The biggest knock against obesity is that it’s just a lifestyle issue, and not a real medical condition. According to Dr Arya Sharma, both are true. While an imbalance in diet and exercise will cause obesity in most people, there are many contributing environmental factors.

 

Dr Sharma notes the irony that so many "legitimate" chronic conditions, like cardiovascular disease, diabetes, and many cancers, are linked to lifestyle. "Even osteoporosis or car accidents are too often lifestyle-related. The heart attack resulting from obesity and poor lifestyle is a legitimate medical condition, but somehow not the investment in preventing it."

 

What’s more, a genetic predisposition to obesity may not make you unhealthy until it is combined with a chronically stressful job. Conversely, you may be tremendously resilient to high stress, but combine that with poor diet,and illness may still be the result. Our circumstances limit our options and determine our behaviours. Necessity often encourages unhealthy choices.

 

While we must take individual responsibility, there are a host of factors that conspire against us. Dr Sharma asks: "When did you last feel you had the time to walk around the block or to the store for milk or bread?" He notes that even at the office, many desks now have their own printers. "Of course this helps efficiency, but it means the 100 steps to the printer down the hall don’t happen any more." Conclusion? A series of changes, mostly small, subtle, and unconnected, make weight gain almost inevitable. In essence, effective prevention strategies are also made up of many small things…but treatments are often expensive and invasive.

 

In obesity, appearances can be deceiving. The thinner person with a "healthy" Body Mass Index (BMI) of 25 may be far less healthy than the borderline overweight person with a BMI of 27. Dr Sharma asks why we focus on the obese person riding the elevator or sitting at the fast-food restaurant, but don’t ask why the rest of us are there too: "Our health risks may be worse, but just less visible."

 

While BMI is now a common term, it is not the best predictor of a heart attack. New research, in which Dr Sharma participated, studied 27,000 people in 52 countries. BMI was found to be only slightly higher among people who had suffered a heart attack than in those who had not. The researchers concluded that waist-to-hip ratio predicts someone’s risk of a heart attack three times better than BMI. A waist-to-hip ratio over 0.9 for men and 0.85 for women spells trouble. And a waist size over 102 cm for men and 88 cm for women is also harmful.

 

Dr Sharma notes that even one or two kilograms of extra fat around the belly is unhealthy, but that just losing a few kilograms will improve both blood pressure and cholesterol levels. He advises that simply maintaining our current weight over the next five years would be good progress for many of us.

 

The issue is not how much weight can be lost or how fast, but can it be kept off. Dr Sharma believes there should be no such thing as a "weight loss drug"; today’s drugs should be taken to sustain weight loss. "The best results occur when lifestyle changes are combined with drug therapy."

 

Today’s drugs are not "silver bullets", and cannot overcome the effects of too much food and too little exercise. But do they work? "The best way to tell, says Dr Sharma, "is to consider what happens when the drug is discontinued. Almost always, the weight comes back, even with improved exercise or diet." Conclusion: access to medicines is important.

 

For employers and advisors, Dr Sharma suggests the single biggest improvement would be support for those who are overweight: reduce the stigma, and acknowledge their struggle. "These people aren’t lazy or ignorant; almost always they’ve tried to lose weight – and have succeeded – many times. But the triggers remain unresolved – the underlying and unremitting stress, lack of control over workload, or the nasty co-worker. This where employers can make the biggest difference."