day. That amount decreases with age; teenagers need 8 to 10 hours of sleep per day, and adults need 7 or more hours of sleep per day.

Disabilities – Obesity is more common among people with disabilities than for people without disabilities and is an important risk factor for other health conditions. The importance of overweight and obesity related to people with disabilities is a particular problem of public health importance.

Obesity is more prevalent among people with disabilities than for people without disabilities and is an important risk factor for other health conditions.

It is of omnipotent importance that:

• Researchers (Endocrinologists) have shown that BMI may not be the best measurement for some people with disabilities. For example, BMI can underestimate the amount of fat in people with spinal cord injuries who may have less lean muscle mass.

• Some researchers (endocrinologists) prefer measuring a person’s waist where extra fat may be on the body and using other methods to determine if a person is overweight or obese.

Challenges People Facing with Disabilities: People with disabilities can find it more difficult to always eat healthy, control their weight, and be physically active. This might be due to:

• A lack of healthy food choices.
• Difficulty with chewing or swallowing food, or with the taste or texture of foods.
• Medications that can contribute to weight gain, weight loss, and changes in appetite.
• Physical limitations that can reduce a person’s ability to exercise.
• Pain.
• Lack of optimum energy.
• Lack of accessible environments (sidewalks, parks, and exercise equipment) that can facilitate performing exercises.
• Lack of resources namely money; transportation; and social support from family, friends, neighbours, and community members.

Physical Activity for People with Disabilities: Evidence shows that regular physical activity provides important health benefits for people with disabilities. Benefits include improved cardiovascular and muscle fitness, improved mental health, and a better ability to do tasks of daily life. It is now obvious to recommend that adults & children with disabilities should get regular physical activity.

The Obesity Epidemic: Obesity affects different people in different ways and may increase the risk for other health conditions among people with disabilities.

• Children and adults with mobility limitations and intellectual or learning disabilities are at greatest risk for obesity.

• 20% of children 10 through 17 years of age who have special health care needs are obese compared with 15% of children of the same ages without special health care needs.

• Annual health care costs of obesity that are related to disability are estimated at approximately $44 billion.

Health Consequences of Overweight and Obesity: Overweight and obesity increases the risk of a number of other conditions, including:

• Coronary heart disease
• Type 2 Diabetes
• Cancers (endometrial, breast, and colon)
• High blood pressure
• Lipid disorders (high total cholesterol or high levels of triglycerides)
• Stroke
• Liver and gallbladder disease
• Sleep apnoea and respiratory problems
• Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
• Gynaecological problems (abnormal periods, infertility)

One of the hurdles in tackling obesity, as a health issue, is that it is shrouded in myths and misconceptions. To make things worse, the mass media, the public, and sometimes the government spread misinformation about obesity.

The latest fad to join the obesity myth is the “body positivity” movement. According to the proponents of this movement, individuals who are morbidly obese (BMI > 25 kg/m2) must be celebrated and accepted as they are instead of encouraging them to lose weight.

We have said this before and will say it again. Being obese is dangerous for your health. It is not a fashion trend. Do not get distracted by such movements.

Here are some common myths about obesity and what the actual scientific facts are.

1) I am obese because of my genetics – Genetics most certainly plays a role in increasing risk for obesity. However, it is not a direct cause.

Fact: Obesity is usually multifactorial. There is no one direct cause of obesity. Stress, sleep health, hormones, chronic pain, undetected medical conditions, and other environmental and economic conditions could also contribute to obesity. Moreover, even if obesity in an individual develops because of genetics, steps can be taken to resolve or reverse the condition.

2) I need to start losing weight dramatically – Do not get intimidated by the “before-after” images used by health studios and gyms. Weight loss is a slow process and holistic process.

Fact: Average healthy weight loss of ~10 kg takes a minimum of 3 months. Looking for dramatic results and setting unrealistic goals usually backfires. Endocrinologists advocates for process goals in order to attain outcome goals.

Here is an example of a process goal and an outcome goal:

• Process goal: Walking briskly for 30-60 min per day; Process goals help you focus on your habits instead of being fixed on the results.
• Outcome goal: Losing 0.5 to 1 kg per week.

3) I need to burn more calories than I eat, to lose weight – Individuals tend to fall for the “calories in versus calories out” formula. In other words, burning more calories than that you have consumed will help you lose weight. It is remember-worthy that the human body is a living vital system, not a robot! If biological processes were that simple, we would not be one of the most complex and successful species on the planet.

Fact: The human body is a complex system with several interlinked processes. The macronutrients and minerals in food have multiple effects in the body. They take part in thousands of signalling pathways that are involved in different metabolic reactions.

A better approach to food would be to focus on eating a balanced diet every day. To fulfill additional needs getting a basic blood biomarker profile done could help.

4) Losing weight equals knocking off those extra kilos – Technically, losing weight is measured by how much the scale moves left. However, studies have shown that keeping that as the sole metric in your weight loss program could be unproductive and lead to frustration.

Fact: Aim to be healthier. Losing weight is only one part of that; Any effort to lose weight is better off prioritising health over the reading on a weighing scale. Studies have suggested using other weight neutral metrics like blood pressure, diet quality, and physical activity in a weight management program.

5) I am obese because I don’t have access to healthy food – More than a myth, this is probably just an excuse. A food can be made healthy, or junk by personal preference. People need to be educated about food and diets. Knowledge about macronutrients, minerals, spices, and artificial flavours are very important in designing a diet. A 2024 study noted that 65.8% of people who shop do not make their purchase decisions based on nutritional information on the label of food products.

Fact: Lack of education about healthy food plays a bigger role in weight gain. Identifying and cutting down on unhealthy food, coupled with increased intake of fresh food promotes healthy weight loss.

Special diets, like the ketogenic diet, are under promoted India. The ketogenic diet is a very good way to address both overall health and losing weight.

The takeaway is that obesity is a complex, yet preventable health condition. Staying healthy should be the goal of any health exercise. Moreover, “Sensible eating is the best solution towards a Healthy Life-Style”. The quest to become, and the thrive to remain healthy should always be inculcated.