ILL EFFECTS OF OBESITY
The impact of obesity on health are
Physical disability: Since the feet have to carry extra load complications like flat feet, osteoarthritis of knee, hip and lumbar spine are common, Adipose tissues around chest and diaphragm interferes with respiration and predisposes to bronchitis.
There is a close association between obesity, diabetes mellitus and cardiovascular disease (fig. 11b). There is insulin resistance especially in muscle.
Plasma cholesterol level is high and hence obese individuals are more prone to develop gall stones.
Excess cholesterol and triglycerides with low levels of HDL in plasma leads to atherosclerosis
Obese people develop high blood pressure and there is an increased incidence of varicose veins.
Obsterical risk: Obese women when pregnant have greater obsterical risks because of hypertension, diabetes mellitus and post partum infection.
Cancer: Certain cancers (colon, rectum and prostrate in men, uterus, breast and ovary in women) are more prevalent in the obese.
Psychological Disturbances: Obese adolescents have personality characteristics of self blame, withdrawal and feeling of inferiority.
People with BMI less than 18.5 are considered as under weight
Aetiology: Some of the causes of underweight are
Starvation due to famine
Diet inadequate in proteins
Debilitating diseases like tuberculosis, diabetes mellitus
Malabsorption syndrome or cancer
Psychological factors as in anorexia nervosa seen in girls in the age group 15 to 25 years
Pathological conditions such as fevers, gastro-intestinal disturbances where the digestion and absorption capacities are decreased.
A high energy, high protein, high fat diet with liberal vitamin intake is recommended. Before consuming such a diet the first step should be to determine and eliminate the cause for under eating.
Energy: The calorie requirements vary depending upon the activity. An additional 500 kcals per day to the recommended dietary allowances is recommended. The increase should be gradual over one or two weeks to prevent digestive disturbances.
Proteins: Instead of 1g of protein, over 1.2 g per kg body weight is recommended for tissue building. Good quality protein which is completely utilized by the body should be given.
Fats: Easily digestible fats are to be included. Excessive consumption of fried and fatty foods are not recommended as they may cause diarrhoea. Further, fatty foods taken at the beginning of a meal also reduces appetite. High calorie foods such as cream, butter, and oils increase weight and can be included.
Carbohydrates: High carbohydrate sources must form the basis of the diet. Dried fruits, sweets, nuts, jams, desserts, cereal and cereal products, potato chips and non vegetarian foods are a rich source of energy and should be included in the diet. Apart from the three meals, two feeds incorporating soups, juices or sweets in between main meals improve the nutritive value of the diet.
Vitamins and minerals: There is no need for extra vitamin and mineral supplements when the dietary intake is liberal.
Fluids: Fluids should not be taken before or with a meal, but only after a meal so that the food intake is not reduced.
Exercise: Regular outdoor exercise (light/moderate activity) should be performed as it helps to stimulate appetite and thereby increases foodintake.