Thursday 23 May 2019

Dear Dr Nina: My daughter insists she's happy but I would really like her to lose weight

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

Question: My 35-year-old daughter is very overweight. She tells me she is not in the obese category, but rather the middle of the overweight category. I would really like her to lose weight as there is a history of breast cancer in our family on my side and heart disease on her father's. She insists to me that she is happy as she is and is healthy - she recently had a check-up and her blood pressure and cholesterol were fine. Is it possible that she is healthy being in the overweight category? I keep reading all these articles about the dangers of being overweight.

Dr Nina replies: There is no denying that obesity is bad for your health. It has been linked to heart disease, diabetes, liver problems, breathing difficulties, arthritis and various cancers including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon.

Obesity is defined as having a body mass index (BMI) over 30. Worldwide obesity has more than doubled since 1980. In Ireland, the prevalence of obesity amongst men was 26pc in 2011, and among women it was 21pc. Data from the 2015 Healthy Ireland Survey show that 60pc of the population aged 15 years and over are now either overweight or obese - 37pc are overweight and a further 23pc are obese. In children, the estimates are approx 25pc overweight and 7pc obese.

Irish people are among the heaviest in Europe. So what is the cause of this problem? The answer is fairly simple - we are eating more calories and exercising less than previous generations. Sales of ready-made meals, fast food and high-calorie snacks are booming - however, one in five adults report no physical activity on a weekly basis. We are thinking about obesity - 43pc of people admit to being concerned about their weight. They are right. Studies have suggested that for a BMI between 30 and 34, life expectancy is reduced by two to four years. Having a BMI over 40 reduces life expectancy by eight to 10 years - the same as smoking.

A BMI between 25 and 30 means you are overweight. While it is good that these people are not in the obese category, it doesn't mean they should be complacent about their weight as the chances of a slow, steady gain bringing them eventually to obesity is quite high.

The talk recently is about 'healthy overweight'. This is a group of people who are fit and active, don't smoke, don't drink excessively, eat well and follow a healthy lifestyle. Studies of fat cells in "metabolically healthy" overweight and obese people show that they are undergoing the same change that any other obese cell shows as regards insulin resistance. If you lead an extremely healthy lifestyle, it is actually extremely unlikely that you will find yourself overweight. If you do, it is important not to consider oneself OK just because the BMI is below 30. In the same way those with a normal BMI who smoke, drink excessively and don't exercise are not healthy either.

The message is simple - a healthy lifestyle overall is important. Weight is one of a number of chronic disease risks. It is important not to focus on purely one factor but to aim to be healthy overall. If a healthy lifestyle is the focus, it is likely health and BMI will fall into line. This is your greatest chance of adding years to your life, but most importantly life to your years.

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