DISCIPLINING OBESITY

A Healthy Life Style

Nasým Butt

No religion commends self-indulgence;all religions, and all traditional ways of life inspired by religious principles, commend self-discipline, that is containing and limiting, rather than expanding, one’s needs. Islam, with its conspicuous patterns of regular prayers, fasting and taxation of one’s wealth and property is particularly emphatic about the importance of self-discipline. Within the norms of Islam, self-discipline means a controlled, moderate, balanced way of living - not orgies of self-denial, followed (inevitably enough) by orgies of self-indulgence. Modern Western ways of life are not traditionally based, not inspired by religion, but motivated instead by what the economic market requires, which is for individuals to spend more and more, regardless of need. One area of such spending is food and drink: certainly among the better-off classes in Western societies, food is purchased, partly eaten and partly wasted, on an unimaginable scale. Muslims who are responsive to the Qur’an’s command to avoid squandering and waste, and to avoid activities or habits which cause harm to oneself (as over-indulgence always does), can never feel at ease living according to the modem Western values and norms.

But the reality is that non-Muslims cannot do so either, at any rate not for long, certainly not for ever. Just as over- exploitation and abuse of the environment demands, sooner or later, a return to saner and ethically more sound relationships with the earth’s finite resources, so too overindulgence at the level of individual lives demands, sooner or later, a return to a healthier life-style, a simpler, more sustainable diet. For the present, this reassertion in Western societies of the saner traditional norms (which, as we have noted, are common to all religious traditions) appears in many individual lives as an unpredictable swing between extreme over-indulgence (visible as obesity) and extreme self-denial (seen in crash courses to lose weight). It is true that vast, even obscene, amounts of wealth are engaged in the slimming industry which (as it were) feeds on the inability of many people to achieve a change in life-style and eating habits which they can sustain. Nevertheless, there is a growing understanding that, in the end, fat-free fats are a real waste of energy: the only point in slimming foods and dieting generally is to train oneself to live in a different, healthier way, and do it for good.

What is obesity?

Generally, obesity is regarded as being synonymous with being overweight. This is not strictly accurate. What actually matters is the excess of fat present in the body. One man may be overweight because he sits all day and eats but does no exercise; another, say an athlete, may be overweight because intensive training has increased his muscle bulk. The first man might be called obese, the second could not. However, as it is difficult to measure the amount of fat present in the body but easy to measure weight by simply using scales, the terms overweight and obesity are for everyday purposes interchangeable.

Does obesity matter?

Statistical studies (done by life assurance companies who have to be good at assessing health risk) provide undeniable evidence that obesity increases morbidity (illness) and the likelihood of early death. Fat people are more likely to suffer, among other things, from increased blood pressure (which may be the cause of stroke, kidney disease or coronary thrombosis), diabetes, arthritis, gallstones, varicose veins, complications of pregnancy or labour, and post-operative problems. Other illnesses not necessarily directly caused by obesity may be aggravated by a person being overweight. For example, a man suffering from angina (pain caused by impaired circulation of blood to the heart muscles) is more likely to die suddenly if he is overweight than if he is of normal weight. Obesity matters therefore because it can lead directly to illness (often serious) and reduces lifespan.

Causes of obesity

The one obvious and direct cause of obesity is that food intake is in excess of the body’s energy requirements or, in plain English, overeating. Why do some people eat more than they need?

By far the commonest reason is that their energy use slows down while their food intake remains the same. This happens in many people as they grow older because little by little they slow down physically, whereas their eating habits remain unaltered. This leads to the well-known condition of middle-age spread. Just one potato or one slice of bread more than the body needs each day can add to its weight each week until, perhaps, by the end of the year the excess amounts to a whole stone.

The genetic make-up of some individuals can make it difficult for them to avoid putting on excess weight because their bodies function at a low metabolic rate. Many fat children, though by no means all, probably fall into this category. It is well recognized that fat parents often produce fat children, and it is unlikely that this phenomenon can he explained entirely on environmental grounds as the children adopted by fat parents are no more likely to become fat than other children.

There are people who overeat because they have a psychological or psychiatric disorder of a lasting kind. Others may overeat when they are temporarily depressed or under emotional stress: they look for consolation for their trouble in eating. For example, some cigarette smokers when trying to give up their bad habit try to compensate by eating. It has also been suggested that, after giving up smoking, the bowel tends to absorb food more efficiently which may aggravate the problem of increased weight.

According to a theory that has been popular for some years now children who are allowed to become fat during the first two years of their lives form a large number of fat cells. They then spend the rest of their lives filling up these cells with fat that is, they have an increased predisposition towards depositing fat within their bodies. However, though popular, this theory has not yet been proved.

