Preventive Medicine: Exercise and Obesity

 

# PreventiveMedicine 

Exercise and Obesity:

Food is more universally connected with pleasure. In contrast exercise is not. There are fewer people in this world who will proclaim “ I love to exercise “. 

Procuring and eating food takes much less effort in the modern society than exercising. And we easily forget that just as much as food is a necessity for living, exercise is essential for healthy living. 

What is the primary purpose of food ? To acquire energy for bodily functions. 

Do we eat what is just enough for the basic functions like circulation, respiration , digestion, excretion, brain activity? 

Never. We tend to eat much more than the energy needs of these activities call for. 

What happens to that excess? 

Like all other things we hoard in our lives it goes into storage space or bank account. 

Here the currency of storage is fat. 

Initially that fat is not visible. If we look at the pictures from our teens or twenties we can’t find flab. Then with each decade there are signs of flourishing 😃. Facial bones and collar bones no

longer stand out. Blouse size is nowhere close to that from twenties. Waist and hip sizes don’t want to know where they stood few years back. Saree becomes an ally for the tummy, well fitted dresses or kurtas are in the enemy camp. Our fat cupboards are overflowing and hard to hide from prying eyes. 

What happens to self esteem when it reaches this stage ? I see this all the time in my practice in the USA. There the fat stores are overcrowded in childhood and teens itself. Self esteem never gets a chance to develop, forget about getting lower. These young people are starting their lives with an uphill battle against themselves. 

By the time they are in the thirties their weights are three and four times the ideal weight. Joints are showing signs of wearing out. Endurance for work is poor. Diabetes, high blood pressure, high cholesterol are making an appearance. Heart disease is a real threat. The pharmaceutical industry is constantly flashing promise of new drugs that can help weight loss. Their lobby is so strong that the drugs are approved for marketing without adequate testing and verification of safety data. As a doctor I find myself in a weak position to deny them such medications when there is so much ( inaccurate) propaganda about their benefits. 

So first we start a lifestyle trend that is harmful for us. Then we seek such remedies to counter the effects of this lifestyle that themselves pose significant risks. Weight loss medication, bariatric surgery, liposuction, breast reduction, medication for treatment of diseases.

There is an alternative to this absurdity! 

It is simple equation. If what you burn matches what you consume there will not be stored calories and fat. Keep the accounts clean each day. No credit, no balance. Watch your weight. If it is not getting low and not increasing and remains within the normal range then you know your diet and burning calories is maintaining a good balance. 

What is normal weight?

Weight by itself is a meaningless number. It has always to be considered in the context of height and muscle mass. A weight of 70 kg may be good for a person whose height is 5 foot 3 inches. But the same weight may be unhealthy for someone who is not even 5 feet tall. Body mass index ( BMI) is a simple calculation based on a person’s height and weight. Normal range of BMI is considered between 18 to 25. BMI of 25-30 is considered overweight and above 30 falls into category of obesity. This classification is based on the fact that higher BMI is associated with increased risk for developing diseases such as diabetes and heart disease. 

Our goal from the beginning should be to maintain the BMI under 25 or as close to it as possible. If you are eating healthy and exercising regularly and BMI is 26, don’t fret over it. 

How much should one exercise?

Guidelines recommend at least 45 minutes of sustained aerobic exercise at least 5 days each week.

Walking is a very good exercise. It must be fast walking and not leisurely stroll. 

Wear suitable shoes and comfortable clothing to walk.

Schedule a time to walk either before work or after, preferably around sunrise or sunset when it’s not too hot. 

In places with extreme of heat or cold temperatures go walking inside malls or such places.

Walking on the roads is less damaging to knees than walking on a treadmill. 

It also gives an opportunity for enjoying outdoors, seeing the sky and watching birds and feeling the breeze. 

A companion is great for staying motivated but don’t give up your commitment if no companion is available.

Lifting weights, swimming, yoga and such things can complement the benefits of walking. You can keep a schedule of one or more of these exercises from day to day. 

Often my patients will say I do a lot of walking at work all day. That doesn’t count towards the exercise. Because at work you stop, then go. There is no sustained challenge on your heart and body. So irrespective of your activity at workplace you must set aside time for exercise.

Exercise not only burns calories and optimizes weight, it has some other lesser known benefits.

It releases some useful chemicals in the body called endorphins which help pain relief. Patients with non specific pain conditions like fibromyalgia have been shown to benefit with simple regular exercise regimen. Those on pain medication can manage to reduce dose or come off medication if they exercise regularly. 

Exercise tones muscles and increases endurance for activity. 

It increases cardiovascular function. 

It increases neurotransmitters that bring sense of well being.

Thus overall functionality in both physical and mental health improves with exercise.

It is said that if two friends are obese, one exercises, the other does not, the one who exercises will live longer. If one has high blood pressure and diabetes and exercises, another does not have high blood pressure, diabetes or other conditions and also doesn’t exercise, the one who exercises will live longer despite having diabetes and hypertension.

Such is the benefit of exercise.

All three things food and water intake, exercise and management of weight are tied together. Keeping them all disciplined is both important and challenging.

Consistency matters. 

If you seem to be falling behind in your commitment, get reinforced in your motivation by speaking to your doctor or counselor or a friend who is a good role model. 

Reinvent your lifestyle. Invest your time in these good habits and enjoy the benefits of good functioning for a long time. Pass these habits to your family , especially children, and friends. 

Saree is a handloom cotton from Assam with the wildlife of Kaziranga, prominently the one horned rhino.