PATIENT ENQUIRY

Obesity


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What Is?
What is Obesity
How to Treat Obesity
Natural Treatments for Obesity

What is obesity?

A person’s height and gender determine what is a healthy weight. The terms ‘overweight’ and ‘obesity’ refer to body weight above what is considered healthy for a certain height. A useful measure to determine whether a person is overweight or obese is body mass index (BMI),which is calculated from height and weight.

The Australian population is ranked as one of the most overweight nations in the developed world. The number of Australians classed as obese (BMI > 30) has doubled during the past 20 years to more than five million people. Obesity is now the single biggest threat to public health in Australia and the leading cause of premature death and illness, with smoking second.

Being obese increases a person’s risk of diabetes, coronary artery disease, congestive heart failure, stroke, osteoarthritis, and some cancers. Reducing your weight by just 10% can delay or prevent the onset of some chronic diseases.

Until recently the connection between obesity and heart disease was believed to be indirect resulting from high blood pressure, dyslipidemia, cholesterol and insulin resistance or type 2 diabetes, with the likelihood increasing as BMI increased. However, doctors now know that obesity not only relates to, but also can independently predict the course of developing coronary artery disease.

Simply jumping on the scales to check your weight doesn’t really provide an accurate picture of body fat content. Bones, muscles, fluid, and fat all contribute to weight. To assess chronic disease risk, correlating height and waist measurements provides a more accurate pciture. The ratio of your weight to your height – your BMI – enables you to determine whether your health is at risk because you are overweight or obese. And measuring waist circumference indicates how much fat is deposited around the abdominal organs.

Maintaining a healthy weight is crucial to remaining well and preventing chronic disease. A healthy weight can help you keep cholesterol, blood pressure, and blood glucose levels under control and prevent disease dependent on weight, such as heart disease, diabetes, osteoarthritis, and some cancers.

Overeating or not getting enough exercise will cause a person to gain weight and become overweight or obese. To maintain an ideal weight, the calories you eat must equal the energy you burn each day. In order to lose weight, you must burn more calories than you eat.

Medicines, thyroid problems, heart failure, and kidney disease can cause sudden weight gain. Fluid retention, hormone imbalance, postpartum depression, alcohol abuse, and dysthYmia are additional reasons for gaining weight without overeating.

Unfortunately, obesity is a chronic disorder and less than 5% of people who manage to lose enough weight to reach their healthy weight range keep the weight off for four years or more. The habits adopted to lose the weight can be modified slightly, but must be maintained for a lifetime to prevent weight gain, which can happen so easily.

Prevention of obesity by diet and regular physical activity remains the highest priority for maintaining cardiovascular health. This is particularly important for small children and adolescents struggling with weight problems. Also, overweight children are more likely to become overweight or obese as adults, with the same disease risks.

How to determine if you are overweight or obese

How to determine if you are overweight or obese

A useful measure to determine whether a person is overweight or obese is body mass index (BMI), which is calculated from height and weight. http://www.heartfoundation.org.au/healthy-eating/Pages/bmi-calculator.aspx

A person’s waist measurement correlates with BMI and provides a simple check of the amount of weight that is due to abdominal fat. A waist measurement more than 94cm for men and 80cm for women indicates too much fat is present around the heart, kidneys, liver and pancreas.

This excess abdominal fat is a greater risk factor for coronary heart disease and other chronic disease than having extra fat in other parts of the body, such as the hips, thighs and bottom.

What are the health risks of being overweight or obese?

What are the health risks of being overweight or obese?

Achieving your ideal, healthy weight doesn’t just mean you look good but also reduces your risk for developing chronic disease, premature ageing, and even premature death.

Health issues associated with obesity: Bookmark these

  • Cardiovascular disease
  • High blood pressure
  • Type 2 diabetes
  • Abnormal blood fats
  • Syndrome X
  • Cancer
  • Osteoarthritis
  • Snoring and sleep apnoea
  • Obesity hypoventilation syndrome
  • Infertility and menstrual issues
  • Gallstones
  • Psychosocial effects

Atherosclerosis is present 10 times more often in obese people than those who are not obese. A person’s coronary heart disease risk directly correlates with BMI – the heavier you weigh the higher your risk.

In coronary heart disease fatty arterial plaques (atherosclerosis) develops along the arterial wall of the arteries that supply oxygenated blood to the heart muscles. As disease progresses, the plaques narrow and later occlude one or more of the arteries, causing angina or worse a heart attack – when the heart muscle is deprived of blood, causing pain and tissue ischaemia.

Following a heart attack the heart muscles can become weakened and fail to pump adequate blood around the body, leading to heart failure. While the heart continues to pump blood, over time the pumping action fails to provide enough oxygenated blood to meet the needs of organs, in particular the brain.

Just as athersclerosis can block the heart arteries, the carotid arteries that carry blood to the brain can narrow as a result of plaque disease and cause a cerebral stroke. This can result from inadequate blood reaching the brain or a clot from a carotid plaque dislodging and blocking a distal artery in the brain.

A person’s risk for high blood pressure (hypertension) increases with obesity because the additional body fat increases the workload of the heart, because it must pump more blood through additional blood vessels to supply the excess body fat. More circulating blood means more pressure on the artery walls and increased blood pressure.

Blood pressure is the force exerted against the arterial wall when the heart pumps arterial blood around the body. High blood pressure may damage the heart, arteries, kidneys, visual problems, and cause stroke.

Type 2 diabetes
Obesity is the major cause of type 2 diabetes. After the intestine breaks down food into glucose, the body cells use insulin, a hormone secreted by the pancreas, to absorb the glucose into the cells where it is converted into energy. Obesity leads to insulin resistance – when the body fails to respond to insulin or fails to supply enough insulin.

Insulin resistance leads to high blood glucose levels, which over time damages blood vessels and the kidneys. You don’t have to be obese, just being overweight dramatically increases the risk of developing type 2 diabetes.

Obesity increases a person’s risk of having high blood cholesterol and abnormal levels of blood fats – high LDL and low HDL. And having abnormal levels of blood fats increases a person’s risk for cardiovascular disease.

Syndrome X or metabolic syndrome is the name given to a group of risk factors that increase a person’s risk for cardiovascular disease, type 2 diabetes, and fertility problems. Syndrome X occurs when insulin resistance is combined with elevated blood pressure, triglycerides and cholesterol, and excess body fat.

