More than a beer belly

NST: Six per cent of adult Malaysians are obese, with their body mass index (BMI) ofbetween 23 and 27.4.
BMI is a relationship between the weight and the height.
Using the waist circumference is another way of measuring obesity. The size of the waist is related to the amount of fat in the abdomen.
“The waist circumference can be a very sensitive indicator of heart disease. It is the surrogate marker of visceral fat,” says Datuk Dr Khoo Kah Lin, consultant cardiologist and physician at Pantai Medical Centre and Sentosa Hospital.
Visceral fat is different from subcutaneous fat, which is fat under the skin.
“Subcutaneous fat is not dangerous. Visceral fat is,” explains Dr Khoo.
“People with fat around their intestines have a higher risk of developing heart problems and an increase in early mortality.”
It is common knowledge that obesity is the first step to chronic disease.
Obesity, the development of Type 2 diabetes mellitus and vascular risk are inextricably linked.
Dr Khoo, who has co-authored several medical books, says that a waist circumference of over 90 cm for men and over 80 cm for women is not only associated with increased risk of cardiovascular disease but also high blood pressure and Type 2 diabetes mellitus.
Seventy per cent of all case fatalities with Type 2 diabetes mellitus are a net result of cardiovascular complication.
There is ample epidemiological evidence that the majority of cases of type 2 diabetesmellitus are related to obesity, physical inactivity and other lifestyle factors.
The vast majority of new cases over the next 20 years are predicted to emerge in developing countries.
If that is not bad enough, diabetes, which is characterised by insulin resistance and progressive beta cell failure, is also associated with a host of other abnormalities which comprise the metabolic syndrome.
Metabolic syndrome — which is also known as Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome — is a collection of health risks that increases your chance of developing heart diseases, stroke, and diabetes.
In 2003, Malaysia’s metabolic syndrome stands at 18.5 per cent while it is 13.3 per cent in China and 12.4 per cent in India.
Moderate weight loss, in the range of five per cent to 10 per cent of body weight, can help restore your body’s ability to recognise insulin and greatly reduce the chance that the syndrome will evolve into a more serious illness.
Most studies indicate that co-morbidities are improved by a weight loss of fiveto 10 per cent and has proven to be the most important causal measure to prevent Type 2 diabetes.
The Royal College of Physicians in Britain has suggested that a weight loss of five per cent after three months of therapy indicates the treatment is successful.
Weight loss strategies include healthy lifestyle changes.
“This incorporates dieting, exercise, behaviour modification and education,” says Dr Khoo.
Pharmacotherapy, surgery, psychological and social support are also forms of weight loss strategies.
Surgery such as gastric bypass or vertical banded gastroplasty are for those with a BMI of more than 40 with serious co-morbid conditions and for those who have failed medical therapy.
Drug therapy is advisable for those with a BMI of more than 30 (without additional risk factors such as hypertension Type 2 diabetes mellitus or coronary heart disease) or a BMI more than 27 with more than two risk factors.
“The therapy is an addition to diet, exercise, behaviour modification and a lifestyle treatment which hasn’t succeeded in a weight loss of 10 per cent after trying it out for at least six months,” says Dr Khoo.
Three drugs are generally prescribed by doctors. One of these, which acts to suppress appetite, can be additive with side-effects such as depression, hallucinations as well as an increased risk of primary pulmonary hypertension.
Another has to be taken with caution as it may increase heart rate and blood pressure and should not be used in patients with heart failure, coronary heart disease, previous stroke or renal impairment.
According to one study, the third, which is a gastrointestinal lipase inhibitor is the most effective weight loss drug.
“Drug therapy is not for people seeking a quick fix for obesity. Neither is it for those who are non-obese and have contraindications to drugs.”
Drugs in obesity management which produce side-effects such as amphetamine can cause addiction. Dinitrophenol, meanwhile, can result in cataracts and neuropathy.