OBESITY
What Medical Science Says
DR.VIKRAM RAJADNYA
MBBS, MD
CLINICAL NUTRITION
NIN (National Institute Of Nutrition )
WHO (World Health Organization)
ICMR (Indian Council Of Medical Research) Govt Of India
OBESITY CONSULTANT
APEX
MEDICAL FITNESS
www.apexmedicalfitness.com
OBESITY What Medical Science Says
OTHER CONTRIBUTING AUTHORS
1) DR.MILIND V. BHUTKAR
MBBS , MD ( PHYSIOLOGY )
PROFESSOR AND HEAD OF THE DEPARTMENT
M. R. MEDICAL COLLEGE ,GULBARGA
MEMBER OF THE BOARD OF STUDIES,
RAJIV GANDHI HEALTH UNIVERSITY.
2) DR.PARESH P. KULKARNI
B.A.M.S, D.P.P .H.
DIRECTOR AND CONSULTANT,
APEX MEDICAL FITNESS PVT. LTD. AND DOCTORS GYM.
3) MRS. CHAITRA V. RAJADNYA
B.A. PSYCHOLOGY ( PUNE UNIVERSITY )
M. A. PSYCHOLOGY ( SAYAJIRAO GAIKWAD UNIV. BARODA )
ACTING HEAD OF THE DEPARTMENT, NEW COLLEGE , KOLHAPUR
4) DR. MRS RAJASHREE P . KULKARNI
PRIVATE PRACTITIONER
B.A.M.S.
OBESITY
What Medical Science Says
DISCLAIMER
This book is intended to deliver scientific information, as well as some strategies for
self - help to the concerned reader. The information and advice contained in this book
are based on the experience of the experts in this field, as well as the latest medical
knowledge available. Every attempt has been made to accommodate up to date
knowledge and concepts.
But the authors do not wish to take any responsibility for the use of the information
contained in this book. The reader should use this information on his / her own
responsibility. It is expected that one who wishes to use the information contained in
this book would consult an expert in advance .
IN SHORT ABOUT THE PRINCIPAL AUTHOR
Dr. Vikram Rajadnya completed his MBBS and MD from one of the prestigious medical
Colleges in India, the B.J. Medical College, Pune .
Right from his school days he is an avid fitness and sports enthusiast. He himself is a
National medal winner and had been the captain of the Pune university team at all India
Inter university levels. Even during his medical education he was always inclined
towards nutrition, exercise, sports medicine. He has worked at the famous Pune
based yoga institute – Kabir Baug .
After completing his MD he obtained training in nutrition from NIN ( The National
Institute of Nutrition, Hyderabad).which is most premier Institute in nutrition research
and training in south east asia region .
This is an Institute of ICMR ( Indian Council of Medical Research ) Government Of
India. NIN is also a WHO ( World Health Organization) center for nutrition
Education and research.
He is also specially trained in obesity, and certified by the IASO ( International
Association for the Study of Obesity), the worlds largest body in obesity Research
and training.
Dr. Vikram Rajadnya has also published numerous research papers in medical
Journals and, presented his research at conferences. Thus he is one of the most
qualified doctors in this field. He has also delivered Lectures on Akashwani ( All India
Radio), on numerous occasions.
OBESITY What Medical Science Says
Currently he is working as a director of Shardh institute and Apex Medical Fitness Pvt. Ltd.
both based at Kolhapur. Kolhapur, the hometown of the author is a very rapidly progressing
city in Maharashtra State. Here he has a long nine years experience in dealing with sports
persons, fitness Enthusiasts and patients suffering from obesity , Diabetes, Hypertension ,
Heart disease , Knee osteoarthritis, PCOS, Pediatric obesity., using most up to date
nutrition and exercise Principles
ACKNOWLEDGEMENT
I am thankful to all those, who helped me directly or Indirectly while writing this book.
All my family members, my colleagues , other contributing authors, my staff members, my
clients and patients, my friends, all have helped me in one way or the other.
Even if it is not possible to mention them all by name, I know that their contribution has been
invaluable. Smt. Ujjwala Prafull Deshpande whose proof reading and suggestions make
reading this book an enjoyment. My long time friend Uday Kulkarni, for his support and
encouragement during some bad patches while writing this book.
Last but not the least, the readers and users of this book, who are at the center of my
inspiration to write this book.,,
Thank you all.