A diagnosis of metabolic syndrome is made if you have at least three of the following risk factors:

  • A large waistline or ‘apple shape’. A higher than normal triglyceride level
  • A lower than normal HDL cholesterol level
  • Higher than normal blood pressure
  • Higher than normal fasting blood sugar

Regardless of whether a person is taking medication to control abnormal blood fat levels, blood pressure, or blood sugar these factors remain associated with syndrome X even if treatment with medication is successful.

Insulin resistance may occur without syndrome X being present, but the diagnosis of syndrome X always includes insulin resistance. Approximately 20-30% of people with Syndrome X will ultimately develop diabetes, though this may not occur until after coronary artery disease has developed.

An elevated waist:hip or umbilical:hip ratio is a reasonably strong predictor of both insulin resistance and cardiovascular disease risk.

For women, obesity increases the risk for a variety of cancers including breast, colon, gallbladder, and uterus. For men, obesity increases the risk for colon and prostate cancers.

An obese person is much more likely to develop osteoarthritis of the knee and hip joints, because the additional strain placed on those joints destroys the cartilage that lines the bones. While genetic, mechanical, and biochemical play a role, obesity is beyond doubt the most prominent factor.

The overload effect on joint cartilage explains the increased risk of osteoarthritis, at least for osteoarthritis of the knee, in overweight and obese people. In addition, dysregulation of lipid homeostasis and the formation of advanced glycation end products (AGEs) contribute to the pathophysiological mechanisms leading to osteoarthritis.

Obesity can lead to snoring and sleep apnoea – when the airways become obstructed during sleep, causing loud snoring in its most benign form to a complete cessation of breathing, cardiac arrhythmias, and low blood oxygen levels at its worst. When a person lies down the fat deposited around the neck and throat may narrow the airway, making it difficult to breathe and get adequate oxygen into the lungs.
Obesity leads to more fat around the neck and throat, increasing a person’s risk for sleep apnoea. Waking up tired and grumpy because sleep has been interrupted can lead to a person eating more to provide more energy, leading to a vicious cycle and a worsening of symptoms.

Obesity hypoventilation syndrome is a condition in which poor breathing leads to lower oxygen and higher carbon dioxide levels in the blood. The condition is thought to result from a lack of brain control over the basic process breathing and excess body fat preventing the chest wall from expanding adequately during inspiration. Most patients also have a form of sleep apnoea and treatment is the same as for sleep apnoea.

For women obesity is associated with ovulation problems, and also infertility in women who ovulate normally. Severely obese women are less likely to fall pregnant. The exact cause remains unknown. The role of obesity in reproduction is complex and researchers are just beginning to understand the causal links. A 2013 study showed that approximately 34% of young women with infertility were obese and 45% of young women with abnormal fertility cycles were obese.

Obesity contributes to anovulation and menstrual irregularities, reduces conception rate and a impairs response to fertility treatments. Also, obesity exposes the mother and baby to increased health problems during and after pregnancy, including gestational diabetes and pre-eclampsia.

The risk of gallbladder disease and gallstones increases with obesity, because people who are overweight or obese have more cholesterol in their bile, which is stored in the gallbladder. As the cholesterol content in bile increased, so does the risk for developing gallstones. The gallbladder becomes inflamed when gallstones irritate the lining and gallstones may obstruct the bile duct, which delivers bile from the gallbladder to the duodenum when a person eats.

Today’s highly image-conscious society encourages people to look physically attractive. Photographic and runway models are very tall and overly thin and young people dream of looking just like them. The reality is that the normal body shape and general eating habits don’t enable that dream, in particular for women.

A person who is overweight or obese gets treated differently and can suffer disadvantages within peer groups, at work, and socially. People without weight problems assume that overweight and obese persons are lazy or lack will power. An obese person is likely to have a lower income and fewer or no romantic relationships.

Disapproval may progress to personal bias, discrimination, and even bullying. School children can be very cruel when it comes to obesity, which means the torment starts at an early age and can impact the normal development of confidence, trust, social skills, and resilience.

Adult health risks associated with overweight and obesity

Body system Health risk
Cardiovascular Cardiac failure Coronary heart disease Hypertension Stroke
Endocrine Type 2 diabetes
Polycystic ovary syndrome
Gastrointestinal Fatty liver disease
Gallbladder and pancreatic disease
Gastro-oesophageal reflux
Bowel, oesophagus, gallbladder and pancreas cancer
Genitourinary Chronic kidney disease
Kidney cancer
Kidney stones
Prostate cancer
Stress incontinence
Sexual dysfunction
Pulmonary Obstructive sleep apnoea
Obesity hyperventilation syndrome
Asthma
Musculoskeletal Osteoarthritis
Spinal disc disease
Lower back pain
Injury and inflammation tendons, fascia, cartilage
Foot pain
Mobility disability
Reproductive health Menstrual disorders
Miscarriage and poor pregnancy outcome
Infertility
Breast, endometrial, and ovarian cancer
Mental health Depression
Overeating disorders
Reduced quality of life
Taken from NH&MRC clinical practice guidelines 2013 Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia
How to maintain a healthy body weight

How to maintain a healthy body weight

Good nutrition and exercise can help a person to lose weight, while increasing muscle mass and strength. Eating an appropriate amount of food within a well-balanced diet and treating any underlying medical problems can enable weight loss.

Maintaining a healthy weight starts with making healthy choices such as:

  • Choosing low-fat, low-calorie foods
  • Eating smaller portions
  • Drinking water instead of soft drink, mild shakes or cappuccinos
  • Getting daily exercise and keeping physically active Portion size

Stay on track when eating out
Eating out and takeaway meals make for an easy alternative to cooking every day, but make sure you watch the size of the meal you order and keep to your usual portion size. Avoid deep-fried sides such as chips or swap chips for a baked potato or salad. When choosing a burger, decline the added bacon, cheese, or egg.

Asian restaurants offer stir-fries and steamed dishes with delicious vegetables. Skip deep-fried entrees such as spring roles, prawn crackers and dim sims. Thai curries often use satay sauce, which contains sugar and peanuts, so avoid these. Both coconut cream and peanuts are high in saturated fat. Choose a stir-fried dish flavoured with basil, lime, chilli, or lemongrass instead. If you decide to have rice, try to limit your intake to half a cup. Remember that half of one cup is one serve of rice.

