Obesity

Fat. Overweight. Obese. If you dust off your biology and chemistry books, you will see that the term “fat” (in this case human fat) is actually adipose tissue (loose connective tissue) comprised of mainly adipose “fat” cells that store energy, as well as some blood vessels, macrophages, etc. To save time, let’s just say it is a group of carbon, oxygen, and hydrogen atoms in various permutations. Overweight is defined as an excess amount of total body weight that includes all tissues including fat, bone, and muscle and also includes water. Obesity is referred to as significant excess of body fat that does not include other tissues.

Now that we have clarified these points, let’s focus on obesity. How is obesity measured? The most common way obesity is measured is by determining BMI (Body Mass Index). A person’s BMI is a mathematical formula that divides their weight by the square of their height.  BMI = weight (kg) / height (meters) squared.  For us non-metric Americans, it is calculated as BMI = 703 multiplied by weight (pounds) divided by height (inches) squared.  According to the National Institutes of Health, the following ranges are used to determine one’s weight category:

In case you were wondering, the answer is yes, the United States made the top twenty list for most obese countries in the world. Here are some statistics on obesity that are listed on the website of the Centers for Disease Control (CDC) regarding obesity in the United States:

• Approximately 1 in 4 people are obese
• More females are obese than males
• Hispanic American and African American communities show the most prevalence for obesity whereas Asian Americans show the least
• Middle aged adults show more prevalence for obesity than younger adults, however, the gap is narrowing
• Children and teens show more prevalence for obesity than toddlers
• College educated adults are less obese than non-college educated adults
• Higher income brackets showed less obesity than lower income brackets

Let’s take a closer look at some of these statistics.  Age plays a role in obesity because as we age, our metabolism slows down. It takes being more “active” activity to maintain or lose weight. With the advent of technology and a more “desk-centric” lifestyle, adults need to be more conscious of consuming less and moving more. Obesity is making its way into younger children. We can thank a more sedentary, technologically advanced lifestyle for this trend as well. Socioeconomic backgrounds make a difference in obesity levels. College educated adults tend to have more information on health as well as a propensity to earn higher incomes. Higher income levels have the luxury of spending more on healthier foods and exercise. We can tie this in with the fact that a higher percentage of people in the Hispanic and African American communities have less educational opportunities and resources, therefore impacting their health.

There are many causes for obesity.  Dr. EhteshamJ. Ghani, a bariatric physician and founder of ThinFastMD, explains that there are five major categories that affect weight gain. These categories are genetics, physiological disorders, medications, environment, and psychological factors. Each of these categories can be broken down further to showcase all the known factors of obesity.

Heredity and genetics affect obesity. Families can inherit obesity. This can be through genetic material as well as the fact that eating habits and lifestyle usually are learned from a very young age.

There are many physiological factors that increase the risk of obesity. Neurological damage, especially in the hypothalamus which regulates appetite, can cause weight gain. Hypothyroidism, which is common amongst individuals from south Asia, slows down metabolism. Hormonal imbalance affects weight. The hormones leptin and ghrelin affect appetite. Leptin curbs the appetite whereas ghrelin stimulates it.  Of course we have that wonderful physiological aspect of aging as well which is a major factor of our metabolic rates slowing down.

Medications are used for healing illnesses; however some may have negative side effects when it comes to weight. “Steroid medications are common culprits for increasing the fluid amount and deposition of fat in our bodies while antidepressants and other mood altering medications can increase sluggishness and appetite” says Dr. Ghani.

Environmental factors can range from what we experience to what we feel to where we live and so on. Some of these factors are the ease and accessibility of unhealthy foods. Drive thru eating is becoming more and more prevalent. We can get everything from a grande mocha latte with extra whipped cream, a burger with everything under the sun on it, and a chocolate sundae, all without leaving our cars. But wait….now we don’t have to leave our home recliner either, thanks to the food delivery apps. Those are some of the environmental factors we can easily control. However, factors such as air quality, radiation, and pesticides may be a bit more challenging, (but not impossible) to control.  Geography can affect eating habits. Some cities are more health conscious than others because of culture, weather, or overall lifestyle.

