I arrived a day before the conference. The idea was to spend the day with Vignesh, a friend from my schooldays. He was now running his own software consultancy in Bangalore. It was immediately after my MBBS, and both of us were bachelors. I remembered Vignesh as a pleasantly plump boy who smiled while licking at his ice candy.
When I met him at the airport, the smile was in place. He was munching a huge diary milk silk at 6.00 am in the morning. There was nothing pleasantly plump about him now. He was decidedly fat. Horribly fat, if one doesn’t want to mince words. He must be a hundred kilos, on an average stature.
I deliberately chose not to comment on his girth. But he brought up the subject himself.
“I am putting on weight. I don’t know what to do.” He said. “I eat very less.” He clarified.
On the way we stopped at a roadside cafe. He ordered the usual. I ordered a pair of iddlis and one vada.
“I usually don’t have breakfast,” He said, sipping on his big cup of Cappuchino. “Heavy dieting, you know. My parents are looking for a girl, and my damn fatness is getting in the way.”
We went to his private firm, where he was the boss. His room was small, but posh, with a refrigerator humming away at a corner.
“I am thirsty.” He said, taking out a coke bottle, and pouring out almost half a litre into two glasses. I told him I will take only one fourth of that. He poured the excess into his own glass.
One of the employees had brought a chocolate cake for her birthday. Vignesh ate two large pieces. Then while congratulating the girl, he scooped out icing from the sides and kept licking it off in between sentences.
During tea break, a peon brought in two samosas and tea. He distractedly ate both, while working on his computer.
At 12.00, he jumped up. “The afternoon is ours! Let us enjoy. First we will go to Bavrichis and have mutton Biriyani and fried chicken. I am starving. I haven’t had a thing from morning.”
In 2005, Kopelman and Katerson studied and reported that obese people consistently underreport their own food intake, when compared to people of normal weight.
At least some overweight people feel that overeating is not the cause of their problem. But here I attempt to argue that excess intake of inappropriate food is the primary cause of obesity- except in a small proportion of people.
Take a look at the epidemiology. Before the 20th century, it was not a widespread problem. Now it is more widespread in the rich nations, like the USA. In the richer nations, initially, it was a disease of the upper class. Later, it migrated to the lower classes. In developing countries, it is still a disease of the privileged rich. In India, the highest rates of the weight problem (30 to 40 percent) are in Kerala and Punjab. Poorer states like Jharkhand and many North-east states, have rates around 10 percent. This rise parallels the amount of food purchased by people on a per person basis. Data shows that it steadily increased in most parts of the world from 1970s to 2000. The average calorie consumption per person in a country has been shown to correlate closely with the rates of prevalence of obesity. Again, we have to look at the USA, for which carefully done reports are available. From 1970 to 2000, obesity rates in the states increased from 15 percent to 30 percent. The average calorie intake in the same period increased by about 336 calories among women and 170 calories in men. Most of this increase was in the form of carbohydrates rather than fat. This fact is of some importance, as we shall see later.
In any region affected by famine, the people are all thin. You can hardly see any overweight person at all.
There is a popular misconception that some of us have a slower metabolic rate, and hence don’t burn calories well. These become fat. The naturally thin ones, some will have us believe, have a higher metabolic rate that evaporates away all the food. This doesn’t stand up to scrutiny. As a rule, the obese or overweight have a higher metabolic rate. As they restrict their calories and become thinner, the metabolic rate drops.
And it is not true that it is extremely difficult to lose weight. Have you seen the advertisements of in-house weight loss programs? They are very effective. They will have you live there, prescribe your daily routine and restricted diet. The masters will teach you yoga and exercises. Within a few weeks, you have lost an astonishing amount of weight.
The only problem is, as you return back to your old life and ways, the kilograms slowly creep back in as you fill up to your usual self. And continue on, the flesh piling up gram by gram. It is not losing weight that is difficult, but maintaining that low weight.
There is a treatment that is almost guaranteed to lose weight, and if we are a little bit careful, keep that weight off permanently. It is usually administered to morbidly obese (that is BMI greater than 40) patients. Some with BMI more than 35- patients with diabetes, hypertension etc also are offered this treatment. It is called bariatric surgery. The most common bariatric surgery is nothing but removing a major portion of your stomach so that it is a fraction of the previous size. What it does is that it makes you feel absolutely full with a lesser amount of food. Some lose 30 to 40 percent of their weight with this treatment.
So, taking into account all these, I contend that the vast majority of obesity and overweight is caused by ingested calories exceeding the spent ones on a chronic basis. This is just a medical way of saying that you eat more than you spend by exercising- in the long term. This leads to the extra calories accumulating as fat.
There is one thing though. There are a number of actual medical diseases that can cause obesity. This includes certain hereditary syndromes, hypothyroidism, certain medicines especially some medicines used for mental diseases etc. But these constitute only a small proportion of overweight people.