Italian dining usually starts with shared garlic bread, which tastes great but is drenched in butter, so skip that option. If you choose pizza, avoid thick crusts and high fat toppings such as bacon, salami, or meatballs. Ask for less cheese or light cheese. If you enjoy pasta choose a small serve with a tomato-based sauce rather than cream. Remember that half of one cup is one serve of pasta.

When making rolls or sandwiches use margarine or avocado instead of butter to moisten bread and choose lean meats such as roast chicken, beef, or turkey rather ham, salami, or Devon sausage. Leave out the cheese and mayonnaise and instead add nutritious lettuce, cucumber, and tomato and add roasted capsicum, eggplant or zucchini for flavour.

The importance of regular exercise

The importance of regular exercise

We all know that regular exercise has many benefits, including burning calories for weight loss and building muscle for strength. But did you know that exercise can help elevate mood and improve you sex life?

Keeping off excess body fat may delay or prevent chronic disease such as type 2 diabetes, heart disease, some cancers, and osteoarthritis. The health benefits of regular exercise and physical activity are hard to ignore. Regardless of your age, gender or physical fitness a person who exercises for just 30 minutes five days each week will enjoy better health and quality of life.

Staff at the Mayo Clinic have developed seven good reasons to make time to get moving and keep well.

No. 1: Exercise controls weight

Exercise can help prevent excess weight gain or help maintain weight loss. When you engage in physical activity, you burn calories. The more intense the activity, the more calories you burn. You don’t need to set aside large chunks of time for exercise to reap weight-loss benefits. If you can’t do an actual workout, get more active throughout the day in simple ways — by taking the stairs instead of the elevator or revving up your household chores.

No. 2: Exercise combats health conditions and diseases

Worried about heart disease? Hoping to prevent high blood pressure? No matter what your current weight, being active boosts high-density lipoprotein (HDL) or ‘good’ cholesterol and decreases unhealthy triglycerides. This one-two punch keeps your blood flowing smoothly, which decreases your risk of cardiovascular diseases. In fact, regular physical activity can help you prevent or manage a wide range of health problems and concerns, including stroke, metabolic syndrome, type 2 diabetes, depression, certain types of cancer, arthritis and falls.

No. 3: Exercise improves mood
Need an emotional lift? Or need to blow off some steam after a stressful day? A workout at the gym or a brisk 30-minute walk can help. Physical activity stimulates various brain chemicals that may leave you feeling happier and more relaxed. You may also feel better about your appearance and yourself when you exercise regularly, which can boost your confidence and improve your self-esteem.

No. 4: Exercise boosts energy

Winded by grocery shopping or household chores? Regular physical activity can improve your muscle strength and boost your endurance. Exercise and physical activity deliver oxygen and nutrients to your tissues and help your cardiovascular system work more efficiently. And when your heart and lungs work more efficiently, you have more energy to go about your daily chores.

No. 5: Exercise promotes better sleep

Struggling to fall asleep? Or to stay asleep? Regular physical activity can help you fall asleep faster and deepen your sleep. Just don’t exercise too close to bedtime, or you may be too energized to fall asleep.

No. 6: Exercise puts the spark back into your sex life

Do you feel too tired or too out of shape to enjoy physical intimacy? Regular physical activity can leave you feeling energized and looking better, which may have a positive effect on your sex life. But there’s more to it than that. Regular physical activity can lead to enhanced arousal for women. And men who exercise regularly are less likely to have problems with erectile dysfunction than are men who don’t exercise.

No. 7: Exercise can be fun

Exercise and physical activity can be a fun way to spend some time. It gives you a chance to unwind, enjoy the outdoors or simply engage in activities that make you happy. Physical activity can also help you connect with family or friends in a fun social setting. So, take a dance class, hit the hiking trails or join a soccer team. Find a physical activity you enjoy, and just do it. If you get bored, try something new.
Based on content from the Mayo Clinic website

The link between obesity and type 2 diabetes

The link between obesity and type 2 diabetes

Food choices influence metabolic control, through complex interactions between food components, gastrointestinal neuropeptides, and the gastroenteric neuronal complex. This interaction modulates carbohydrate and lipid metabolism, thus enabling genetic mutations or variations to manifest when an ‘incorrect’ diet is consumed.

Research suggests that diets high in refined carbohydrate foods, with a high GI, and saturated fats enhances gastrointestinal mucosal transport of glucose and pancreatic insulin secretion, which in turn increases the deposition of abdominal fat around the waistline and elevates insulin production.

More than 900,000 Australians suffer from type 2 diabetes, which affects 85-90% of all people with diabetes. Untreated diabetes means chronic high blood sugar levels and damage to blood vessels, nerves, and body organs. Even a mildly raised glucose level that does not cause any symptoms can have damaging effects in the long-term.

A person with diabetes is five times more likely to develop cardiovascular disease or have a stroke. Diabetes may lead to peripheral nerve damage and peripheral vascular disease, which in severe cases can lead to limb amputation. Diabetes may also lead to visual disturbance, chronic renal disease, sexual dysfunction, and miscarriage and stillbirth.

Type 2 diabetes, a largely preventable condition, results from both environmental (obesity and physical inactivity) and inherited factors.
Diabetes has a strong familial risk, but that risk is greatly increased when a person makes poor lifestyle and diet choices that lead to excess weight in the form of fat around the abdomen, excess food and alcohol intake, and inadequate physical activity.

Carrying excess body fat, in particular around the waist, goes hand-in-hand with developing type 2 diabetes, when the body is unable to control blood sugar levels. Diabetes results either because of inadequate insulin production by the pancreas or the body’s inability to utilise insulin – called insulin resistance. Approximately 90% of people with type 2 diabetes are overweight or obese.

Non-genetic, environmental factors apparently contribute 60-70% towards type 2 diabetes, with the two most important factors being dietary macro¬nutrient intake and physical exercise level. Excess consumption of total energy (relative to daily and physical exercise), saturated fats and refined or high GI carbohydrates, with insufficient intake of dietary fibre and unsaturated fats, has been reported to enhance the development of obesity, insulin resistance, and type 2 diabetes.

