Lifestyle changes to lower obesity, as per new Indian guidelines

Indian doctors have issued new guidelines for diagnosing obesity, which has become a major crisis in India.

Published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews, doctors from the National Diabetes Obesity and Cholesterol Foundation (N-DOC), Fortis C-DOC Hospital, and the All India Institute of Medical Sciences (AIIMS), shared lifestyle changes for obesity, different for each stage.

Obesity has been divided into Stage 1 and Stage 2.

Stage 1: Excess body fat (BMI over 23 kg/m2) without affecting organ function or daily activities is considered Stage 1 obesity. While this stage doesn’t cause health issues yet, it can progress to Stage 2 obesity, which is linked to mechanical and disease-related problems.

Stage 2: An advanced stage of obesity is marked by a BMI over 23 kg/m2, increased belly fat, larger waist size, or a high waist-to-height ratio. This can affect physical and organ functions, causing issues like knee arthritis from excess weight or obesity-related diseases like type 2 diabetes.

LIFESTYLE CHANGES AND MANAGING OBESITY

Obesity evaluation involves reviewing medical history, performing a physical exam, and conducting relevant tests. This helps rule out secondary causes and detect related health conditions.

STAGE 1 OBESITY

Lifestyle Changes

For stage 1 obesity, focus on personalised nutrition plans, regular physical activity, and behaviour modifications. These steps often suffice to lower the risk of advancing to stage 2 obesity.

Medication might be necessary for: people at risk of stage 2 obesity (such as family history of diabetes or heart disease), significant weight gain (more or equal to 10%) despite following lifestyle interventions, and individuals with a BMI of 27.5 kg/m2 or higher.

STAGE 2 OBESITY

For stage 2 obesity, consistent and intensive lifestyle changes are essential.

Dietary Management

• Reduce calorie intake to create a negative energy balance. Balance macronutrients while cutting calories. Follow low-carbohydrate and ketogenic diets as these are effective for short-term weight loss, especially among those with high-carb diets. Aim for a daily calorie deficit of about 500 kcal through diet and exercise.
• Maintain long-term dietary efforts to prevent regaining weight. Focus on protein and include more protein or supplements to aid weight loss and improve nutrition.
• Ketogenic diets promote fat metabolism by reducing carb intake.
• Choose dietary plans based on personal preferences, nutritional needs, and sustainability.

Role of Physical Activity

Physical activity help with weight loss, preserves muscle mass, and boosts overall health. It works best alongside dietary changes to maintain a negative energy balance.

• Aim for at least 60 minutes of daily physical activity.
• Limit sedentary (inactive) habits and incorporate light-intensity movements.
• Combine aerobic and resistance exercises for better results.
• Tailor exercise routines to individual needs and gradually increase intensity.
• Conduct pre-exercise health checks for those with medical conditions.

Pharmacological Management

• Set realistic weight loss goals and acknowledge potential plateaus during treatment.
• Prepare patients for possible weight regain after stopping medications.
• Use medication alongside lifestyle changes to achieve a 5-10% reduction in body weight within 3-6 months.
• Avoid drugs that promote weight gain and opt for weight-neutral options instead.

Medications for Non-Diabetic Individuals

In India, approved options include orlistat and GLP-1 receptor agonists. Orlistat remains the most widely available anti-obesity drug.