How many of those reading this article truly understand the meaning of the word “obesity”? The term conjures up mental images of people swathed in fat, so fat that they can hardly stand. The word obesity makes us think of news stories from the UK and the US, with images depicting individuals grown so large – too fat to fit through the door –that they have to demolish the walls of their house in order to be transported to hospital for treatment. Well, yes, these individuals are obese, but obesity is more insidious than that. Obesity starts small, and the habits that lead to that destination are seemingly benign, pleasant and highly enjoyable.
Obesity is defined as levels of body fat sufficient to impinge upon health. This is in comparison to overweight which is defined as levels of body fat sufficient to increase the risk of health problems. So let us be clear, if you are overweight then you are running the risk of ill health, but if you are obese then you WILL suffer from ill health. It may not be today, it may not be tomorrow, but it will happen.
So how can we tell if we are overweight, obese, or even a healthy weight? This is a highly contentious issue, worldwide. In the 1950’s, insurance companies drew up height and weight tables from the data they had collected from clients taking out health insurance, and they found that there was a point beyond which further weight increases definitely resulted in health problems. This data was formulated into the old-fashioned height weight tables with which we are all so familiar, but is less than scientific, as at the very tall and the very short were, of course, markedly under represented in the insurance companies’ data.
Later, the body mass index (or BMI) became the most preferred body weight assessment method, used by clinicians and health and fitness instructors worldwide. Your weight per unit of height is calculated by dividing your weight in kilograms by the square of your height in meters.
A traditional Nepali diet is healthy: Lots of vegetables and not so much ghee (because traditionally, it wasn’t so easy to get hold of). Nowadays, however, so many of the popular foods are fried and even those that aren’t tend to be packed full of fats and sugar.
There is some variation of the result indicating obesity, caused by ethnic variation, but the fine-boned Nepali people would be considered obese by a BMI of 23 or more and overweight by a BMI of 22 – 22.9. It is an easy calculation and can be calculated and understood not only by the doctors and professionals but also by the average person on the street. Of course, not everyone thinks highly of this particular way of measuring obesity. Remember, obesity is defined as an excess of body fat but BMI looks at weight per unit of height. It is entirely possible that a body builder could have very low levels of body fat and yet have a calculated BMI indicative of obesity. However, in the general population, worldwide, BMI has been found to correspond very well with body fat percentages. Thus, it continues as a preferred way of calculating the likelihood of NRNCD in the medical profession (and they can always ask their patients if they are body builders, if they think there is a risk of a mistake being made).
Hang on, hang on. What is this NRNCD? When did that come up? Who introduced that topic to the mix? Well, you did, he did, she did, and I did too. NRNCD is what kills you when you have too much body fat.
Oh no! So what are the symptoms? And if I have them should I go straight to the doctor and demand medicine? There must be medicine, especially if this is a worldwide problem.
Yes, there are symptoms, and the first one you will see is an increase in your size. Your shirts and trousers did not shrink in the wash, Mr Sharma. The clothes sizes you buy in the shops are NOT getting smaller Mrs Baidhya. And when your sons complain that the clothes they love no longer come in large enough sizes, sit up and take notice, for the problem actually lies elsewhere. Nepali people are getting bigger, much bigger and it is killing them.
NRNCD stands for Nutrition Related Non-Communicable Disease – you can’t catch it from your neighbor or from any other person but you can get it and so can I. In fact, anyone can suffer from this terrible collection of diseases and disorders, and the first symptom in every single case is an increase in size. Your clothes get a little tight, so you buy a larger size. You find physical exercise is a little more difficult, so instead of walking to school, college work, you take a bus or a taxi. You can’t keep up with the others on the team so you decide to sit on the sidelines and eat chips and soda – and suddenly a small problem has become a bigger problem.
Now I am not talking about growing here. A child must grow to attain adulthood and it is never desirable to restrict their growth. Young girls need to develop fat reserves to enable their body to grow and develop reproductive capacity, but there comes a point where growth is no longer sufficient explanation for the increase in Junior’s waist size, and at that point there is a problem. If you tackle this problem at the point of occurrence, then you will be in with a chance of beating the problem. If you leave it you are stacking the deck against yourself and your family.
It is so easy to dismiss a small weight gain: You will lose it again soon, you just ate too many sweets at your friend’s wedding or maybe ate a biscuit or two too many. But will you lose it? And when? One scientific study found that an overweight child has an 80 percent chance of becoming an obese adult. Obese adults suffer in work prospects and earn less than slimmer colleagues. They suffer more ill health and, dear friends, they DIE earlier than their slimmer colleagues.
Do I have your attention now? NRNCD sufferers can approach their doctors and can beg various prescriptions and medications which will make their lives less uncomfortable but the best treatment is free – eat healthier food and take regular strenuous exercise which makes you at least a little sweaty.
The worst thing about getting fat is that it is so much fun. It is so hard to resist. A traditional Nepali diet is healthy: Lots of vegetables and not so much ghee (because traditionally, it wasn’t so easy to get hold of). Nowadays, however, so many of the popular foods are fried and even those that aren’t tend to be packed full of fats and sugar. One study carried out recently showed that nearly everybody eats biscuits on a daily basis. Biscuits look so innocent, but that lovely crunchy crumbly texture comes from high levels of saturated fats and the sweetness indicates the presence of way too much sugar – you would be surprised at the levels of fat and sugar in even the blandest biscuits. Biscuits are best avoided. Yet, they taste so good. They are convenient to eat, you can buy them anywhere. They are reasonably priced, in most instances. You don’t need a plate or any cutlery. They leave your hands clean, you don’t need to visit the bathroom after eating them. And they taste so darned good, don’t they?
When the human race evolved, way back in the mists of time, food was hard to come by. Ask you grandma what it was like when she was young. She will tell you that food was not so easy to find. And you had to work to make it edible. Food had to be prepared and it took time and effort. When she was young there was no chowchow which only needs water to be added to make it a tasty snack. In earlier times, a woman had hard work to do in preparing cooking the food for her family and that was probably a factor in the tradition of a woman working in the home rather than going out to work for money.
Nowadays, convenience foods in packets and tins need only have water added, or some need only to be opened before the food is ready for consumption. And scientists work hard to make sure that the food tastes so delicious. But beware. It tastes so good you just want to eat and eat and eat. A little more won’t hurt, surely? And today you are too tired to walk down to the market, aren’t you Mrs Tamang, so you send your maid instead. And then your trousers become a little tight, Mr Pandey, and you find that it is more comfortable to wear a larger size, and your wife begins to complain that the clothes she likes only come in sizes for teenage girls, and you son gives up playing football because he needs to study for that public examination… And NRNCD is just around the corner.
Writer is a graduate psychologist with a Post Graduate Certification in Education
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