Medicosnext
Dr. Dina Shrestha
She is an endocrinologist working in diabetes, thyroid disorders, obesity, and endocrine research. She currently serves as a Senior Consultant Endocrinologist at Norvic International Hospital and Siddhi Polyclinic, Kathmandu.
Dr. Shrestha is the President of the South Asian Obesity Forum and has previously led both the Diabetes and Endocrine Association of Nepal (DEAN) and the South Asian Federation of Endocrine Societies (SAFES). She is a founding member of the Diabetes Rehabilitation and Research Centre (DRRC) and chairs the Trial Steering Committee for the Co-Direct Nepal Study. She is actively involved in various national and international organizations, serving as an executive member of the PCOS Society Nepal and the Down’s Syndrome Society of Nepal (DSSHA), and as a member of the Global Endocrine Leadership Coalition (GELC) and the ISE Advocacy Working Group.
Dr. Shrestha also contributes to academic publishing as an international editorial board member of the Asian Journal of Obesity and was the Chief Editor for the National Consensus Statement on Type 2 Diabetes Mellitus and Hypothyroidism. Her research interests include thyroid disorders and diabetes in pregnancy, as well as obesity management. She has authored numerous national and international publications in these fields.
Obesity, the word once so dormant, so undaunting, so neglected has now become the mother of chronic diseases. It is now recognized as a disease with serious complications and needing urgent management and treatment. Obesity is no more a silent asymptomatic disease; we now need to recognize and tackle its symptoms and signs. It can start at any age and one needs to be vigilant about it.
We also have to address that obesity now is not only about increased BMI and being obese or overweight. We need to understand that obesity can have different phenotypes like central obesity and sarcopenic obesity. Children and adolescents, both male and female, if not diagnosed on time and if not intervened early, can go on to develop sexual and psychological issues including PCOS and micropenis in adulthood.
A Tsunami of Obesity
South Asians including Nepalese have a strong socio-cultural background of associating increased weight with health and prosperity. Being lean is looked down upon and also associated with negative health. However, with this tsunami of obesity more than 1 billion people worldwide being diagnosed with obesity and overweight, amongst which 159 million are children we can no longer afford to look the other way. That’s 1,000,000,000 and 159,000,000!!! Power is in these numbers.
We know that diabetes, a debilitating and lifelong disease and hypertension, a life-threatening chronic disease are both increased with obesity and both are very common in Nepali society. These are and were the most common complications of obesity, but adding to the basket now are cancers and many more. The risk of cancer is very high in obese patients, and so is sudden death including heart attacks.
Why Are We Still Unable to Fight the Surge?
Despite having the awareness and the knowledge both by physicians and patients we still are unable to really fight the surge of this disease due to multiple factors.
First, patients lack awareness, and food remains one of the most common and easily available sources linked to happiness and that dopamine hit. In the world of urbanization and lack of time, the one pleasure that surely hits the hedonic center is food. Also, very often people associate food with energy and think that they will become weak and frail if they don’t eat.
Second, physicians also have a high inertia to treat obesity as a disease, since it doesn’t present in the emergency. Only once the complications cause serious morbidity and mortality does it really get addressed. Patients usually have more pressing, dire conditions, and hence obesity and being overweight in the OPD gets sidelined.
Third, management of obesity especially with medicines in the past 2–3 decades wasn’t without side effects and was associated with lots of adverse events. Bariatric surgery, though successful and still recommended, isn’t very acceptable for both physicians and patients given the associated risks and cost. However, with the dawn of the era of GLP-1 agonists and other therapies, weight loss with medications can now be achieved successfully.
Prevention is still the No. 1 Strategy
Needless to say and to emphasize prevention should remain the No. 1 strategy for obesity. Children should have adequate balanced calories with good macro- and micro-nutrients and enough protein. Lack of protein in our diet is one of the fundamental issues driving obesity, and sarcopenic obesity specifically. Less muscle mass translates to a low BMR, and these patients are also unable to exercise creating a vicious cycle. So both children and adults should have adequate protein in their diet.
For vegetarians, plant-based proteins are safe and can easily be consumed. Soya, mushroom, whole grams and lentils can be part of the staple diet. Egg whites, skinless chicken and steamed fish, when used appropriately, are great sources for non-vegetarians.
Rethinking Exercise
The role of exercise needs to be overemphasized and we need to clearly explain the different kinds: stretching, balance, yoga, resistance, and aerobic exercise. Most Nepali people associate exercise with the morning walk. However, age, weather, joints, air quality, and various social obligations can always be a hurdle, leading to inconsistent and unreliable schedules. How to exercise at home, how to stretch, do yoga, or perform chair and in-bed exercises for patients with joint issues, and how to use one’s own body weight for resistance training all of this can and should be taught and reinforced.
Our Biggest Challenge
Food remains the biggest challenge, especially the fast food, which is cheap and easily available at wo0rkplaces and school canteens, with very poor nutritional value but very high calories. Festivals and celebration parties are also packed with calorie-dense food, which can go on for weeks and months at a stretch in our country. “Bhoj season,” Dashain season, “again bhoj season,” rainy season, winter season, they take away the whole year!!
Knowing how to eat wisely at home, with high-fiber, less oily food and practicing safe fasting routines with adequate hydration and a minimum of high-calorie sugary items is of utmost importance. A lot of religious fasting in our country is actually designed to consume more sugar and high calories than on normal non-fasting days. Learning to identify high-calorie foods like kheer, puri, and selroti amongst other “pure foods” is important during those days.
Women as the Pillars of Family Health
I have always believed that women in our society play an important role in health and are the pillars of health for their families. When men eat unhealthy food, they may or may not influence the health of the whole family. However, in our society it’s not the same for women. We still live in a society where women irrespective of whether they are working or not are still running the household. Housewives or working women, they are usually still responsible for the food and the kitchen, and this is where they play a vital role.
The kitchen determines the health of all three generations: the children, the parents, and themselves. So from grocery shopping to cooking, one must follow a healthy kitchen rule using less salt, sugar, and oil. Having handy healthy snacks like nuts, seeds, fruits, and salads is a good way to start fighting obesity right at home.
Sleep, Stress, and the Obesity Connection
Sleep deprivation and stress can also cause obesity. One should charge their phone in another room if they are distracted by social media at night, and try music and breathing exercises to sleep at least 7–9 hours. Sleep hygiene these days is disrupted largely by phones, TV, and caffeine. Stress management needs to be a priority not something one simply lives with.
Conclusion
As mentioned earlier, we now have an Armageddon of anti-obesity drugs that we can use with very good safety profiles and benefits that extend well beyond weight loss. They can help cardiovascular and renal health and prevent other complications of obesity. The tools are here. What we need now is the will to use them wisely.