The good news is that swapping old habits with healthy food choices and increasing physical activity can prevent or delay the onset of type 2 diabetes. Keeping you weight and BMI within the ideal range for your height (BMI < 30) and reducing your waist measurement to under 94cm for men and under 80cm for women will greatly reduce your risk of diabetes.

Regular physical exercise improves peripheral glucose utilisation and raises basal metabolic rate, which stave off insulin resistance. Increasing activity levels and working toward small amounts of weight loss if you are overweight will reduce your likelihood for developing diabetes. Keeping your weight within a healthy range is the best thing you can do to prevent the development of diabetes.

Aboriginal and Torres Strait Islander Australians have the fourth highest rate of type 2 diabetes in the world and are 1.9 times as likely as non-indigenous Australians to become obese.

Adult Australians who report heart, stroke, and vascular diseases were much more likely to be classified as overweight or obese than those without heart stroke and vascular disease (65% compared with 51%).
Health disorders in children, such as type 2 diabetes, high blood pressure, asthma, hypertension, and sleep apnoea can be directly attributed to childhood obesity.

Cardiovascular disease, diabetes, and chronic kidney disease account for approximately 25% of the disease burden in Australia, and just 75% of all deaths. These three diseases often occur together and share risk factors, such as physical inactivity, overweight and obesity and high blood pressure.

Things to remember

  • Type 2 diabetes is strongly associated with being overweight and physically inactive
  • Type 2 diabetes may be prevented, but it cannot be cured
  • Lifelong management should include regular exercise, healthy eating, weight reduction and, where appropriate, use of prescribed medications.
Simple steps for losing weight and regaining health

Simple steps for losing weight and regaining health

Even if your weight is within the normal range, doctors recommend you follow healthy eating and physical activity habits to help prevent weight gain as you age.

Adopt these simple steps and avoid known traps, in order to shed those extra kilos. Identify problem foods in your food and drink intake. Refined sugar, saturated fat, and high GI carbohydrates are often the culprits when it comes to gaining weight, or an inability to lose weight.

Some experts believe the hidden sugar in our diets is causing the obesity epidemic. We enjoy an instant boost of energy and good feeling from sugar. Many parents reward their children with sugar treats and from an early age we are led to believe these treats bring comfort.

Celebrations around birthdays, weddings, Christmas, and Easter are all laden with sweetened foods – cake, chocolate, biscuits, and lollies. While we might be justified in blaming our parents for our ‘sweet tooth’, we can’t blame them if we continue these poor food choices as adults, and pass the habits on to our own children.

Sugar is a carbohydrate found naturally in many foods – from lactose in cows’ milk to fructose in fruit. We need sugar for a ready energy supply to maintain essential bodily functions and to fuel brain function.

Did you know that the fructose in some fruit has deliberately been increased as new varieties are bred to satisfy our desire for greater sweetness? When shopping for apples, choose red delicious and granny smith over pink lady, fuji, and jazz varieties.

Many of the processed foods we eat contain added sugar that boosts calorie content but provides no added nutrition. A build up of by-products from excess sugar can affect our health, in particular our immunity, leaving us susceptible to cold and flu viruses, and bacterial infections.

Eating too much sugar elevates a person’s blood sugar levels and stimulates insulin production. The short-lived sugar ‘high’ plummets to lowered blood glucose level, leaving us tired, and irritable and craving more sugar. Eating sugar-rich foods can start a vicious cycle that packs on extra kilograms and increases a person’s likelihood of chronic disease.

A healthy eating plan means eating plenty of fresh fruits and vegetables, whole grains, and fat-free or low-fat dairy products, includes lean meats, poultry, fish, beans, eggs, and nuts, and is low in saturated fats, trans fat, cholesterol, salt, and added sugar.

Limiting portion size means reducing the size of the meal at mealtimes – breakfast, lunch, and dinner. Avoid snacking, instead eat one apple or similar serve of raw fruit at morning and afternoon tea breaks and don’t eat anything during the four hours before bedtime.

Working long hours, looking after the family, or not getting enough refreshing sleep can make a person feel very tired. If the person who provides meals for the household is too tired to shop and cook healthy meals then the entire family will suffer.

Online shopping is a great way to avoid impulse buys of carbohydrate and fat-laden processed foods at the supermarket. Avoid visiting the supermarket on the way home from work, when you’re more likely to choose convenient options that aren’t usually the healthiest. Why not ‘Google’ something healthy to cook before leaving work and instead stop at the fruit and vegetable shop for fresh ingredients, instead of the supermarket?

Encourage children and teenagers to contribute to healthy cooking, in order to share the workload and empower them with useful skills. When children are exposed to healthy food choices at an early age they benefit from a lifetime of enjoying nutritious food.

We don’t always eat simply to satisfy our hunger. During stressful times or when we are unhappy, we turn to food to appease our emotions, and the additional sugar can make us feel much better. However, emotional eating is a major cause of obesity and a vicious cycle may develop because being overweight can cause frustration and depression. Don’t let emotional eating take over your life.

Are you an emotional eater?

  • Do you eat more when you’re feeling stressed?
  • Do you eat when you’re not hungry or when you’re full?
  • Do you eat to feel better (to calm and soothe yourself when you’re sad, mad, bored, anxious, etc.)?
  • Do you reward yourself with food?
  • Do you regularly eat until you’ve stuffed yourself?
  • Does food make you feel safe? Do you feel like food is a friend?
  • Do you feel powerless or out of control around food?

Taken directly from Helpguide.org – Understanding emotional eating

Get moving and boost the calories that you burn each week.

    • Attack the stairs instead of the escalators or elevators. Live in a high-rise? Get off three flights before your floor and walk up the stairs.
    • Break up a long workday with a walk around the parking lot at lunchtime or jog up a few flights of stairs, or power walk through your work place
    • For one week, park your car in the first space you come to in the car park and walk the rest – at work, the supermarket, and school pickup
    • Do crunches, planks, or dynamic stretching while watching evening TV
    • Record an exercise show and follow along in your living room for 15 minutes in the evening
    • Assemble your staff for a walking meeting
    • Meet a friend for a walk at the park instead of at a coffee shop or for a movie
    • Buy a pedometer and try to walk more each successive day for seven days
    • Pace the sidelines at your child’s soccer or softball game; leave the foldout chair at home.

