CONSULTANT cardiologist Dr Andrene Chung is urging Jamaicans to seriously consider the issue of obesity and being overweight, as both pose serious risk of cardiovascular diseases.

Though she would not describe obesity and being overweight as reaching epidemic proportions in Jamaica, Dr Chung told the Jamaica Observer that “it is a serious problem that we need to be paying attention to”.

Dr Chung, who is also the new chair of the Heart Foundation of Jamaica (HFJ), was speaking at last Tuesday’s HFJ launch of Heart Month at Spanish Court Hotel in Kingston. Heart Month, which is observed in February, is being recognised this year under the theme: ‘Obesity, a weighty matter’.

The consultant cardiologist explained that obesity is a risk factor for non-communicable diseases (NCDs), which is a huge burden worldwide.

She said NCDs are the leading cause of morbidity and mortality worldwide, and that the top causes of death in the world now include coronary artery disease; stroke and other cerebrovascular disease; cancer; and chronic obstructive pulmonary disease, which is a type of long-term lung disease closely associated with tobacco smoking.

The doctor said that, over time, the major risks to health have shifted from the more traditional issues, like unsafe water, poor sanitation and poor nutrition, to more modern risks such as overweight and obesity.

“In the Caribbean, five times as many people die from non-communicable disease than from all other illnesses combined, and 10 times as many people die from non-communicable diseases than from HIV/AIDS,” she said.

She pointed out that the four leading causes of death in the Caribbean in 2000 were heart disease, cancer, stroke, and diabetes. That has continued to escalate.

“And these conditions all have common underlying risk factors. They are unhealthy eating habits, lack of physical activity, obesity, excessive tobacco and alcohol use, and inadequate utilisation of preventive health services,” Dr Chung explained. “So we wait until we are sick and become a burden on the health system rather than preventing the conditions.”

The HFJ chair defined being overweight as an excess amount of body weight which can be from muscle, bone, fat, or water. While obesity is defined as an excess amount of body fat.

“So, for example, you can have people with a large amount of muscle who weigh a lot, but they are not considered to be obese, in the true scientific sense of the word,” she said.

OBESITY

Obesity, according to Dr Chung, is measured by a number of different indices, but the most common is the body mass index (BMI), which is a person’s weight in kilogrammes divided by their height in metres squared.

Dr Chung explained that the differerent categories of weight status include underweight in which your BMI would be less than 18.5. Normal is considered to be 18.5 to 24.9 BMI. Overweight is 25 to 29.9, and if you are 30 and above, you are considered to be obese.

“Within that category there are certain sub-categories,” Dr Chung told those gathered for the launch, which was also the launch of the HFJ’s 45th anniversary.

“So we can see 30 to 34.9 would be obese class one, 35 and over you are considered to be morbidly obese… then, of course, those who are 40 or greater, it is extreme,” she continued.

Dr Chung said that, in Jamaica, because of urbanisation, there have been increased levels of obesity and decreased levels of physical activity.

“In the Jamaica Health and Lifestyle Survey done in 2000 to 2001, you can see that the proportion of women who are overweight, or obese was 60 per cent,” she shared. “Thirty per cent of men were overweight or obese, and the levels of low physical activity is 21 per cent. But, 51 per cent, that is half of the women, had what was considered to have low physical activity.”

She said when the survey was repeated in 2007 to 2008, “we found that 65 per cent of women were considered to be overweight or obese and 38 per cent of men”, which was not an improvement.

“The levels of low physical activity were 16 per cent in men and 43 per cent in women, so it marginally improved; but the obesity rates were obviously still unacceptable,” she continued.

Dr Chung said, when both studies are compared, the overall level of obesity had increased from 2000 to 2007 in the population in general.

“So, we are not doing well,” she insisted.

CAUSES OF OBESITY

Regardless of underlying conditions, Dr Chung said the principal causes of obesity are inactivity and unhealthy diet and eating habits. She pointed out, though, that there are a number of risk factors and contributing factors.

“There is no question that there can be genetic disorders, because some people just don’t process calories as quickly as others. They don’t burn off calories and how the fat is stored in the body may be different based on genetic make-up,” she said.

The consultant cardiologist posited that family lifestyle is also important, because obesity tends to run in families, which is, to some extent, genetic, but it can be environmental.

