Meeting Challenges in Obesity Management

Is obesity inherited," Dr. Augusto Litonjua asked on the morning of September 13 at the EDSA Plaza-Shangri-la hotel. "Or is it a case of the environment?"

    Keynoting the eighth convention of the Philippine Association for the Study of Overweight and Obesity (PASOO), Dr. Litonjua spoke on "Battling the Obesity Epidemic: Learning from the Past and Planning for the Future." He explained that, genetically speaking, it is not obesity per se but the "susceptibility to becoming obese" that is inherited and therefore, there is hope for those genetically predisposed.

    With the correct lifestyle, particularly eating the proper diet and engaging in regular exercise, obesity can be prevented. And even among those that are already overweight or obese, a diet and exercise regimen can help them to lose weight.

    Dr. Litonjua cited studies showing the benefits of weight loss especially among obese diabetics, noting that a five to ten percent weight loss improved glycemic control, reduced the need for anti-diabetic medication, and improved the lipid profile.

    Discussions also focused on the appropriateness of Dutch mathematician Louis Quetelet's concept of body mass index (BMI) as the measure of obesity and body fat. Is the BMI a true representation of a person's weight condition? What is the BMI based upon? These and more complex queries about obesity in the Asian region were addressed by a medical marriage of east and west

"To create increasing awareness of obesity, which can lead to diseases like diabetes and hypertension--for their prevention--and to update the public on current studies in that area."   - Dr. Litonjua

    Dr. Litonjua, for one cited the need to look at adipocytes in the visceral area, which excrete a hormone that increases fat storage capacity to infinity.

    Citing his study on the "Impact of Body Build on the Relationship between BMI and Body Fat Percent" involving a multi-racial sample, Dr. Paul Deurenburg, a World Health Organization consultant, concluded that the validity of many predictive methods regarding body mass is dependent on body build.

    Moreover, he said that different assumptions across ethnic groups are needed to accurately determine body comparisons.

    Holding all BMIs equal, his study showed that Caucasians have a lower body fat percentage than Indonesians, urban Thai, and Chinese with Singaporean and Hong Kong origins.

    Dr. Mabel Yap-Deurenburg, nutrition director of Singapore's health ministry, presented the results of a recent WHO expert consultation on BMI for Asian populations. She prefers to use the word "risk" rather than "obesity," which has a negative connotation in certain cultures.

    She believes that true BMI is elusive. "BMI cannot be categorized," she said, stressing the importance of recognizing that the risks go up steadily as BMI increases, so instead of feeling relief at being below the cutoff BMI overweight index one should instead try to aim for normal weight conditions.

    The WHO consultation resulted in prescribed BMI standards specific to certain Asian populations. The BMI currently used worldwide sets obesity (or high-risk) at 30, which may be inaccurate for Asians. Suggested cutoff points for Asians are:

•     <18.5, underweight;

•     18.5 to 23, low to moderate risk;

•     23 to 27, moderate to high risk; and

•     27.5, high to very high risk.

    For Pacific Islanders a BMI of 27.5 is deemed high risk while for Polynesians, it is 32.5. However, the WHO will not dictate BMI cutoff points for each country. Asian states are asked to choose the BMI that they believe is appropriate to them.

    Dr. Nobuo Yoshike, deputy director of the National Institute of Health, elaborated on the state of obesity and gave an in-depth scenario on the weight of Japan's population.

    The Japanese obesity indices almost doubled in the past 20 years although a high intentional weight loss among young Japanese females was recently observed. Despite this, the Japanese government aims to lower BMI indices by 15 percent for both men and women next year. How? By encouraging more exercise. The key is not to compartmentalize physical activity but to incorporate it into daily life, like taking the stairs instead of the elevator.

    Dr. Yap-Deurenburg, presenting the WHO's moves for better lifestyle, said that one hour of cumulative physical activity for most days a week is highly recommended.

    Convention participants made up a rainbow tribe of medical practitioners, nutritionists, and students. Physical fitness specialist William Go, expressed enthusiasm for the entire conference but dismay at the palatable but fatty pastries served during the "health break."

    Mr. Go, picking up from Dr Litonjua's pre-natal obesity control, proposed a ban on the sale of all soft drinks in elementary schools.

    At the end of the day what does the PASOO wish to accomplish? "To create increasing awareness of obesity, which can lead to diseases like diabetes and hypertension-for their prevention-- and to update the public on current studies in that area," Dr. Litonjua said with a smile.

    During the convention, PASOO launched "Whiz Kids Thru Fitness," a program for obesity intervention in children. Nicole Tigno