DEDICATION
I dedicate this book to all my family members . My mother who has played a key role in
making me whatever I am today. My brother who encouraged me all those years. His
whole family who supported, his support for me. Neeraj, thank you for the photographs .
My in laws who were the major force behind starting my first clinic. My wife who kept me
away from all the hassles of daily life while I was busy writing this book.
My daughter and son who make me forget all the efforts, difficulties of the day when I see
them in the evening. Father, you are my most ideal patient.
AUTHORS NOTE
Almost world over the prevalence of overweight and obesity is on rise, so also that of
closely related diseases such as Diabetes mellitus, Hypertension, Cholesterol related
diseases, Knee osteoarthritis, some cancers , PCOS (Poly Cystic Ovarian Syndrome).
It is estimated that almost 60 percent of the USA population is either overweight or
obese. We Indians are not far behind. Its only that the prevalence in Indian population
is not correctly known. The economic, health related, negative work related impact
of obesity is astounding. There is an urgent need to take this menace seriously both at
the population level and at the individual level.
OBESITY What Medical Science Says
But sadly the experts dedicated to research, prevention and treatment of this
problem are very few in numbers, at least in this country. Many who practice as obesity
consultants are either not doctors or if doctors are not really trained in Obesity.
This is the reason why real treatment does not reach upto the needy. Many a times
treatment given by such less qualified persons may be very rigid, less effective or worse
harmful. For example it is commonly held that all foods we like must be abandoned
during the treatment of obesity. This approach has far reaching negative consequences
than we realise. In practice how ever one can enjoy non vegetarian foods, sweets, some
fast foods etc. And still do very well during weight loss.
Considering all this, we have written this book. The book also takes into account the
unique requirements of Indian population. In many ways we are quite different from the
Europians and Americans. Thus a book written by an expert from these countries may
not be as useful for us.
I am sure this book will prove to be useful .
OBESITY What Medical Science Says
26) EVALUATING YOUR OBESITY BASED ON BMI AND WAIST CIRCUMFERENCE.
WHO ( World Health Organization ) puts a lot of emphasis on evaluating obesity based
on BMI and waist circumference measurements. Recently scientists in India under the
guidance of the WHO have developed BMI and waist circumference based guidelines
for Indians.
These are accepted now by the department of health Government of India, thus,
1) If your BMI is between 23 and 25 kg / meter square then you are overweight.
2) If your BMI is greater than 25 kg / meter square then you are obese.
This is applicable for both adult men and women.. in addition to this,
If your waist circumference is,
--- More than 90 cm ( Men)
--- More than 80 cm( Women)
Then there is a reason that you should take your weight more seriously. Guidelines for
classifying obesity in Indian children are also available.
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32) WEIGH ONLY ONCE A WEEK
This is the most crucial statement I would make regarding Anthropometry. A lot of people
under treatment tend to weigh themselves daily sometimes many times in a day. This practice
is unnecessary and many a times harmful for your weight loss attempts. Daily changes in weight
are mostly due to day to day variation in the hydration status of the body that is the fluid content
of your body, and some other factors. In addition, in women ,weight may change during various
phases of their menstrual cycle. Thus daily variations in your body weight are not due to variations
in your body fat but actually are due to factors mentioned above.
One example of one of my patients illustrates this. Pratima (name changed) used to weigh
herself daily and accordingly used to change her food and fluid intake daily.
One day in spite of following her recommended diet and exercise her weight showed a rise of
400 gm, as compared to the previous day. She restricted her food and fluid intake that day.
This was totally wrong on her part. This is an absolute no-no in your diet and exercise routine.
Actually her 400 gm gain was not due to fat gain but was due to the factors mentioned before.
Pratima often followed this practice of changing her diet daily according to changes in her body
weight . This used to cause much stress for her. Overall, this whole practice had become a very
unhappy and stressful experience for her. By now the readers may have realized how apparently
very trivial practice such as watching your weight daily can create such a negative impact. Next
section will tell you what Pratima should have done instead.
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49) THE STORY OF A DIABETIC PATIENT TRYING TO LOSE WEIGHT.
One of my new patients, a diabetic trying to lose weight had a counseling session with me.
She said ”Doctor I have tried weight loss many times. Every time I manage to lose some weight
but eventually regain all the lost weight. And here I am, with no actual progress after all these
years of such attempts.” She also said, “every time i lose some weight it feels like heaven.
