Is obesity merely a risk factor that can lead to lifestyle-related diseases, or is it a disease in itself? Why do some people lose weight fast, while others find it difficult to do so in spite of trying the most exotic-sounding diet combinations?
Obesity, as a risk factor for more than 25 different health conditions including type-2 diabetes, hypertension, gallstone, fatty liver disease and joint and muscle pain, has been known since the time of Greek physician Hippocrates.
When the American Medical Association this year voted on whether obesity was a disease, the responses were mostly in the affirmative.
"Most people think excess weight can be knocked off by exercising and controlling the food intake. However, research has shown that out of 20 people starting a controlled diet and exercise routine, 19 will regain the weight they lose. Not more than 1% manage to keep the kilos off and even they have to struggle very hard to maintain their weight," says Dr Arya M Sharma, professor of medicine and chair in obesity research and management, University of Alberta, Canada.
It takes at least 90 minutes of daily physical activity and a constant check on the calorie in-take to shed excess weight.
The point is, once a person puts on weight, it becomes difficult to lose it. Nobody succeeds in cutting out the flab permanently, much less without hard work.
The reason being, "our bodies tend to defend our weight by regulating the body weight," explains Sharma.
If a person weighs 50 kgs, the body will standardise the weight at 50 kgs. However, the weight regulation point keeps increasing with increasing weight.
"The way our bodies are built, the regulation point only keeps increasing. It never decreases. As a person tries to lose weight, his body fights to maintain the regulation point," he adds.
According to experts, even Bariatric surgery — commonly known as weight-loss surgery, wherein a portion of the stomach is stapled to reduce a person's appetite, the only treatment available for morbid obesity globally, is not a permanent cure.
If the stomach is unstapled later, the weight that had been lost, which is anyway not more than 25 to 30% of one's initial body weight, will eventually be gained back.
The weight regulation point grows as the body grows and continues growing even after the body has stopped doing so. The centre where this regulation happens is inside the brain, called hypothalamus.
"Every time there's weight regulation, there's a micro inflammation termed as gliosis or scarring of the nervous system. It's like the process of building a scar in the skin that cannot be undone. Every scar is permanent. Similarly, obesity is also permanent," he adds.
Experts say this is the reason that treatment for obesity is not only difficult, but has to be a life-long process. Some people will find it harder than others to keep excess weight away, as the battle of the bulge depends on various factors.
"Eating healthy is a journey, not a destination. Diet fads are for a short period only and need to be followed correctly," cautions Anjali Mukerjee, nutritionist and founder, Health Total, a nutrition counselling centre.
"The goal is to stay healthy and that can't be achieved through any short-cuts. Constitutionally, people are different, with different digestive systems. The food therapy for each individual must match his or her constitution. Once the formula (that works for a certain individual) is understood, it needs to be followed through life," she adds.
It may be easier to keep excess weight away if one understands the reasons behind gaining it: Obesity may result from one's genetic make-up, due to lack of time (to eat healthy or exercise), lack of sleep, cultural forces that promote over-eating, emotional issues or ailments like a thyroid malfunction, heart problems, asthma or use of certain medicines for diabetes and depression.
In the end it does not matter how much weight one has gained. One would need to treat the underlying problem that had led a person to over eat or gain excess weight.
From the scientific point-of-view, obesity is a disease, and what makes it worse is that obesity in itself is not seen as a disease by most.
"We don't treat it (obesity) as a medical problem, but as a lifestyle problem. Even in developed countries it is not covered under health insurance, making it difficult for many to afford the treatment," said Sharma.
There is a full spectrum of treatments possible involving nutritionists, behaviour analysts, physicians and surgeons.
Unfortunately, there are no obesity specialists available yet, as a result of which people take recourse in hitting the gym or popping tablets that promise to help in losing weight.
Bariatric surgery is the extreme form of treatment. In India, an estimated 200 million people suffer from weight-related issues, but not all of them can be helped through surgery.
"People need to double their efforts against the tendency to put on weight," says Sharma. But lack of time to cook at home and to exercise; lack of sleep and high stress levels contribute to obesity. These are also the major barriers that prevent weight loss.
The best way to prevent obesity from assuming epidemic proportions is to fight it early. "Monitor children's weights carefully," says Sharma.
Prescribes Mukerjee, "Once the excess weight has been reduced, follow the 80-20 rule, that is, eat 80% healthy and 20% of whatever you want to."