Taken from Runners World – Boost Your Burn

Obesity means having too much body fat, while being overweight, which means weighing too much, usually because of too much body fat.

Clinical classification of insulin resistance

Clinical classification of insulin resistance

Obesity-driven insulin resistance is a major risk factor for type 2 diabetes and cardiovascular disease. Research during the past decade has found that in obese patients a large number of endocrine, inflammatory, neural, and cell-intrinsic pathways are dysregulated.

Although one of these factors may play a dominant role, these factors are interdependent, which underlies the pathophysiology of insulin resistance. Further research will enable a better understanding of these body systems and holds the key to effective prevention and treatment of insulin resistance and type 2 diabetes.

Category 1 – mild or early insulin resistance
A person with category 1 insulin resistance will usually demonstrate changes in weight and body composition and the blood glucose and insulin levels are generally in the high-normal range or only slightly elevated. Blood lipids are usually within the normal range, but the HDL cholesterol may be in the low end of the range, and there is no major evidence of oxidative stress.

Category 2 – overt, mild insulin resistance
A person with category 2 insulin resistance will demonstrate overt though mild insulin resistance, with frankly abnormal insulin and glucose levels and significant changes in blood lipid levels – usually elevated triglycerides and lowered HDL cholesterol. Borderline hypertension may also be present.

Category 3 – syndrome X
A person with category 3 insulin resistance will demonstrate syndrome X indicators, such as hypertension, excess weight, and abnormally elevated insulin, glucose, and blood triglyceride levels. Evidence of oxidative stress may also be present.

High risk indicators of insulin resistance

High risk indicators of insulin resistance

Many clinical features exist that indicate an individual has a high risk of developing insulin resistance or has impaired insulin sensitivity. These features are easily defined from the history, physical examination, and routine laboratory tests. Any combination of these indicators should alert the practitioner to insulin resistance and warrant formal investigation.

The clinical features suggestive of insulin resistance:
1. Increased body-fat weight

  • Overweight (BMI > 25) and obesity (BMI > 30)
  • Body fat percentage above 15% in males and 25% in females
  • Increased fats stores despite exercise and/or restricted energy diet

2. Body shape and central fat deposition (pot-belly)

  • Apple shape or endomorphic (cow-pony) body-shape
  • Waist:hip ratio >0.9 in males and >0.8 in females and/or
  • Waist measurement of > 94 cm for men and > 80cm for women

3. Dietary imbalance

  • High intake of saturated fats and refined carbohydrates foods
  • Low intake of fibre and omega-3-fatty acids
  • Symptoms of reactive hypoglycaemia – sleepy after meals, shakiness before meals or when hungry, addiction to carbohydrate-rich foods, insomnia relieved by midnight snacks, frequent mood swings, severe irritation or aggression

4. Lifestyle and genetic indicators

  • Family history of Type II diabetes, cardiovascular disease and hypertension
  • Indigenous ethnicity – Australian aboriginal, Pacific Islander, Asian Indian, Pima Indian (Mexican), Canadian Indian (Oji-Cree), Southern Italian, Sardinian and Finnish
  • Low exercise level, particularly with sedentary employment
  • Cigarette smoking
  • Excess alcohol consumption – average intake in excess of two standard drink a day

5. Clinical and laboratory features indicative of Syndrome X

    • Elevated blood pressure

vRecurrent intestinal or vaginal candidiasis

  • Excessive mood swings or cognitive decline
  • Unexplained decline in energy levels and vitality
  • Polycystic ovary syndrome symptoms – acne, weight gain and trouble losing weight, extra hair on face and body, thinning head hair, irregular periods, fertility problems, depression
  • Diabetes symptoms – excessive thirst and appetite, increased urination, unusual weight loss or gain, fatigue, nausea, blurred vision, yeast infections, dry mouth, slow-healing sores
  • Elevated fasting triglyceride level – > 2.5mmol/L
  • Fasting blood glucose level > 5.5 mmol/L
  • Elevated serum uric acid > 0.42 mmol/L
  • Reduced HDL level < 0.9mmol/L

 

Relationship between obesity, insulin resistance, and type 2 diabetes

Relationship between obesity, insulin resistance, and type 2 diabetes

Insulin resistance is present when the effect or action of insulin is reduced, caused by impaired activation of the downstream enzyme pathways (post receptor defect) or, less commonly, inefficient insulin binding to cellular insulin receptors.

Normally, insulin binding to the cell receptor stimulates phosphorylation of tyrosine residues within the cytoplasm of the cell, leading to phosphorylation of the insulin receptor substrates (IRS-1 and IRS-2), thereby enhancing glucose-transporter activity and potentiating glucose metabolic pathways.

Contemporary studies show that IRS activation may be impaired 10-15 years before the development of diabetes and this impairment appears to result from a combination of factors, such as genetic predis¬position, excessive carbohydrate and saturated fat intake and reduced physical exercise.
Excess production of tumour necrosis factor (TNF-α), platelet activating factor (PAF) and free radicals has also been reported to reduce IRS activity, as have chromium and vanadium insufficiency. Also, both insulin receptor binding and IRS activity appear to be modulated by cell membrane fluidity and integrity, which are of course dependent on essential fatty acid balance and antioxidant status.

According to Kelley, “insulin resistance is present in the majority of patients with impaired glucose tolerance and all non-insulin-dependent diabetes mellitus and in approximately 25% of non-obese individuals with normal glucose tolerance”.

Altered production or activity of the satiety-induced peptide leptin may be also contribute to obesity and insulin resistance, leading to development of type 2 diabetes, as an elevated leptin level reportedly antagonises insulin signalling by interfering with insulin-induced tyrosine phosphorylation of IRS-1.

Leptin is encoded by the recently identified obese gene and is an adipocyte hormone that usually regulates appetite and energy expenditure. Leptin is hypothesised to be a messenger molecule that identifies body fat level and acts to conserve energy during times of starvation and prevent obesity in times of food excess.