Psychological factors can affect your risk for obesity. Stress, depression, anger, boredom, happiness, etc. can cause people to eat more, especially high caloric, sugar laden foods. We spoke about hormones earlier, but hormones can be affected by stress. Chronic stress can elevate the cortisol hormone levels in the body. This can lead to an increase in weight, especially in the middle region. High cortisol levels also weaken muscles, which in turn can make you lethargic and less active.

Some Symptoms of Obesity:

• Cardiovascular disease (hypertension, cardiac arrests, congestive heart failure, stroke, etc.)
• Type 2 diabetes
• Sleep apnea
• Abnormal skin conditions
• Asthma
• Pulmonary dysfunction
• Gallstones
• Cancer
• Gynecological disorders
• Male hormonal dysfunction
• Urinary stress incontinence
• Hyperuricemia (gout)
• Osteoarthritis
• Psychological disorders (anorexia, bulimia, depression, low self-esteem, drug use, etc.)

Let’s take a look at a few of the non-obvious symptoms. Sleep apnea is the interruption of normal breathing cycles and can be potentially life threatening with severe obesity. Obesity can cause abnormal skin conditions such as acanthosis nigricans which is darkened, thickened skin in folds and especially on elbows and the back of the neck. An increased risk of developing asthma can occur with a higher BMI. Other respiratory dysfunctions can occur as well, including dyspnea (shortness of breath), decreased oxygen concentrations in arterial blood, and a decrease in tidal volume (inability to take deep, long breaths). There is a higher risk of gallstone formation because of the cholesterol levels in bile. This risk also increases when people gain and lose weight repeatedly (“yo-yo dieting”). Women need to be mindful of certain gynecological conditions such as polycystic ovarian syndrome, endometrial cancer, infertility, elevated androgens (such as testosterone), and hair loss. Men need to be careful of conditions that affect hormone levels, shifts in testosterone, and an increased risk of colon cancer (along with other cancers). Obesity adds extra pressure on the kidneys, which can increase the risk of hyperuricemia (gout) in which uric acid is not adequately removed from the body. Of course we can diagnose that obesity can cause musculo-skeletal conditions such as hernias, plantar fasciitis in the feet, and overall pressure on the muscles and bones, which can cause pain and damage.

Ok, great. Reading all this has stressed us out! Now what do we do? Well, first we relax (remember…cortisol). Then we make a conscious decision and pact with ourselves to change our behavior and attitude regarding weight loss. Nutrition is key. We need to make healthy changes. To avoid the clutter of all the trendy diets, talk to your physician, get a complete physical and blood work screening to make sure there are no underlying conditions, and then devise a program that works for you. Diets are not “one size fits all”. Learn how to correctly read food labels and the breakdown of nutrients. Understand the difference between carbohydrates, proteins, and fats and know the perils of excess sugar. Remember that nutrition is primary and exercise is secondary. Also, stop streaming TV shows, stop watching video forwards from friends and family of animals juggling, and get moving. We need to live life outside of screens.

What if there is a medical emergency for a more immediate and intensive solution? There are many risks and side effects involved in these treatments. Here are some options that need to be discussed and monitored by your doctor and medical professionals:

Intermittent fasting is the latest trend in weight loss. It requires a person to “fast” (you may have water at times) between 10-16 hours. Why not make the intention and really fast to gain rewards in health and spirituality?  Our Prophet, Peace Be Upon Him, used to fast outside of the month of Ramadan as well. If we follow the Sunnah, we have opportunities to fast several days during the year, including on Mondays and Thursdays and on the 13^th, 14^th, and 15^th day of each lunar month.

Islam has given us the tools to live a mindful, “middle path” life for all aspects of our well-being. We should refer to the Quran and Sunnah on living our healthiest life of moderation, including it is incorporating prophetic foods, eating in moderation, and not being idle. As stated in the Quran, “O children of Adam, take your adornment at every masjid, and eat and drink, but be not excessive. Indeed, He likes not those who commit excess.” (Quran 7:31) The main goal is to make concrete healthy changes that last a lifetime!

Husna T. Ghani has an MSEd and an MBA. She has taught health and science for years. When she’s not working, she reads, writes, sketches, and tries to save the world (or something like that).