Last week’s news mentioned that overweight / obesity is not an affliction confined to people in North America and Europe. It is a problem for Asian and Middle Eastern people too. So how bad is the problem? A recent research paper (Obes Rev 2006; 7: 139 – 145) on the prevalence of overweight, obesity and psychological problems in Qatari’s female population found that among 14 – 19 year-old adolescent females, the prevalence of overweight and obesity was 14.3% and 1.8% respectively. In the adult Qatari population, overweight and obesity for males were 34.4% vs. 34.6% and for females were 33.0% vs. 45.3%. Another recent study (Eur J Paediatr 2006; May 5 epub) on Iranian adolescent school children aged 11 -17 years involved 1200 males and 1700 females. In this population, the prevalence of overweight and obesity was 17.9% and 7.1% respectively. In fact it is a problem for the South American population too. A Brazilian study (Diabetes Res Clin Pract 2006; April 16 epub) on 12 – 19 year-old public school girls found the prevalence of overweight and obesity was 14.2% and 2.9% respectively. The prevalence of metabolic syndrome in those who were overweight / obese (21.4%) was 200 times more than those non-overweight female students (0.1%).

How big is the problem in the US population? A recent publication (JAMA 2006; 295: 1549 – 1555) from the National Center for Health Statistics studied 3958 children and adolescents aged 2 – 19 years and 4431 adults aged 20 years or older. In 2003-2004, 18.2% of male and 16% of female children and adolescents were overweight. When compared to 1999 – 2000, the prevalence has increased (14% for male and 13.8% for female). The prevalence of obesity in men increased significantly from 27.5% in 1999-2000 to 31.1% in 2003-2004. However, the prevalence in women showed no significant increase in the two periods, 33.4% (1999/2000) vs 33.2% (2003/4). When the body mass index of an individual is ≥ 40 kg / m2, he or she has extreme obesity. In 2003-2004, the prevalence of extreme obesity was 2.8% in men and 6.9% in women. Like most things, the prevalence of obesity is influenced by ethnicity. Non-Hispanic black adults had the highest prevalence of obesity (45%) followed by Mexican Americans (36.8%) and non-Hispanic white (30%). The prevalence of obesity was found to be higher for those aged 40 and above - 28.5% for those aged 20-39 years and 36.8% for those aged 40-59 years.

Obesity is truly a global health problem. It does not differentiate between sexes, age or ethnic background. It can become a problem for anyone. Hang on, what health problem? Indeed, what health problem. The metabolic syndrome is a starter and more about that next week.

Obesity is an increasing health problem in developed countries in the world. The idea that obesity is a problem afflicting only the Western population is not correct. With increasing affluence, obesity is increasingly affecting individuals of Asian and Middle Eastern origin. Obese individuals are at an increased risk of developing orthopaedic problems, such as chronic low back pain and increased incidence of arthritis in the hips and knees due to the excess weight which the joints and back have to carry. They are also predisposed to increased risk of cardiovascular problems such as high blood pressure and heart problems, development of diabetes mellitus, raised levels of triglycerides and cholesterol in the blood. In addition they are also at risk of developing fatty liver which, if severe, can lead to fibrosis of the liver (hardening of the liver).

A recent study (Annals 2006; 144: 625) looked at the effect of performing an operation on the stomach of obese patients to help them lose weight. (The operation involves placing a band around the stomach using keyhole surgery. This leads to a feeling of early fullness and thus a reduced intake of food.) The operated group of patients is compared to a group of similar patients who were given non-surgical treatment. This non-surgical treatment includes very-low-calorie diets, weight loss drugs, and behavioral change to improve diet and exercise habits. In addition to monitoring weight loss over time, these researchers also looked for the presence of the metabolic syndrome. The metabolic syndrome is a condition in which 3 of the following abnormalities are present in an obese individual: overweight, high blood pressure, high triglyceride level (‘bad’ fat in the blood), low level of high-density lipoprotein cholesterol ("good" cholesterol) and high blood sugar level. At the end of the two years, the researchers found that the operated patients lost an average of 21.6% of their initial body weight compared with 5.5% in the non-surgical group. Prior to any treatment, 15 patients in each group had the metabolic syndrome. After 24 months, 1 patient in the operated group and 8 patients in the non-surgical group had the metabolic syndrome. The operated group of patients reported better quality of life at 24 months.

This seems good news for obese individuals but is operation always better? It is important to bear in mind that maintaining the initial weight loss achieved at the beginning of a non-surgical programme is the most difficult task. Constant and frequent positive reinforcement and encouragement will help these patients maintain the weight loss they have achieved. Once the frequency of positive reinforcement is reduced, some patients are likely to lapse into their previous habits, thus leading to weight gain. The above study showed this is what happened to those treated by a non-surgical approach. However, despite the reduction in the frequency of visits for positive reinforcement, the number of patients in the non-surgical group with metabolic syndrome was halved. This was in spite of achieving a loss of only 5.5% of the initial weight, far less than the 21.6% achieved in the surgical group.

Any weight loss in obese or grossly obese patients is likely to be beneficial to their general health and well being. While it would be ideal to achieve the prescribed body mass index of between 18.5 and 25 kg / m2, it may not be easily attained in those who are obese or morbidly obese. However, any reduction in weight achieved by these patients should be encouraged and they should be given regular and frequent reinforcement to maintain and possibly improve on the weight loss achieved. Before we can recommend a blanket surgical solution to obesity, bigger and more detailed studies comparing surgery and non-surgical methods of treating obesity should be conducted.