Cultural norms and expectations influence people in all sorts of ways, among them, in the way they look. In most Western societies of the present, the cultural preference is for slimness. But this is not true of all societies, not even all Western ones - for example, in southern Italy and elsewhere in Europe, a mother is expected to be ‘well-rounded’.

Treatment of obesity

Treatment of obesity requires a reduction of calorie intake to below the level of the body’s daily energy requirements. Weight will he lost only if there is a negative calorie balance. Eating less food than the body requires means that the body uses up its own fat to meet its energy requirements. In extreme cases, where losing weight is of paramount importance and where, for one reason or another (usually psychological), dieting has failed, surgical procedures may be necessary. These can include wiring up the jaws to prevent entry of solid food while allowing liquid matter to enter the mouth, or even more rarely, short-circuiting large sections of the bowel, a high risk procedure that carries with it a very significant mortality rate.

Nutrition and diet

Nutrition is concerned with the correct provision of essential factors for body growth, maintenance and repair, together with the necessary number of calories to meet the body’s energy requirements. A correct slimming diet is one that reduces the daily intake of calories without depriving the body of its nutritional needs. Some understanding of nutrition and correct dieting is important not only for those who are already obese, but for many young, normal individuals who, without this knowledge would be likely in the course of time to become obese. A well-balanced diet must have adequate amounts of proteins, carbohydrates, fats, vitamins, minerals, mineral salts and water. Proteins, fats and, particularly, carbohydrates, are important sources of calories and hence of energy. Proteins also supply the amino acids essential to body growth and repair. Fat in addition to being a subsidiary source of energy is the principal source of some vitamins.Vitamins are important in the utilization of energy and in the body metabolism but are not themselves a source of energy and do not contribute to body weight. Lack of vitamins causes disease but so too can an excessive intake of some vitamins.

A number of mineral salts are essential for the human body. Iron, for example, is essential for the formation of hemoglobin. Calcium is necessary for ossification of bone (the change of cartilage into bones). Phosphorus is required for many purposes including the manufacture of ATP. Iodine is necessary for the correct functioning of the thyroid gland. Other important minerals include potassium and sodium.

Water is one of the most important elements in our diet. It makes up about 70% of body weight and shortfall in its intake results in dehydration. Caloric foods are essential for body energy requirements. To appreciate their importance it is necessary to understand both how calories are expended by the body and how these calories are provided by the food eaten. The total calories expended by the body each day is the sum of the calories required for basal metabolism and those required for physical activities. Basal metabolism is the chemical change occurring within the body in the state of complete physical rest when the only bodily functions that are occurring are respiration, growth and repair of body tissues. Physical activity includes obvious exercise such as walking or running and other activities such as digestion and absorption of food. The requirements of basal metabolism depend on the size of the person, but on average about 1,700 calories per day. For comparison it is interesting to note that walking utilizes about 200 calories per hour, household work about 100 calories per hour, and mental work no calories.

Calories are provided by certain constituents of the diet. The most prolific source on a calorie-per- weight basis are fats, which yield 9 calories per gram, followed by carbohydrates and proteins which each yield 4 calories per gram. It would appear that, in order to lose weight with maximum efficiency, the part of the diet which should be reduced is the fat content. However, the average diet contains nearly twice as much carbohydrate as it does protein and fat put together. Therefore, in practical terms, most slimming diets concentrate on the reduction of the carbohydrate content of the food eaten.

Dieting

By ‘dieting’ people usually mean a ‘reducing diet’, that is, a programme of eating less in order to achieve weight reduction. But there are other types of diets used for different purposes such as lowering the level of cholesterol or increasing the bulk content of food in the bowel.

Reducing diets are designed to provide less calories in the food intake than are used by the body in the expenditure of energy. There are infinite variations, both in the content of such diets and in their efficacy.At its simplest, good diets are diets that work. The important criteria of such diets are:

1 Palatability: it is pointless following a diet which forbids all foods that one likes and allows only foods that one dislikes.

2 Practicability: that is a diet that can be followed with a minimum of fuss and preparation and can be used when one is out at work or at a restaurant.

3 Moderation: a diet should be one that ensures a weight loss of not more than 2 lb a week. Diets which produce weight loss in excess of 2 lb are usually crash diets and come into the second category namely, bad diets.