But my way to heaven goes through hell.” Why ? I managed to get the answer. Every time she
decided to lose weight she used to be very strict with herself. She used to avoid all the foods she
liked or enjoyed. Especially the non vegetarian food, and some nuts. She also used to eat very
restricted amount of food and used to exercise a lot, sometimes excessively. This way she used
To torture herself. She used to lose a substantial amount of weight in a few months. But eventually
she used to get fatigued with all this torture. Then slowly she used to stop her stressful lifestyle.
But once stopped, used to lose all her control over her eating, and sadly used to regain all her lost
weight in another few months. She was initially in a shocking disbelief when I managed both tasty
non vegetarian dishes as well as nuts in her diet plan. Later she realized the real difference between
a diet which deprived her of everything she liked and the one which allowed her to indulge in such
foods at least to some extent. The first type of diet which deprives you, is very easy to prescribe. The
advisor may not need to have a lot of knowledge and skills. Even some magazines and books will
publish such diets.
The later type of prescription which allows you to eat, requires real knowledge, skills, and close
supervision, on the part of the consultant. The first one feels like going through hard labor, the
later being very comfortable and enjoyable. The former is impossible to follow for a long time
and thus results achieved with it are short term. The later is more likely to be followed for a long time
and thus the results achieved are likely to be sustainable. Many a times those who are trying to lose
weight especially diabetics are given a list of forbidden foods. If you look at such a list the life will start
looking worthless. Today the modern medical science says, that a diabetic can enjoy many if not all
the foods he or she likes. Rather it is unethical and criminal to impose unnecessary restrictions.
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52) MILK AND HEALTH
One of my doctor patients once suddenly stopped her milk intake altogether. I had prescribed
milk along with other regular foods in her diet.
This doctor was suffering from obesity and cholesterol related problems. She was advised
to stop milk completely, by another doctor. It was feared that the saturated fats in the
milk will further aggravate her cholesterol problem. This may be one of the worst advices
you can get. Milk is a good source of good quality Proteins, Calcium, some Vitamins and
Minerals. Diet of many people provides calcium, mostly through milk. The question of
saturated fat intake can be easily sorted out. Whole milk of the buffalo contains 6.5 gm of
fat per 100 gm of milk. This quantity can be reduced to a large extent, if you boil the milk
twice and keep it in the refrigerator and remove the cream. It is also a good idea if you
use reduced fat milk which is available.( but one has to be careful while choosing one. The
label on the milk carton may be misleading). Remember calcium in the form of tablets can
never replace the calcium intake through diet.
Next, in the belief that the cow milk contains less fat than the buffalo milk many may prefer
it. But this is not entirely correct. Rather, for the same calcium intake you need to
consume the cow milk in such amounts that, you will land up consuming rather more fat.
Thus, for many of us milk proves to be an essential component of our diet.
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59) THE MYSTERY OF THOSE 4 DAYS OF WEIGHT LOSS CAMPS.
I often hear from my patients and get so see testimonials of patients on some TV channel,
proudly talking about 1 kg, 1.5 kg, weight loss in 4 days and so on. I often wonder how
easily these people are cheated. Someone should really tell them the science of weight loss.
Remember almost 70 percent of weight loss you achieve in initial 4 days is due to water
loss from the body. Thus almost 700 gm kg of 1 kg lost weight is water.
Fat loss will start occurring to a significant extent only after about 8-9 days of the treatment.
60) DOCTOR I HAVE BEEN FOLLOWING YOUR PRESCRIPTION, I HAVE BEEN DOING WELL ALSO
But, a friend of mine has tried a diet which I am thinking of following for further weight loss.
I said “ fine, lets discuss this issue.” I asked her “ what kind of a diet do you wish to follow ?”
She said “a diet where I am supposed to eat only fruits for 7 days. Then add only vegetables,
then something else and so on.”
I said “lets discuss whether the plan you are thinking is nutritionally sound. Does this provide
good quality proteins right from the beginning, in the quantities required for your age,
weight etc.? What about dietary iron supply ? You are a 20 year old girl, who menstruates
every month. Have you ever considered, how much iron do you need to eat daily ?. What
About your calcium needs, what about oil and so many other things ? ”
Ask your friend about the quality of life she lead when she was following this diet. Was she
feeling full of energy during this period ? Was she able to exercise comfortably ?