In humans, leptin activity strongly correlates with body fat percentage, BMI and basal serum insulin concentrations. However, in obese persons, research shows that leptin secretion and blood leptin levels are increased and do not feedback as they should to satisfy hunger. Thus, in obesity, there appears to be resistance to the actions of both leptin and insulin.
Obesity is substantially associated with the development of insulin resistance, but recent studies query whether or not it is the prime causal factor, reporting that many people with low or normal BMI also exhibit insulin resistance or impaired insulin sensitivity.

It now appears that slim or normal weight people also accumulate excessive intra-abdominal fat depots, albeit to a lesser extent than over-weight persons, and this central fat accumulation is associated with the development of insulin resistance. It is generally thought that obesity, secondary to dietary energy and fat consumption in excess of physical exercise requirements, is a major cause of insulin resistance. However, recent work suggests that central fat deposition may be an effect of reduced insulin sensitivity rather than a cause.

Studies have reported that insulin therapy in young patients with type I diabetes results in intra-abdominal fat accumulation and a progressive reduction of insulin sensitivity, whilst other studies report that high carbohydrate intake, particularly of high GI foods, increases serum insulin and triglyceride levels, suggesting reduced insulin sensitivity.
Hence, Kahn and Prigeon report: “variations in insulin sensitivity are responsible for modulating β-cell function. Thus subjects with reduced insulin sensitivity have increased responses to glucose and non-glucose secreta-gogues”.
Thus, contemporary research apparently indicates that dietary nutrient intake, physical exercise, gene-related IRS activity, and β-cell function are all causatively involved in the development of insulin resistance, obesity, and diabetes.

Free Get Healthy Information and Coaching service

Free Get Healthy Information and Coaching service

Each individual is unique and so is his or her ideal weight. Jumping on the scales once a month simply isn’t enough to adequately manage a weight problem. Two methods used to determine a person’s healthy weight range are the body mass index (BMI) and waist circumference measurement. Combine your weight, BMI, and waist circumference to determine whether you fall within the ideal size and weight range.

The Queensland Government provides a free Get Healthy Information and Coaching Service that includes a confidential telephone-based service to help people make lifestyle changes regarding healthy eating, getting physically active, and achieving and maintaining a healthy weight. The service offers up to 10 free coaching calls with a personal health coach for up to six months, information with practical tips on healthy eating and being physically active, and online tools to help you track your progress.

Also you can asses your health and fitness age online at http://healthier.qld.gov.au

http://www.health.qld.gov.au/healthieryou/gethealthy.asp

Conventional medical treatment for obesity

Conventional medical treatment for obesity
The obesity epidemic continues to affect developed countries. Australia has one of the highest rates of overweight and obesity in the developed world, with more than 20% considered obese. In 2008 Australian healthcare costs reached $58.2 billion and obesity-related illness was the greatest contributing factor. The direct healthcare costs for obesity are though to exceed $8 billion per year.

Obesity has costly medical consequences – for productivity, the community, and the individual. Medication, restricted calorie diets, and surgery may all be considered for a very obese patient, particularly if health complications exist. The mainstay of treatment remains a low fat diet and increased physical activity, including medication for appetite where appropriate.

Many people struggle to lose excess weight. While choosing nutritious food and making time for regular physical activity can help, maintaining weight loss over the long term may require prescription medications.

Hormonal changes, hypothyroidism, hypercortisolaemia, and acromegaly are often blamed for obesity, but in reality they produce relatively minor weight increases.

A woman going through menopause is likely to deposit additional fat in the abdomen. Certain drugs can cause weight gain, such as steroids, some psychotropic and antidepressant drugs, and beta blockers may slow weight loss. Any medical condition that restricts mobility or activity, such as vision problems, musculoskeletal injury, severe arthritis, and depression can lead to weight gain.

To be successful, any treatment for obesity must revise diet, physical activity, cognitions, and behaviour in combination. While doctors continue to advise patients to eat less and exercise more, human frailty is such that less than 10% of people (Mel to check) successfully lose weight this way.

The prescription drugs currently available for the treatment of obesity generally are not ideal, so patients need to be selected carefully. Only those with significant hunger and overeating problems are usually prescribed obesity drugs, which have unpleasant side effects.

The drug orlistat (Xenical) is a pancreatic lipase inhibitor. It blocks the enzyme lipase, preventing approximately one-third of the food eaten from being digested. Without lipase fat cannot be broken down and absorbed, so the calorific content of food is artificially reduced. A person taking Orlistat should take a quality multivitamin because of the consequential reduction in nutrients being absorbed.

Orlistat works best when combined with a low fat diet. Orlistat reduces LDL cholesterol and has beneficial effects on some aspects of the syndrome X, including hypertension, type 2 diabetes, abnormal blood fat levels (low HDL,high LDL, high triglycerides), and waist circumference.

Lorcaserin acts on seratonin receptors in the brain that signal the stomach is full. A person feels fuller sooner and as a consequence eats less.

Phentermine-topiramate (Tompmax) combines phentermine to suppress appetite and topiramate to prevent any headaches caused by phentermine. It appears to have additional health benefits, including improved indicators for blood pressure, sugar levels, lipids, and inflammation.

Other appetite suppressants that curb hunger by affecting chemicals in the brain:

  • phentermine (Adipex-P, Oby-Cap, Suprenza, T-Diet, Zantryl)
  • benzphetamine (Didrex)
  • diethylpropion (Tenuate, Tenuate Dospan)
  • phendimetrazine (Adipost, Bontril, Melfiat)

If after 12 weeks taking weight loss medication a person has not lost 5% of weight, the drug is unlikely to work and should be stopped.

Establishing whether a person is overweight or obese

Establishing whether a person is overweight or obese

In order to establish whether you are overweight or obese, your doctor may review your weight history, weight-loss efforts, exercise habits, eating habits, related medical problems, medications, lifestyle, stress levels, and level of physical activity. Relaying your family’s health history may increase your risk for obesity, or type 2 diabetes.

A general physical examination will include, height and weight measurement, calculation of BMI, waist measurement, blood pressure check, listening to the heart and lungs, and heart rate check to determine whether your weight fits the ideal range for your gender and height. Your doctor may also request diagnostic heart tests, such as an electrocardiogram or echocardiogram.

A blood test will establish blood fat levels (cholesterol) and liver function test, fasting glucose, and thyroid hormone levels will help establish any underlying cause. Your body mass index (BMI) determines your level of obesity, overall risk for developing cardiovascular disease, diabetes, and hypertension, and treatment options.

