The Hindu Business Line : Shooting from the hip

The problem arrived after two children and a decade of marriage. Rohini Khanna's body-mass started increasing when she hit the mid-30s. From a petite 55 kg, the distressed software engineer now tilts the weighing scales at 69 kg.

Rohini is not alone. A growing number of 35-plus urban Indian women are falling prey to sedentary lifestyles, rich food, lack of exercise and a gradual slowing of the metabolic rate.

Obesity in urban women is worrying the medical fraternity. Stressful jobs, hectic schedules and rich food all play havoc with the body leading to the accumulation of extra body mass. Excessive weight in women is also seen as the cause for related diseases like diabetes, cardiovascular ailments and high blood pressure.

Says Dr Rajeeve K. Rajput, Senior Cardiologist at Delhi's G.M. Modi Hospital, "Some of the most common causes of heart disease are unhealthy diet, inadequate exercise and genetic predisposition." Doctors use two parameters to measure obesity. The first is general obesity — which encompasses the whole body, and the second is truncal or central obesity, where fat is concentrated only on the waist and the hips. "Truncal obesity leads to a combination of diseases including diabetes, high cholesterol, insulin resistance and hypertension," he says.

A study by the All India Institute of Medical Sciences (AIIMS) shows that in urban centres, especially in north India, over 50 per cent women and 40 per cent men are overweight. The ratio of weight-to-height and waist-to-hip circumference is higher in urban areas compared to rural areas. The study formed part of a multi-centric survey of the risk factors for heart disease and was organised by the Indian Council of Medical Research (ICMR).

Going strictly by international standards, the study shows that in the 35-59 age group, 48.7 per cent of urban Indian women in north India are `apple shaped'. This basically implies that the women have protruding bellies defined by the ratio of waist-to-hip circumference. In contrast, only 33.9 per cent rural women in north India are overweight.

Says Dr Rajput, "The risk of heart disease in women with waistline exceeding 35 inches increases two to three times. A waist-to-hip ratio of 0.8 or higher in women defines upper body obesity and is an independent predictor of disease risk."

Dr Manju Virmani, a Delhi-based breast-imaging specialist and radiologist, says excess fat deposit in a woman's body can also give rise to gall stones, menstrual irregularity, osteoporosis and serious interruption in the sleep pattern.

Some of these ailments can't be detected in the initial stages, but they trouble a woman in her middle age and after menopause, when the body's resistance starts weakening.

The AIIMS study confirms the findings of another research conducted by Personal Point, a chain of fitness centres across the country, which show that city-based women in India are more prone to obesity compared to their western counterpart. The two main culprits, says this study too, are rich and oily food and lack of physical work or exercise.

Covering a cross-section of women in seven metros and ten smaller towns, the findings suggested that women in villages and smaller towns were healthier and far more balanced in their body mass index (BMI).

"Women in rural areas do a lot more manual chores because of the absence of gadgets. Washing clothes, scrubbing floors, lighting fire, carrying water... these are all strenuous exercises that burn excess calories," says Dr Shobha Kaul, managing director of Personal Point.

In cities, says the report, automation has done away with most manual chores. "You have washing machines, vacuum cleaners, food processors, mixers, grinders and microwaves — a plethora of gadgets that have virtually eliminated hard work. Thus hardly any calories are burnt in household chores and women usually spend a lot of spare time in front of the TV, usually with a snack," she adds.

In the case of working women, computers, telephones, fax machines and the Internet have reduced manual work in offices.

More surprisingly, the study says that besides these commonly known facts, the other contributory factor for increasing waistlines and broadening hips in women over 35 may be the lack of sexual drive in the husbands.

Many women respondents have admitted that their partners reach home late and are tired and stressed about their business or job. They have dinner and go straight to bed. The woman who craves for attention feels unwanted. When this pattern persists, she loses interest in looking good and goes on a food binge.

Doctors say women must have a strict control over their diet and follow an exercise regimen to avoid coronary complications. In the case of overweight expectant mothers, the problem gets complicated as the child could fall prey to similar diseases and run the risk of a heart ailment.

Dr Rajput says exercising is the best way to lose weight and keep fit. "Working out at a gym at least three days a week is a must. For those who cannot take out the time, half an hour of brisk walking on an empty stomach should also do the trick. Yoga helps but only if supplemented with exercise."

Apart from this, he suggests a diet that is low in fat (especially fried stuff and sweets), proteins and carbohydrates but rich in vitamins and minerals. The daily calorie intake should be proportionate to day-to-day activity.

With the growing incidence of obesity, the urban Indian woman is beginning to feel the burden of associated chronic diseases. Only a controlled diet and regular exercise can save her from this oversized load.

Fat track

Body mass index (BMI) is a measure of body fat based on the height and weight of a person.

A BMI between 18.5 and 24.9 is considered the normal range.

Obesity can lead to depression and hypertension.

A waist-to-hip ratio of 1 or higher in men and 0.8 or higher in women is indicative of upper body obesity.

Obese patients between 20 and 40 years may experience a 12-fold reduction in life expectancy.

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