“If you grew up in a family where you have unhealthy eating habits, those are the habits you will have. If you are not accustomed, as a family, to exercise or to being active then that is the lifestyle that you will have,” she asserted.

“In Jamaica, we are now having more and more fast food, we are having larger portions, we are having large amounts of sugar, sweetened beverages,” Dr Chung posited. “So we are having less fresh fruits and vegetables and this is a huge contribution to the development of obesity.”

The doctor said there are medical problems that can cause people to be more likely to gain weight.

“This is not as common as obese patients would have you think, but there are some conditions, there are certain hormonal disorders that can cause this,” she said, adding that there are also medications that can cause one to gain weight, such as steroids and some anti-hypertensive medication.

Certain social and economic situations, such as a safe place to exercise, were also thrown into the mix.

“So, if you have no safe place to exercise, if you have never been taught how to prepare food healthily, if you cannot afford to buy healthy foods, then this is going to have an impact on whether or not you are likely to become overweight or not,” she said.

So will ageing.

“As we age, it is harder to keep the weight off. There are hormonal changes that will tend to increase your likelihood of putting on weight. We tend to become less active as we get older and, as we age, you have less muscle mass, so your metabolic rate also reduces — you don’t burn off the calories as quickly as you used to,” the doctor said.

She said quitting smoking is also often associated with an increase in weight, but categorically stated that the Heart Foundation’s position is that quitting smoking is a far greater health benefit than continuing to smoke.

Lack of sleep or too much sleep and pregnancy rounded out her list of factors that might contribute to weight gain.

“There are hormonal imbalances that occur that will tend to increase your appetite and make it easier for you to eat more and put on weight,” she explained.

HEALTH RISKS ASSOCIATED WITH OBESITY

Dr Chung listed type 2 diabetes, heart disease of different varieties, high blood pressure, stroke, and cancer as the health risks related to obesity.

“Obese men are more likely than non-obese men to die from cancer of the colon, rectum and prostate,” she explained. “And obese women are more likely than non-obese women to die of cancer of the gall bladder, breast, uterus, cervix, and ovaries.”

Some of the other conditions associated with obesity include gall bladder disease and stones, osteoarthritis, gout, and breathing problems of different kinds.

“Someone who is 40 per cent overweight is twice as likely to die prematurely, and medical professionals now agree that if you are 20 per cent overweight, you should be actively pursuing programmes to lose weight, especially if you have high blood pressure or diabetes,” the consultant cardiologist said.

“And, if you are less than 20 per cent overweight, but you have hypertension, heart disease, diabetes, then you should definitely start trying to lose weight at that point in time. You do not wait until you become 20 per cent overweight to start because your risk has already started,” she continued.

TREATING OBESITY

Treatment for overweight needs to be long-term, it cannot be short-term, Dr Chung insisted.

“It needs to be a lifestyle change. Weight loss should be gradual and careful. Follow-up is needed to prevent rebound weight gain,” she explained. “Crash diets do not work. Yes, they take weight off, they take the weight off quickly, but the important thing is to maintain that weight loss.”

She pointed out that no weight loss diet has been found to be more superior than any other. Instead, she said the bottom line is to burn more calories than your intake, which means increased physical activity.

“You need to change your behaviour and lifestyle to focus on gradual, permanent changes in eating and exercise,” Dr Chung continued. “…You need to learn about nutrition, change your eating habits, increase physical activity — these are the cornerstones of weight loss and maintenance of weight loss.”

The consultant cardiologist pointed out, too, that attitudes to eating should be changed.

“In all the time I have been practising, I have never had one overweight person say to me ‘the reason I am overweight is because I eat too much’, but I have had many of them say to me ‘I don’t know what I eat enuh, doctor, because I hardly eat anything’,” Dr Chung shared.

Drug therapy is another form of treatment, and surgery for the extremely obese may be necessary. She was quick to point out, however, that most patients who are obese do not need surgery and can lose weight through a process of reduced calorie intake and increased physical activity.

“The treatment of obesity and maintenance of a healthy weight will have a positive impact on personal health and on the health of the region in general,” Dr Chung said. “Given the role of obesity as a common risk factor for many non-communicable diseases, even a modest weight loss of 10 to 20 pounds can bring significant health improvements, such as lower blood pressure and cholesterol levels. It is well worth it.”

Dr Chung said the more obese a person is, the more likely he/she will to have health problems and concluded that obesity is a weighty matter, but reducing it is achievable.