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Obesity is fast becoming one of the developed world's most serious health problems. Being obese can take up to nine years off your life and make you far more susceptible to diabetes, heart disease, stroke and many other conditions.

GP David Haslam, the clinical director of the National Obesity Forum, tells us what he would want to know if he was obese.

What is obesity?

Obesity means your weight has reached a stage where it’s harmful to your health. This doesn't happen when you reach one particular weight or waist circumference, but the risk of illness does increase with every extra pound and added inch. Almost a quarter of the UK population is obese, and another 40% overweight.

Why am I so overweight?

There are many different reasons for being overweight but there are also a lot of myths. In some people there is a genuine genetic element and obesity does run in families, but no one is 'big-boned'. Some people, especially those with diabetes, will find it harder than others to lose weight. Others may be on drugs, or have medical conditions that cause weight gain. 

However, these factors are rare compared with the principal cause, which is eating too much and not getting enough exercise. It’s not easy getting the balance right between energy consumed as food and energy burnt off as exercise, but it's the key to curing obesity.

How can you tell that I’m obese?

Currently, obesity is often measured by a system known as the Body Mass Index (BMI). This is worked out by taking your weight in kilograms and dividing it by your height in metres squared (Kg/m2). A BMI of 25-30 counts as overweight; 30 and above is obese. There is some debate, however, as to whether BMI is the best way to measure obesity.

If you’re trying to lose weight then waist circumference is a far better guide, especially as fat around your middle is the most dangerous sort. Measure your waist with a tape measure, measuring just above the hip bone at the side, while breathing out. A waist measurement of more than 40 inches in men and 35 inches in women constitutes obesity.

What are the risks of being obese?

It’s possible to be obese and otherwise healthy, especially if you live a physically active life. But for many people, obesity is an underlying factor that could lead to heart disease, diabetes, high blood pressure, stroke and many other conditions including liver disease, polycystic ovarian syndrome and even cancer. 

Depression is also linked with obesity. Obese people tend to have high cholesterol, which alongside blood pressure and sometimes smoking, raises the risk even higher. If you have any of these conditions, or a family history of diabetes or heart disease, it’s particularly important to seek medical advice. Losing weight rapidly reduces all these risk factors.

Dieting and exercise don’t work for me. Can I try weight-loss drugs?

Weight-loss drugs have an important role in the management of obesity. Not only do they cause a reduction in weight, but they also reduce the risk of diabetes and lower cholesterol and blood pressure. Ask your doctor, nurse or pharmacist for advice. They can assess whether you fit the criteria for these medications. 

Am I eligible for obesity surgery?

Obesity or bariatric surgery is one of the most cost-effective and clinically productive procedures in any field of medicine. With the appropriate operation, around 99% of diabetes cases are cured and approximately a third of body weight can be lost and maintained. However, bariatric surgery is a life-changing step. Eligibility depends not only on your size, but also on any obesity-related condition that you may have, whether you are fit enough to have the operation, and whether you have been fully assessed by a multi-disciplinary team before being considered for surgery. It is something you should discuss with your doctor. Generally, a person with a BMI of 40 is eligible for bariatric surgery, assuming their doctor agrees, and someone with a BMI over 35 with diabetes or sleep apnoea can also be considered.

What sort of operations are available?

There are two major types of operations:

  • Restrictive: this reduces the size of the stomach to around the size of a golf ball, allowing less food to be eaten before a feeling of fullness occurs;
  • Malabsorptive: this procedure reduces the length of the bowel so less food can be absorbed.

So-called gastric banding procedures are becoming more popular, where an inflatable ring is placed around the top of the stomach to restrict food intake. A gastric bypass operation combines stomach banding with a surgically reduced length of bowel, thereby causing weight loss by two different methods.

How can I prevent my children from becoming obese like me?

Encourage your children to eat healthily and to be physically active. Don't force them to finish off their plateful of food; let hunger be their guide. If you’re about to have children then it’s essential to eat well and be active in pregnancy, as your baby will be better equipped to avoid obesity and overeating if you do. Also, breast feeding appears to protect babies against obesity and will help you return to your best weight quickly. 

view information about Obesity on www.nhs.co.uk »

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