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Calorie content of local foods should be made available digitally: S. Kahandawa

9 months ago

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  • Academic recommends development of web based apps and programmes tailor-made for Lankan society to calculate calorie intake and expenditure
  BY Ruwan Laknath Jayakody Since at present the calorie content of traditional Sri Lankan foods and meals are not freely available and necessary steps need to be taken in order to provide such information to the general public, the development of web-based applications or apps and programmes tailor-made for Sri Lankan society, which calculate both the calorie intake and expenditure, are an attractive way to create calorie-related awareness among the younger generation, an academic noted. Moreover, since a calorie-conscious society is an important concept in reducing the burden of obesity, from childhood onwards, all individuals should be educated on their calorie requirement and intake, with special attention paid to providing information about the calorie content of various foods and meals and the methodology of calculating calorie intake.  These observations and recommendations were made in an editorial entitled “Obesity – The epidemic like no other in human history” authored by S. Kahandawa (Consultant Endocrinologist at the District General Hospital, Matara, and the Editor-in-Chief of the Journal of the Ruhunu Clinical Society) and published in the said journal’s 24th volume’s first issue in December, 2019. Obesity is defined in the World Health Organisation’s (WHO’s) “Obesity: Preventing and managing the global epidemic” as the abnormal or excessive accumulation of fat which is associated with adverse health outcomes. The percentages of Sri Lankan adults in the overweight, obese, and centrally obese categories were 25.2%, 9.2%, and 26.2%, respectively, while per P. Katulanda, M.A.R. Jayawardena, M.H.R. Sheriff, G.R. Constantine, and D.R. Matthews’s “Prevalence of overweight and obesity in Sri Lankan adults”, being of the female sex, living in urban areas, possessing a higher education status, having a higher income, and being middle-aged were shown to be associated with being overweight and obese in Sri Lankans. “In a majority of the cases, obesity is due to a positive energy balance rather than a secondary cause. Excess calorie intake from any source (e.g. refined carbohydrates, processed meat, fast foods) and leading a sedentary lifestyle cause reduced energy expenditure, which in turn leads to weight gain and obesity. The prolonged time spent in front of screens such as the television, laptop, and smartphone is a major risk factor associated with obesity. It is a false belief that genetic factors play a significant role in the development of obesity; a high prevalence of obesity among first degree relatives is observed because they share a common dietary pattern and lifestyle rather than identical genes,” Kahandawa explained. “Obesity is associated with conditions such as diabetes mellitus (where the body does not produce enough insulin or responds normally to insulin, causing blood sugar/glucose levels to become abnormally high), hypertension (high blood pressure), dyslipidaemia (imbalance of lipids), ischemic heart disease (recurring chest pain or discomfort that occurs when a part of the heart does not receive enough blood), stroke (occurs when something blocks the blood supply to part of the brain or when a blood vessel in the brain bursts, and in either case, parts of the brain are damaged or caused to die), obstructive sleep apnoea (caused by the repetitive collapse of the upper airway during sleep and occurs when the muscles supporting the soft tissues in one’s throat, such as the tongue and soft palate, relax), and osteoarthritis (occurs when the protective cartilage that cushions the ends of the bones wears down over time and commonly affects the joints in one’s hands, knees, hips, and spine). In young females, obesity leads to polycystic ovarian syndrome (infrequent, irregular, or prolonged menstrual periods, and often excess male hormone or androgen levels) in which subfertility is a major feature. Furthermore, obese subjects are often stigmatised in education, employment, and health care. Obesity has a negative impact on the productivity of an individual as well,” Kahandawa added. 
  1. Aune, A. Sen, M. Prasad, T. Norat, I. Janszky, S. Tonstad, P. Romundstad, and L.J. Vatten’s “Body Mass Index (BMI) and all-cause mortality: Systematic review and non-linear dose response meta analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants” found that obesity was associated with increased all-cause mortality.
“BMI is the most commonly used anthropometric measurement in the assessment of obesity. In Asian populations, being overweight and obesity are considered if the BMI is 23-24.9, and 25 kilogrammes of force per square metre (kg/m2) or less, respectively,” Kahandawa mentioned.  “Adult criteria used in the assessment of obesity cannot be applied in children because they grow in height as well as weight. Therefore, sex-specific BMI for age charts available in the Sri Lanka Child Health Development Record should be used to asses obesity in children. Childhood overweight and obesity categories are defined if the BMI is between plus (+) one standard deviation (SD) to +2SD, and more than +2SD for age and sex, respectively. “The important components of a weight loss programme are dietary modification, exercise, and behaviour therapy. Special attention should be paid to behaviour therapy which helps patients make long-term changes in their eating behaviour and control stimuli that trigger overeating. Setting up realistic goals and frequent reinforcement are the principal determinants of a successful weight loss programme. Web-based apps and weight loss programmes and schedules can be used effectively in obese individuals who are competent in information technology. “Drug therapy in the management of obesity is only complementary for diet, exercise. and behaviour therapy. and the initiation of such intervention should be decided on an individual basis.” “We, as a society, should make a collaborative effort to tackle the current epidemic of obesity. The first step is to change the attitudes towards obesity. Some in our society still consider obesity as a symbol of prosperity and wealth. We should move away from this attitude and consider obesity as a sign of ill health. During pregnancy and lactation, women gain significant weight due to the belief that they need to significantly increase their food intake in order to accommodate both the mother and the foetus. It is therefore the healthcare provider’s responsibility to advise mothers on adequate, balanced nutrition, and target weight gain on an individual basis rather than giving blanket advice during this period. “It is necessary to develop infrastructure facilities throughout the country in order for the people to engage in exercise and sports. Cycling should be encouraged as a mode of transport. “It is the duty of the leaders in healthcare delivery to create awareness about the epidemic of obesity and make use of every opportunity during individual patient consultations, at one’s workplace/s and in social gatherings to educate the general public on how to overcome obesity. Obesity does kill people and hence, it is important to confront obesity with serious intent and full force,” Kahandawa emphasised.

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