In Canada we get a lot of stories in the news about obesity in the US and sometimes I thing that we look at ourselves as immune to the obesity issue.
Of course that is not at all true and bad habits in the US are the same as the bad habits in Canada. While many people look at the magic BMI number of 30 as the divider of obese or not, there is a number that determines super obese (I of course hate the whole BMI numbering, but that is another conversation).
So why and how is this super obesity epidemic happening? What can we do about it?
First, What Is Super Obese?
According to the 2004 Canadian Community Health Survey, 2.7 per cent of the population had “class III” obesity, meaning a BMI of 40 or more. But Dr Raj Padwal and others believe the prevalence of extreme obesity is now closer to four or five per cent, or about 1.5 million Canadians who are severely obese.
- One in four adult Canadians, or about 6.3 million people, were obese in 2011–2012. Since 2003, the proportion of Canadians who were obese has increased 17.5%.
- More men than women were obese, and obesity has increased more for men than women over the past eight years.
“It’s a bit disappointing that after five or six decades of flogging exercise and lifestyle modification that we haven’t been more successful, not just in the severely obese but in preventing the spread or rise in general obesity and over,” he says.
“I think it speaks to the fact you can’t really say to someone, ‘this is what you need to do. Eat healthier, be more active. Go home and do it.’ It just doesn’t work. It works in a minority of people who are highly motivated and have the means to do it.”
In 2014, 600 million adults (13%) worldwide as well as 42 million children under the age of five were obese. Obesity is more common in women than men.Authorities view it as one of the most serious public health problems of the 21st century
At Montreal’s Royal Victoria Hospital, the obesity surgery program has been closed to patients with a BMI below 55 for more than a year, because of demand.
What Are The Dangers Of Super Obesity?
Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in metabolic syndrome, a combination of medical disorders which includes: diabetes mellitus type 2, high blood pressure, high blood cholesterol, and high triglyceride levels.
Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a sedentary lifestyle.
The strength of the link between obesity and specific conditions varies. One of the strongest is the link with type 2 diabetes. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.
Patients with a BMI over 55 are the ones most likely to die from complications related to their obesity over the next three to five years, says Dr. Nicolas Christou, director of the bariatric surgery program at McGill University Health Centre.
“Four hundred, 450 pounds, those are the type of people who make it into our system,” Christou says.
“It’s getting much worse than we think. Rome’s burning and we’re fiddling, basically. The only ones that are really seeing it are the few of us in the trenches who have to deal with it.”
Christou was recently scheduled to operate on a woman with a body mass index of 72. She has leg ulcers and can barely walk. “She’s such a pleasant lady. You can see she’s going to be dead in six months unless she gets operated on.”
For the super obese, “it’s a vicious circle,” he says. “The heavier they get, the less exercise they can do, the bigger they get, the more depressed they get, the more they eat.”
Why Are People Becoming Super Obese?
The majority of the super obese suffer from one or more of the following, Lau says: sugar diabetes, high blood pressure, heart disease, high blood fat and cholesterol, sleep apnea, fatty liver, hiatus hernia, gallbladder disease and joint pain.
Padwal says people with extreme obesity suffer disproportionately from depression or have difficulty coping, mentally, with social problems.
“Broken homes, single parents with many kids working many jobs, living in poor conditions. Those factors I think contribute substantially to the elevation in BMI.”
He says emotional eating is a significant problem. “They may cope by overeating. They lose control and gain substantial amounts of .”
Lau says people are bombarded by confusing and mixed messages about diets and loss, “to the point they say, to heck with it, I’ll do what I feel like doing.”
“The public is somewhat fatigued. Every day there’s a new diet, every day there’s something new. We don’t have simple ways to help people tackle the and there are misconceptions about how easy it is to gain the .”
Mixed Messages. How Are People Eating Too Much?
Groups such as the Heart and Stroke Foundation and Canadian Cancer Society recommend people eat five to 10 servings of fruit and vegetables per day “without telling people if you eat more fruits and vegetables you have to cut back on the other foods,” Lau says.
“It may be healthier for your heart, it may be healthier for your gut but when it comes to calories the body does not distinguish healthy foods from junk foods. When it comes to gain, it’s all about calories.”
Similarly, Lau says that exercising is a “horribly inefficient way of burning up calories.”
“That’s not to say David Lau does not prescribe exercise. Exercise is great for heart health. It’s great for improving insulin sensitivity but it’s not good for losing calories because you have to work out a lot.”
In order to lose one pound of stored fat, people need to burn 3,500 calories. “People who are over think that just by walking they can burn up a gazillion calories. Little do they know to burn 100 calories they have to walk at a brisk pace for 15 minutes,” Lau says.
A Little Loss Weight Goes A Long Way
For super obesity, often the only thing that works is stomach-shrinking surgery.
But Lau says even a five- to 10-per cent body loss can significantly reduce the risk for diabetes, heart disease, stroke and cancer.
A five-per-cent body loss is associated with a 60-per-cent reduction for the risk of diabetes.