Measuring your waist circumference provides an indirect measure of the stored abdominal fat, which correlates well with chronic disease risk. A waist circumference of 94cm for men and 80cm for women is an indicator of excess abdominal fat, which can surround the heart and kidneys, and deposit within the liver and pancreas, leading to an increased risk for chronic disease.

Weight loss surgery

Weight loss surgery

Weight loss surgery can benefit a person with extreme obesity who is having difficulty losing weight through diet and exercise or who has serious health problems due to obesity. Weight loss surgery usually limits the amount of food a person can eat. All surgery carries inherent health risks and other options should be fully considered before opting for bariatric surgery.

While many people who undergo weight loss surgery enjoy fast weight loss, often they regain the excess weight later on. However, if a person adheres to the recommended diet and exercise following surgery successful weight loss should continue.

Today procedures for surgical weight loss use non-invasive or laparoscopic surgical techniques – widely regarded as the safest, least invasive method for performing these complex weight-loss surgeries.

Bariatric surgery is gaining popularity because it has proven to be an effective way to treat obstinate obesity. Of the three main bariatric procedures performed, in Australia the LAP-band system in used in 95% of cases. This day-surgery procedure is laproscopic surgery and no major abdominal incision is necessary.

Lap-band treatment or laparoscopic adjustable gastric banding, as the name suggests, involves surgical placement of an adjustable restrictive band around the upper stomach. The band constricts the stomach creating a feeling of fullness, reduces the stomach volume, and limits the amount of food eaten during one meal.

After the procedure a person will feel more satisfied more quickly and the urge to overeat is removed. The stomach and small intestine are not surgically cut or rerouted.

Intragastric balloon treatment is suitable for a person who is not yet morbidly obese and needs to lose 15-25kg to kick-start weight loss. A tube is inserted down the oesophagus and into the stomach and then a balloon is inflated to reduce stomach volume and limit the amount of food eaten during one meal. Following treatment a person will feel fuller sooner, or not feel like eating as much, which provides sustained weight loss.

Gastric bypass involves stapling the stomach to create a small pouch in the upper stomach that is attached directly to the small intestine, in order to bypass the lower stomach. This procedure reduces stomach volume operation but also reduces food absorption and so also intake

Gastric bypass surgery enables dramatic weight loss, which in turn improves and resolves associated chronic diseases, including type 2 diabetes, hypertension, abnormal blood fat levels, sleep apnoea, and gastric reflux. Long-term benefits are dependent upon changes to a healthier lifestyle, choosing nutritious food and implementing regular exercise.

Non-adjustable gastroplasty or vertical sleeve gastrectomy reduces the stomach volume to restrict food intake without decreasing intestinal absorption of nutrients.

Obesity is the excess accumulation of body fat. It can be assessed by the body mass index (BMI) – the weight in kilograms divided by the square of height in metres.

Nutritional medicine treatment of obesity

Australia ranks as one of the heaviest nations in the developed world. The incidence of obesity in Australia has more than doubled during the past 20 years.
Obesity is a complex, chronic, relapsing condition and, along with ageing, is the greatest causal factor to chronic disease burden in Australia. Australia ranks as one of the heaviest nations in the developed world. The incidence of obesity in Australia has more than doubled during the past 20 years.

Today’s fast-paced style of living means that for many the time spent in the kitchen cooking is very much reduced. You can improve the quality of your grocery shopping and the nutritional value of the foods you buy by creating a shopping list and keeping a well-stocked pantry.

If you are committed to losing weight choose low-fat food items, and fill your kitchen cupboards with a supply of low-calorie basics. Resist the temptation to purchase sugar-laden products and avoid anything that has been deep-fried or requires frying in fat. Leave children at home when you go to the supermarket or better still shop online and enjoy home delivery. This will limit impulse purchases and tantrum when you choose not to buy their favourite chocolate ice cream.

Learn to read and understand product labels and compare fat and sugar content, to improve your choices. The lower the fat, sugar, and calorie content per 100g the better. Australian labelling rules require that companies list total calories per serving size so you can compare the total calories in the product you choose with others similar products. Simply choose the one that is lowest in calories.

In order to assess the nutritional status for an individual and customise nutritional treatment, a thorough laboratory investigation is needed and may include one or more of the following.

Three-hour glucose tolerance test (GTT) and serum insulin
Traditionally, this test is performed by measuring glucose and insulin levels in blood samples collected before and for each 30 min period following oral consumption of 75 gm of a pure glucose solution.

A peak glucose level above 10 mmol/L or a rise in insulin greater than eight times the fasting insulin level suggest either impaired glucose tolerance or hyperinsulinaemia, both of which indicate the patient probably has insulin resistance. A blood glucose level above 14 mmol/L is diagnostic of diabetes.

Doctors sometimes measure glucose and insulin measurement both before and 60 min after a high GI meal, to reduce the need for repeat testing. However, a significant percen¬tage of insulin resistant patients may be overlooked, because of meal variability.

Evidence of reactive hypoglycaemia during a three-hour GTT, indicated by an unduly rapid fall in blood glucose greater than 2.0 mmol/L in any 60-minite period suggests that blood glucose control is impaired. This may be due to rapid glucose absorption, increased intestinal permeability, or increased insulin response secondary to gene-related pancreatic beta-cell dysfunction.

The HOMA-R index is used to diagnose insulin resistance. HOMA-R is derived mathematically from the fasting glucose and insulin levels, but there is some doubt about the significance of the level of correlation, with levels approximating low r-values of 0.5 accounting for only 25% of insulin resistance variation.

The HOMA-R formula is: Glucose (mmol/L) x Insulin (mU/L) /22.5 and HOMA-R values greater than 3.0 suggest insulin resistance.

Lipid profile may show elevated fasting triglyceride level (>2.5 mmol/L), decreased HDL-cholesterol (HDL <0.9 mmol/L in males and 1.1 mmol/L in females), and increased ratio between total cholesterol and HDL-cholesterol (ratio >5).

A glycosylated haemoglobin (Hb-A1c) level greater than 5.5% suggests increased protein glycosylation secondary to free radical damage and chronic or recurrent hyperglycaemia. This indicates the need for improved blood glucose control and increased antioxidant intake.

