Regardless of metabolic status, any obese and overweight patient should be encouraged to lose weight.
I AM OBESE BUT I AM HEALTHY. DO I NEED TO LOSE WEIGHT? CAN EXERCISE HELP ME TO REDUCE WEIGHT?
Healthy obese is an obese person with normal blood sugar level, normal blood pressure and normal lipid profile. They are also known as metabolically healthy obese (MHO).
About 15 per cent of obese and 25 per cent overweight individuals are considered as MHO. Previously, little is known whether MHO is associated with a higher risk of heart disease.
A recent study in the UK (published in the Journal of the American College of cardiology) showed that a metabolically healthy person had 49 per cent higher risk of coronary heart disease, seven per cent higher risk of stroke and 96 per cent increased risk of heart failure than a person of normal weight.
Another study in Europe and published in European Heart Journal showed that the healthy overweight and obese had 26 per cent and 28 per cent the risk of getting coronary heart disease than those of normal weight. Based on these two studies, there is no concept of healthy obese.
Regardless of metabolic status, any obese and overweight patient should be encouraged to lose weight. An obese person should restrict calorie intake and exercise to lose weight.
They must create negative energy balance or calorie deficit for more than 3,500kcal per week (more than500kcal per day) to reduce 500g body weight or more per week.
Exercise alone will have modest impact on weight loss. A combination of exercise with diet restriction is 20 per cent more effective. The more one exercises, the better the weight loss.
On average, 150 minutes a week of moderate intensity exercise will reduce 2-3kg of body weight and 225-400 minutes a week of moderate intensity exercise will yield 5-7.5kg weight loss.
High intensity exercise at more than 60 per cent of maximum heart rate will deliver additional benefits. The American College of Sports Medicine recommends about 60 minutes a day, 300 minutes a week of aerobic exercise at moderate intensity.
The target is 5-10 per cent weight loss of initial weight in three to six months. Combination of strength training is important to maintain muscle mass and strength. Exercise is good to reduce visceral fat, compared to diet restriction. For morbid obesity, with Body Mass Index (BMI) of more than 40, surgery is usually indicated.
I'M EXERCISING BUT THERE IS NO SIGNIFICANT WEIGHT REDUCTION. DO I STILL GET ITS BENEFIT?
If possible, try to reduce weight. You may need to check the amount of exercise you do. Calculate calorie intake and calorie burned accurately.
A smartphone app like myfitnesspal may help you track calories. You may also consider other factors such as stress, lack of sleep and medical problems.
That said, even without losing weight, you will still get health benefits from regular exercise.
Fitness is a better predictor of mortality than obesity. A study in Europe showed that physical inactivity could twice as likely to kill compared to obesity. When body weight and BMI are taken into account, physical activity performed is associated with reduced mortality of any cause.
Thin, inactive people have higher risk of health problems compared to active obese people.
In a recent Rotterdam study published in the European Journal of Preventive Cardiology 2017, the impact of physical activity on heart disease outweighs that of BMI in the middle-aged and elderly. The risk associated with overweight and obesity was attenuated in persons with high physical activity levels.
This suggests that regular physical activity reduces the cardiovascular disease risks in older adults and further benefits can be gained from maintaining a healthy weight.
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I'VE SUCCESSFULLY REDUCED MY WEIGHT AFTER ONE YEAR. HOW DO I PREVENT MYSELF FROM REGAINING IT?
Many studies have shown that two-thirds of weight regain will occur within one year. They will regain 30-50 per cent of weight lost within one year. After five years, almost all persons, who have successfully reduced weight, will regain their original weight.
The results of The Biggest Loser participants were published in the journal Obesity last year. Fourteen participants agreed for follow-up observations up to six years. They lost about 60kg at the end of the 30-week programme. After six years, all regained significant amounts of weight, except one person.
Maintaining reduced weight and preventing weight regain is usually the biggest challenge in any weight reduction programme. Some researchers suggest that a successful weight control programme is 10 per cent weight reduction to be maintained for one year.
Besides maintaining healthy behaviour, they have to maintain low energy intake, self-monitor body weight and commit to a high level of physical activity, as what they do during their weight reduction programme.
The amount of exercise should be 200-300 minutes a week or more. Sometimes, weight regain is expected and cannot be considered as failure.
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An avid sportsman who believes in the healing power of exercise, Assoc Prof. Dr Ahmad Taufik Jamil is Universiti Teknologi Mara’s public health consultant and exercise physician. Email him at atjamil@gmail.com