Regional Obesity

Regional obesity: Pear better than Apple!

What is regional obesity?

The traditional definition of obesity includes a measure of height/weight and defined as Body Mass Index (BMI). Now with the advancement of science we are realising regional obesity is much more important for health. Here we measure the girth of waist and hip and express that as ratio called WAIST-HIP RATIO (WHR). For men normal is less than 0.85 and for women it is less than 0.90. What we describe as apple – middle protrusion of the tummy, so called pot-belly. In that sense a shape like a pear would be considered healthy.

What is the relation with general obesity?

In most of the cases it does not go hand in hand. You may have a normal BMI but your WHR may not be. So normal height-weight ratio or maintaining an ideal body weight is not always reassuring.

How does it happen? The fat in the abdomen are resistant to the action of Insulin, more so in comparison to the other part of the body. With an excess of abdominal fat Insulin resistance develops which increases Insulin resistance further and the cycle continues. This Insulin resistance is the main reason of adverse health outcome with regional obesity.

What are the health consequences of regional obesity?

Regional obesity is associated with a cluster of metabolic problems such as Diabetes, high blood pressure, high cholesterol, atherosclerosis which all lead to problems with the heart (heart attack) and brain (stroke). Medically we called this Syndrome X. The other concern is back pain, because of the pot-belly the forward curvature of the lumbar spine increases and is one of the risk of disc propblem and wear and tear leading to the spondylitis.

What is the correlation with the western world?

Obesity is increasing all over the western world and in the cities in India. We do not have much of a population-based study in India, so it is difficult to comment about the Indian scenario. Limited number of studies available to us suggest clearly that in comparison to the west our BMI is less but the WHR is high making us more prone to SYNDROME X.

What is the treatment?

First and most important step is to make us aware that abdominal obesity is bad not only for cosmetic reason but also for health. Change of life style with so-called “modernisation” of our society (less physical work, more and more fast food intake with high fat and refined carbohydrate) has the burden of blame to share. We are using the term “Therapeutic Life Style (TLC)” changing as the most important measure. We need to eat the correct food, which obviously means to avoid high fat and calorie fast food as much as possible. More importantly realising what is healthy eating, like eating plenty of vegetables and optimum fruits on daily basis. We need to undertake some form of physical exercise every day for at least 30-45 min. Also we need to keep an eye on our BMI, WHR, blood pressure, cholesterol, etc on a regular basis.

This article is prepared by Dr A Bhattacharyya
(Arpan@DiabetesEndocrinology.in)