Total antioxidant capacity can detect oxidative stress in many people with chronic disease. A person with insulin resistance and type 2 diabetes will have antioxidant stress caused by impaired GTH status and impaired utilisation of vitamin E. Recent studies suggest that high-dose vitamin E and lipoic acid supplementation may reduce protein glycation and improve peripheral neuropathy.

Hormone analysis frequently reveals reduced steroidal hormone synthesis, both in insulin resistance and type 2 diabetes, due to impaired metabolism and the inhibiting effect of high insulin levels on enzymes involved in steroid synthesis.

Impaired steroid hormone activity generally results in enhanced production of cortisol and reduced synthesis of the anabolic steroids DHEA, androstenedione and testosterone, thereby increasing protein tissue catabolism, and reducing lean-body mass.

Amino acid imbalance is common on amino acid analysis, in particular circulating serine, alanine and threonine, the gluconeogenic amino acids.

Reduce your risk for syndrome X

Reduce your risk for syndrome X

More than half of all Australians have at least one of the metabolic syndrome conditions listed here.

Suggestions for reducing your risk include:

  • Incorporate as many positive lifestyle changes as you can
  • Eat plenty of natural wholegrain foods, vegetables, and fruit
  • Reduce the volume of food you eat and limit foods high in fat and sugar
  • Reduce saturated fats, which are present in meat, full-cream dairy and many processed foods
  • Reduce alcohol intake to no more than two standard drinks per day
  • Increase your physical activity level to at least 30 minutes of exercise five days each week
  • Manage your weight
  • Quit smoking
  • Assess whether medication is making you fat
  • Consult a doctor for a general health check and weight loss advice

A healthy eating plan means eating plenty of fresh fruits and vegetables, whole grains, and fat-free or low-fat dairy products, includes lean meats, poultry, fish, beans, eggs, and nuts, and is low in saturated fats, trans fat, cholesterol, salt, and added sugars.

Limiting portion size means reducing the size of the meal you sit down mealtimes and must include all meals – breakfast, lunch, and dinner. Avoid snacking, instead eat one apple or similar serve of raw fruit at morning and afternoon tea breaks and don’t eat anything during the four hours before bedtime.

Nutrition calculators

Nutrition calculators

The Australian government has developed excellent online tools called nutrition calculators that enable you to calculate your daily food energy requirements – the amount of energy a person needs to get from the food eaten measured in kilojoules. And recommends your average number of serves per day, from the five food groups. You can use this for your own needs or to assess the requirements for an elderly person or your children.

A person’s daily energy need is based on the energy needed for basal metabolic processes plus daily physical activities. Eat the recommended amounts from the five food groups and you’ll enjoy the nutrients essential for health and wellbeing, while reducing your risk of chronic diseases.

You can also calculate your daily nutrient requirements – the food components essential for maintaining optimal health through growth and repair as we age. Carbohydrates, water, fat, protein, fibre, vitamins, and minerals are the nutrients we get from food. You can answer some simple questions about gender and age and the program calculates your daily nutrient requirement, across the range.

Dieticians recommend we eat a balanced diet from five food groups – vegetables and legumes, fruit, cereals, non-dairy sources of protein, and dairy products. The online tool recommends the average number of serves a person should eat from each of the food groups, and takes into account additional served depending on age and activity levels.
Glossary

Advanced glycation end products (AGEs) – also known as glycotoxins created through reaction between reducing sugars and free amino groups of proteins, lipids, or nucleic acids
Anovulation – lack of release of female egg from the ovary
Atherosclerosis – arterial fatty plaque disease
Body mass index (BMI) – a number calculated from a person’s weight and height that indicates overweight or obesity
Carbohydrate – the main food nutrient and source of energy fuel from the food we eat
Cholesterol – fat-like substance found in all human cells that travels trough the blood stream as lipoproteins
Coronary artery disease – athersclerosis of the coronary arteries that supply blood to heart muscles
Dysregulation – abnormal regulation
Dysthemia – chronic type of depression
Gastrectomy – surgical removal of the stomach or part of the stomach
Gastro-oesophageal reflux
Gastroplasty – surgical operation to reduce stomach volume
Gestational diabetes – type 2 diabetes during pregnancy; usually resolves after delivery, but predisposes a woman to developing type 2 diabetes later in life
High-density lipoprotein (HDL) – ‘good’ form of cholesterol in the blood stream. Transports cholesterol from other parts of the body to the liver for elimination.
HOMA-R index – used to qualify insulin resistance and beta-cell function (release of insulin)
Hyperinsulinaemia – too much insulin released by the pancreas
Hypertension – high blood pressure
Hypercortisolaemia – high levels of cortisol, a hormone released by the adrenal glands
Hypothyroidism – low thyroid hormone levels
Insulin resistance – cells fail to respond to the normal actions of insulin
Intragastric – within the stomach
Laproscopy – surgical procedure that uses a thin, lighted tube called a laparoscope inserted through an incision in the abdominal wall
Leptin – hormone made by fat tissue that regulates energy intake and expenditure through appetite, hunger, metabolism
Low density lipoprotein – ‘bad’ form of cholesterol in the blood stream. The higher the LDL level the higher the chance of coronary artery disease.
Neuropeptides – small protein-like molecules called peptides used by brain neurons to communicate
Obesity hypoventilation syndrome – inadequate respiration caused by poor brain signalling to breathe and inability of chest muscles to function due to obesity
Osteoarthritis – aging of the joints due to repetitive strain resulting in wearing down of joint cartilage
Pathophysiology – physiological cause of pathology
Polycystic ovary syndrome – hormonal disease in women characterised by multiple ovarian cysts and increased ovarian volume
Pre-eclampsia – high blood pressure during pregnancy
Seratonin – monoamine neurotransmitter found in intestine and central nervous system, including the brain. Seratonin uptake inhibitors are used to treat depression.
Sleep apnoea – when the walls of the throat come together or collapse during sleep, blocking off the upper part of the airway.
Stress incontinence – lack of bladder control under physical stress
Syndrome X or metabolic syndrome – group of risk factors that increase risk of coronary artery disease, stroke, and type 2 diabetes
Type 2 diabetes – largely preventable chronic disease characterised high blood glucose levels and associated with overweight and obesity, when the body fails to use insulin properly