Finally ask yourself, how long can you sustain this kind of eating pattern? Because once
you stop this drastic practice and resume your usual eating, do you guarantee that you
won’t put on weight again ?
Also tell me, if any magazine, newspaper, internet page can describe this diet for you, and
if it would have been good for you wouldn't I give this plan to you myself ?
Finally this particular patient was convinced and she kept herself away from this. Unfortunately
not many people can stop this urge to try this miracle diet. Such diets look very promising
and lucrative on paper.
Every now and then, someone comes with some new diet plan, invented by him / her. Most
of the times these are likely to fall in the category called as fad diets and most of the times,
If not all the time these are likely to be useless and harmful.
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69) HOW INTENSLY SHOULD I EXERCISE DURING EACH SESSION ?
It is accepted that deciding about the intensity of exercise that is how hard one should
exercise is the most important and most difficult part of exercise prescription. It is always
desirable to develop individualized guidelines, but some general aspects are considered
here. Chosen intensity depends on many factors. Generally speaking, for someone who
is trying to lose weight a moderate intensity physical activity is recommended. The one
which does not put you under a lot of physical and psychological stress is appropriate.
The best indicator for you to know that you are exercising with a correct intensity is that you
should be able to talk without being excessively breathless while exercising. This is
known as conversational intensity. Other and more sophisticated ways are also available
such as using heart rate monitors while exercising. These monitors help you yo to remain
in prescribed intensity and will warn you if you are exercising at very low or very high intensity.
A lot of research has been done on this aspect and recommendations based on your heart
rate, perceived exertion are available. Contact an expert to know more about this.
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Given a choice, patients select high intensity of exercise in a belief that this will burn more
calories and help faster weight loss. In some gyms I have seen people walking on a treadmill
at such speeds which puts them under a lot of physical stress. They walk at such a speed
that its looks as if they are at war with something. This may also put them under constant
danger of orthopedic injuries. Such exercise bout may also leave them tired and fatigued
the rest of the day. Never underestimate the ability of apparently very low intensity activities
to burn substantial calories for you. For example some cooking activities can burn almost
3.54 kcal per minute which is just slightly less than that with walking at an average pace.
One may defend that people manage to reduce weight using very high intensity while
exercising.. I insist that it may be true, but they may not get the full benefit of fat burning an
activity is capable of. As you go on increasing the intensity of exercise, beyond a certain
limit the body shifts away from fat burning, switches to burning more carbohydrates. This is
not desired for our purpose. On the other hand as I mentioned such high intensity activities
put you under some health risks. Thus the risk is more than benefit. In scientific language the
risk to benefit ratio is working against you.
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83) TO START PLAYING TENNIS , BADMINTON FOR WEIGHT LOSS IS NOT A GOOD IDEA.
Sometimes people join Tennis, Badminton or even Soccer clubs for getting exercise to
lose weight. These games or sports need unique physical capacities. People with obesity
usually have reduced their capacities, which may not allow them to play properly. At the
same time such people may be highly prone for injuries which such games might bring.
Actually speaking those with weight problems or obesity, should do very safe and non
competitive exercises under proper guidance, improve their physical capacities or fitness,
and once conditions are appropriate, then only should think of joining Tennis clubs etc.
Mind you, serious sports centers put you under proper body conditioning including training
with weights before you are allowed to touch, even a Golf club.
This science is much more evolved than many of us may understand.
85) DOING ABDOMINAL SIT UPS OR CRUNCHES TO REDUCE ABDOMIAL FAT
Many, including some doctors, are under the impression that doing abdominal sit ups or
crunches or some other abdominal exercises will reduce fat in that area. People do these
one after another, for days together without any effect. Actually it is a myth. This is called
as spot reduction. It means exercising only that area where fat has accumulated.
Please do not do this. You will waste your time. Exercise physiologists world over have
proved this years ago. I am surprised why this kind of concrete conclusion doesn't reach us.
Why we feel better after doing crunches is not because of fat loss but because of tightness
in that area. Done over a period of months together this may also help to improve
muscles in that area. But again this doesn't reduce fat there. “so, does that mean that I
should not be doing crunches at all ?” one of my young patients asked me.
I said you can always do the crunches, but keep in mind that you will be doing these for
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the sake of muscles in that area and not for the fat. Thus, you do not chase a false aim.
