Central obesity significantly increases risk of serious health problems

Obesity is a complex disease characterized by an excessive amount of body fat. It is a medical problem that largely increases risk of other health problems such as heart disease, diabetes, hypertension, sleep apnea and certain cancers. To remain healthy and lower the risks of these chronic diseases, weight control is highly recommended in obese or overweight people.

 

Get to know obesity

Obesity is a chronic disease characterized by the excessive accumulation and storage of fat in the body. Obesity was traditionally defined as an increase in body fat which is greater than 20 percent of an ideal body weight in men or 30 percent of an ideal body weight in women. Fat accumulation in obese people might present as the deposit of subcutaneous fat under the skin or an excess of visceral fat, known as central obesity in which the abdomen protrudes excessively. There are several methods to measure fat and define obesity. The most commonly used on is Body mass index (BMI). BMI is a measure of body fat based on height and weight that applies to adult men and women. The formula is BMI = kg/m² where kg is a person’s weight in kilograms and m² is height in meters squared. 

 

Description	BMI (International)	BMI (Asian populations)
Underweight	< 18.5	< 18.5
Normal weight	18.5 – 24.9	18.5 – 22.9
Overweight	25.0 – 29.9	23.0 – 27.5
Clinically obese (Class 1)	30.0 – 34.9	≥ 27.5
Clinically obese (Class 2)	35.0 – 39.9
Clinically obese (Class 3)	≥ 40.0

 

Obesity and metabolic syndrome 

Metabolic syndrome is a cluster of conditions that occur together, resulting in increased risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, abnormal cholesterol or triglyceride levels and obesity. Obesity substantially contributes to a number of adverse health consequences including development of insulin resistance, high blood lipids and elevated levels C-reactive protein (CRP) –an independent risk factor for cardiovascular disease. Overweight people, without weight reduction, are more likely to develop central obesity up to 25%. 

 

Assessing central obesity

Central obesity is an excess accumulation of fat in the abdominal area, particularly due to excess visceral fat. Since visceral fat is supplied by the portal blood system, excess fat in this area can lead to the release of fatty deposits into the bloodstream, causing health-related problems. Waist circumference has been shown to be one of the most accurate indicators of abdominal fat assessment. However, abdominal obesity measurement guidelines and cutoffs vary among different ethnic groups.

In combination with the measurement of waist circumference, central obesity can be defined if at least 2 of these criteria present: 

• ☑ Blood pressure is greater than 130/85 mmHg. 
• ☑ Triglyceride level is greater than 150 mg/dL.
• ☑ Fasting blood glucose is greater than 100 mg/dL.
• ☑ High Density Lipoprotein or HDL cholesterol is less than 40 mg/dL in men or 50 mg/dL in women.

 

Measurement of waist circumference 

To correctly measure waist circumference, measurement should be conducted in the morning before having breakfast. Steps for measurement involve:

• Stand and place a tape measure around the middle, just above hipbones (iliac crest).
• Make sure tape is horizontal around the waist.
• Keep the tape snug around the waist, but not compressing the skin.
• Measure the waist while breathing out.

 

Waist circumference is strongly associated with BMI. Both indicators have been clinically used to predict health problems potentially caused by obesity. Cut points to define central obesity among different ethnical groups are: 

• For Southeast Asian and Chinese, cut points of waist circumference in men is more than 90 cm. (36 inches) or 80 cm. (32 inches) in women. 
• For American, cut points of waist circumference in men is more than 102 cm. or 88 cm. in women. 
• For European, cut points of waist circumference in men is more than 94 cm. or 80 cm. in women. 

 

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Contributing factors to central obesity

Statistical data reviews that approximately 30% of Thai populations aged over 35 have developed central obesity. Compared to neighboring countries in ASEAN, 32.2% of Thai populations have BMI ≥ 25 which ranks as the second highest number in the region. The prevalence of central obesity has been continuously rising during recent decades. Contributing factors primarily include: 

• The consumption of high-fat diets 
• Physical inactivity, lack of regular exercise and sleep disturbance 
• Genetic alterations 
• Smoking and smoke cessation 
• Certain medications such as psychiatric drugs, anticonvulsants, insulin injection and corticosteroids drugs. 
• Endocrine disorders such as polycystic ovary syndrome (PCOS), Cushing syndrome and hypothyroidism.  

 

Health-related problems caused by central obesity 

Central obesity is associated with a statistically higher risk of developing a wide range of diseases, including: cardiovascular diseases, neurological diseases e.g. stroke, diabetes, hypertension, fatty liver, gallstones, gout, osteoarthritis, sleep apnea, skin disorder e.g. fungal infection, varicose veins and certain cancers. More importantly, people with raised waist circumference, every 5 cm. are 3-5 times as likely to have diagnosed diabetes. To minimize the risks of developing these diseases, weight control and lifestyle changes are viral, especially in younger age. 

 

Treatment of central obesity 

The desired goal to treat central obesity is to lower the risks of health-related conditions induced by an excessive fat. To achieve the treatment goal, body weight must be reduced at least 5% from the baseline. Treatments include: 

1. Regular exercise: To reduce weight, it is highly recommended to have regular exercise at least 30 minutes per day, 5 days each week. For office workers, activities that encourage movement are suggested. 

2. Intensive lifestyle modification in diets:

• Limit daily sugar intake, no more than 6 teaspoons (25 grams) of added sugar per day. 
• Consume high-fiber foods e.g. vegetables, fruits and beans. 
• Reduce food portion in each meal.
• Avoid eating high-energy diets.
• Different dietary plans can be applied among individuals, depending on preferences. However, the amount of food consumed each day must be strictly limited with maximum 500 calories per day. All behaviors or triggers for activating appetite must be avoided. 

3. Weight reduction pills: Certain drugs used to control weight might be prescribed if BMI is greater than 30 or 27 with diagnosed diseases induced by obesity.

4. Bariatric surgery: Bariatric surgery is highly recommended in patients who have BMI greater than 40 or 35 with diagnosed diseases or comorbidity caused by obesity. Procedures include:

• Malabsorptive procedures: Surgeries aim to change the way that digestive system absorbs food such as Jejunoileal Bypass (JIB), Biliopancreatic Diversion and Duodenal Switch. Although these procedures help reducing weight quickly, they often cause a number of undesired adverse effects.  
• Gastric restrictive procedures: Surgeries involve the limitation of the amount of food that patients can eat while the normal digestive process stays intact. Procedures include Gastric Banding and Vertical Banded Gastroplasty (VBG), also known as stomach stapling. 

 

On the occasion of World Obesity Day,  to be aware of the health-related problems caused by obesity remains important to everyone. Not only to stay in shape, but weight control and lifestyle changes also help to minimize chances of chronic diseases associated with obesity.