Bad diets fail to satisfy the criteria described above. They fail because they are monotonous or cause tremendous hunger and are soon abandoned, with a consequent return to previous eating habits and the regaining of weight lost. Even if maintained with perseverance and weight is successfully lost, when the diet is eventually stopped, when the desired weight has been achieved, former eating habits are almost always resumed and weight rapidly regained. Weight rapidly lost is weight rapidly regained in almost every instance. It hardly needs saying that the most important aspect of dieting is the re-training of one’s eating habits so that after a time dieting is no longer a conscious activity but a totally natural and permanent way of eating for health. In practical terms the most effective way of achieving this is by gentle reduction of the amount of food eaten. For example, one potato less, one slice of bread less, substitution of artificial sweeteners instead of sugar, are all ways of reducing calorie intake in a gentle and painless manner. There are numerous other tactics (usually classed as behaviour therapy) such as eating from a smaller plate, which can all help different individuals to adapt gradually and permanently to a different regime of eating.

Slimming tablets are controversial. Opinion as to their usefulness is divided. They appear to be very popular with patients but not so popular with doctors. It is possible that tablets have a use particularly when hunger is a problem during sensible dieting or when the reduction of weight has reached a plateau which appears to be permanent or long-lasting. A short-term plateau is a common occurrence while on a reducing diet and perseverance is required as weight loss is usually resumed after a short period. The problem with slimming tablets is that they can cause unpleasant side effects such as insomnia or, conversely, drowsiness, and they may cause dependency.

Exercise

The importance of exercise in the context of weight reduction is frequently overstated. For example, a walk of one mile will probably use up less than 60 calories. If this activity is undertaken every day it will probably achieve a weight loss of less than 1 lb a month. However studies have shown that sedentary individuals appear to lose weight with more difficulty than active individuals on identical diets.

Bran

Recently doctors have become aware of the importance of something that has been missing in the refined diets of Western societies for a long time: this is vegetable fibre. Observation of peoples in the African continent have shown that the local inhabitants rarely suffer from constipation, bile and other bowel disorders so common in Western countries. This has been convincingly explained as being due to the presence in their diet of vegetable fibre. The theory has been advanced that if vegetable fibre is added to our Western diet the incidence of such bowel disorders will be reduced and this appears to be borne out. The addition of vegetable fibre, generally in the form of bran, may well prove to be a useful constituent of our everyday diet. A further advantage of bran, particularly while on a reducing diet is that it has a tendency to fill up one’s stomach and thus alleviate hunger.

Diet and corona heart dease

Cholesterol is a fatty substance present in everyone’s blood. It causes problems as it is deposited in the lining of arteries making them narrower. Cholesterol also forms an important constituent of arteromatous plaques (lumpy deposits on the inner lining surface of arteries) which may cause narrowing or blockage of the coronary arteries (those supplying the heart), leading to pain on exertion (angina pectoris). Blockage of the coronary arteries causes coronary thrombosis which results in destruction of the heart muscles. The relationship between high blood cholesterol levels and coronary heart disease is undisputed. Numerous studies have shown that the risk of dying from coronary heart disease is more than doubled if one has an abnormally high level of cholesterol in the blood. The relationship between blood cholesterol levels and coronary heart disease is probably a direct causal one. The classic observation is that Japanese men who came to live in San Francisco acquire high blood cholesterol levels and suffer an increased incidence of coronary heart disease in similar proportions to those of the indigenous population and in marked contrast to the low cholesterol levels and low incidence of heart disease of the indigenous population of Japan. However, the possibility remains that some other factor or factors are responsible for both the high cholesterol level and coronary heart disease has been postulated.

Cholesterol is derived partly from the diet and partly from the breakdown of other food substances within the body. The main sources of cholesterol are animal fats and dairy products. These include fatty meats, liver, milk, cheese, cream and butter. All these foods contain a good deal of saturated fatty acid which in the body breaks down to form cholesterol. In addition, eggs contain pure cholesterol. When the amount of cholesterol and saturated fatty acids in the diet is reduced the level of blood cholesterol is also reduced.

What does seem likely is that even a moderately raised level of cholesterol over a long period of time may predispose towards coronary heart disease. Doctors and nutritionists are therefore becoming increasingly aware of the importance of correct diet starting in childhood. It is likely (and certainly it is to be hoped) that, with increased general awareness of the importance of cholesterol levels, there will be some alteration of the present eating habits in schools - informed teachers could provide an important impetus. This is particularly desirable as the eating habits of adults and their likes and dislikes are acquired largely during childhood. There should be a trend towards a reduction of the animal fat and dairy product content of the diet (though by no means their total exclusion because they still form an important source of certain essential nutrients) together with an increase in food containing more polyunsaturated fats (which do not lead to the rise in cholesterol levels) such as lean meat and the substitution of soft margarine high in polyunsaturated fats in place of butter, and the use of corn oil, sunflower oil and safflower oil in cooking instead of cooking fat.

As Muslims, of course, we must be abstemious and refrain from overindulgence. Good health is a valuable gift from God Almighty and we shall he held accountable for how we treated our bodies. In the inimitable words of the Wise Qur’an: Let not your own hands contribute to your own destruction’.

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