Many gyms advertise special so called Abs batches. They claim to reduce fat through abs
exercises. People believing That these gym people might be knowing some secrets that a
qualified doctor may not know, faithfully join such batches. These abs batches have become
a fashion today. Similarly some abs machines or pieces of equipments also claim to reduce
fat . Do I need to tell you that these are fake? Apart from this, doing abdominal sit ups might
be dangerous for some patients especially those suffering from low back pain of certain type.
The details are beyond the scope of this book.
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90) PEER PRESSURE
Raksha a teenager and her group of friends were new in a college. Her group met daily
and discussed about lot many issues. One issue which frequently appeared during their
discussions was their appearance, body weight, looks. It seemed they all admired
thinness of an actress they all liked and adored. It seemed these girls would not accept
anyone who is not thin. Raksha always had this pressure in her mind. She developed
an intense fear about her weight and about getting fat, though actually she was a normal
weight person. She devised many plans of her own to keep her appearance and weight in
her own desired range. She started dropping her breakfast, skipping her meals and so on.
One day she found out about a new plan which allowed her to eat whatever she wanted
and then vomit it afterwards. She was very happy with this new plan. She felt much
relaxed every time she vomited. She also managed to hide this from everyone.
This is a typical picture of a condition called as bullemia Nervosa. (but mind you this is
only an illustrative writing. It is not meant for scientific presentation in its strict sense)
Only a very thorough history taking and evaluation will be able to detect this problem.
It may be associated with some other conditions such as depression, low self esteem.
Patients like Raksha need a good program including counseling regarding this condition,
the psychological and medical consequences it may be associated with, counseling
her about what is normal regarding appearance, body shape, counseling her about peer
pressure, choosing wrong idols or role models and so on.
Finally a sound nutrition and exercise prescription was offered to her. To summerize,
there are many issues apart from the one discussed here. It is obvious that a teamwork
offered by specially trained doctors and their teammates is essential
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92) THE TRAP OF BLACK AND WHITE THINKING
Black and white thinking can also be called as all or none thinking. This is especially
common in people with obesity.
Manali was trying to reduce weight. She had already decided on her own about her dream
weight, which was about 30 kg less than her current weight. Her therapist also made her
believe that this was easily achievable. All their efforts were geared towards achieving this,
30 kg weight loss as quickly as possible. This was a real stressful situation for both the
therapist and Manali. Manali had to sacrifice so many things. She had to go through real
hardship to achieve her set target..Ultimately she managed to reduce 20 kg of her weight.
But she was not very happy with this weight loss. Ultimately she started thinking that all
these efforts were not worth it. She started neglecting the lifestyle changes( that is nutrition
and exercise ) which were required to maintain this weight loss. Ultimately she regained all
the 20 kg back. Today she is a very unhappy woman. What went wrong? First the therapist
and Manali both had set a wrong goal. I do not say it is not achievable, but Manali’s situation
was such that this was an unrealistic goal for her. Her therapist, not so well trained in goal
setting misled Manali, into believing that any amount of weight loss was possible. Second,
the means that is the lifestyle changes they chosen were so drastic that, these were really not
sustainable over the long term. Third, Manali and the therapist did not realise the importance
of the 20 kg weight loss which was achieved. This amount of weight loss is really Incredible
by any standards. Fourth, because of this Manali did not put an efforts to maintain this
weight loss and regained all the weight .
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Does this story sound similar ? Actually this situation can be compared to that in our SSC
exams. Its like saying that it is worth only if I achieve 95 percent marks. Anything less
than this is worthless. This is a black and white thinking. Many situations in obesity
management make people think in black and whits terms. Remarks like, I want to lose
weight. So from tomorrow, I will stop eating meat, stop sweet dishes and many other foods
I like. I will take compulsory 1 hour exercise and so on. Usually such high aims though
look very good on paper, are mostly meant to fail., or are likely to be short lasting.
Rather one should say, I will restrict certain foods to a comfortable level,. I will start
exercising and then go on increasing as per my own comfortable pace, let these changes
be not only effective but also sustainable. And to achieve effective, safe, practicable,
enjoyable, changes, you will need a real expert. Do not ever believe that any particular
food or exercise is a miracle. On the other hand its not that any particular food is harmful
for you if you eat it under proper guidance.. It is the scientific, intelligent plan specially
made for you that will help.
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