Beyond BMI Unveiling the Best Tools for Healthy Weight Management

One of the most concerning health challenges facing modern society is obesity. Obesity increases a person’s risk of developing many health problems. Studies show that people with obesity die younger than people who have a healthy weight. The studies also show that the risk of death goes up the heavier a person is. The degree of increased risk depends on how long the person has had obesity and what other medical problems they have. People with “central obesity,” those carrying extra weight in the belly area, might also be at risk of dying younger. EBR’s Dr. Brook Genene takes a closer look at this health issue and how it affects Ethiopians.

After graduating from Addis Ababa University at the start of 2020, Mikias Abebe focused on one task. It was COVID lockdown at the time, and he wanted to use this opportunity to lose weight. To this end, he started making an extensive dietary and exercise plan. As a health professional, he knew what food items he needed to consume and those he had to avoid to meet the desired goal.

“The target calorie intake was 500 to 750 calories below the daily requirement, but should never be below 1500 calories,” he tells EBR as he explains his meticulous and scientific approach. “I eliminated wheat products and any sugar-containing products. In fact, I avoided almost all grains except for the occasional teff/injera,” he adds.

Mikiays consumed many vegetables such as broccoli, steamed cabbage, beetroot, and carrots but avoided potatoes or sweet potatoes. He also consumed chicken breasts and fish, with a low intake of other meat sources, except occasional 100% red beef.

“The only exercise I did was walking, but a fast-paced walk for 1 to 2 hours daily,” he says. Mikias lost 33 kilograms in eight months, from 103 kg to 70. “This diet and exercise plan worked because of the extended lockdown. It may be difficult to implement it without an energy-intensive work routine successfully,” he adds.

Many people want to lose weight and have the desired body shape. Awareness of the dangers of obesity is increasing. However, there seems to be a lot of information and misconceptions about weight management, primarily online.

“Obesity is a disease on its own, and it is defined as a state of excess adipose tissue (body fat) mass that adversely affects health. It is also independently associated with an increased risk of mortality,” explains Dr. Abel Tenaw, Assistant Professor of Internal Medicine at Tikur Anbessa Specialized Hospital. He states that obesity is one of the biggest health threats worldwide. The issue is becoming more apparent in urban areas in Ethiopia.

Dr Abel explains that obesity in Ethiopia is on the rise, mirroring global trends. He cites two reasons for this change. The current lifestyle is becoming more sedentary, as many people usually spend their days at office desks. The other reason he has identified is a change in dietary habits. “Our foods are becoming more and more energy-dense and highly palatable. This means that we are consuming more sugar, fat, and proteins while taking in less fruits and vegetables,” he tells EBR.

The prevalence rate of overweight and obesity in Ethiopia is high compared to previous studies. Studies were conducted only in urban settings, and the percentage was higher in urban and rural settings. The estimated pooled prevalence of overweight among adults in Ethiopia was 19%, according to a 2020 study (Kassie AM, Abate BB, Kassaw MW. Prevalence of overweight/obesity among the adult population in Ethiopia: a systematic review and meta-analysis).

The complications of obesity are well-documented and numerous. These include, but are not limited to, hypertension, diabetes, hyperlipidemia (high cholesterol), sleep apnea, stroke, heart attacks, gout, gallstones, and cancer. “I have taken care of obese patients with many health problems, although hypertension, diabetes, and hyperlipidemia are the ones I most frequently encountered,” Dr. Abel says.

Body Mass Index (BMI) is popularly used to assess whether someone is obese. It is calculated by dividing a person’s weight by the square of their height. If your BMI is between 25 and 29.9, you are overweight, and if it is 30 or greater, you have obesity.

Dr. Abel states that although BMI is the most commonly used measurement to estimate fat content, it has several limitations. “Muscular people and bodybuilders could have a high BMI, although their fat percentage is low. In addition, BMI was studied and validated in Western white populations, and it might not work as well for other ethnic groups, including Ethiopians,” he says.

“When I measure the amount of fat in some individuals, it’s often surprising to find it at such high levels. Even after they exercise for about five or six months, they still show the same amount of fat, emphasizing the seriousness of the issue,” states Daniel K, a lecturer of sports science at Bahir Dar University and a Soccer Nutritionist for the Ethiopian national team and Mechal sports club. He is also a PhD Candidate in Clinical Nutrition at Addis Ababa University.

Daniel agrees with Dr Abel that Body Mass Index (BMI) is not a perfect indicator of obesity. “I usually don’t use it. I prefer to use Bioelectrical Impedance Analysis (BIA), as it’s more appropriate. It is commonly used in hospitals and other large organizations. Apart from their limitations, BIA and body circumference measurements are the best indicators for me,” he says.

He explains that BIA is preferred because it measures BMI and indicates fat percent, muscle mass, and metabolic age. “I usually use segmental body composition analysis for my gymnast clients,” he tells EBR.

There are different ways to manage weight. One is lifestyle modification, which involves altering diet by consuming less calorie-dense foods and exercising.

Daniel likes to classify the methods into healthy ways and unhealthy ones. “Intermittent fasting is considered an unhealthy method. It is labeled as such because, although it helps in weight loss through fasting, it can also lead to the loss of certain essential nutrients, and it will lead to gastrointestinal (GI) problems,” he tells EBR.

He further explains, “As long as your body adopts eating three times a day, it will be difficult when you shift your diet to just once a day. Intermittent fasting can also lead you to lose some muscle. So, it has some disadvantages.”

There is also a method known as the blood type diet, which involves eating foods tailored to one’s blood type to manage body weight. Daniel sees limitations in this practice and says it requires further study.

“Even in individuals having the same blood type, food that works for one individual may not work for another. The other issue with the blood type diet is its prohibition of certain foods, such as high-calorie, high-fat, and processed foods. For example, omega fatty acids are primarily found in fish, so if fish is restricted in your diet according to your blood type, you may miss out on this essential nutrient. Due to these reasons, I consider this method improper,” he says.

“Weight loss is simple but not an easy journey,” says Daniel. People who cannot modify their weight through lifestyle changes look at other options. Several drugs are approved for weight reduction, the most popular one being Ozempic (semaglutide). The last method is bariatric (weight-loss) surgery.

“Even though exercise is recommended for weight management, the optimal type and intensity depend on the age of the patient, the presence of comorbidities, and individual preferences,” explains Dr. Abel. He states that both aerobic and resistance exercises are recommended.

Daniel elaborates on a question many people pose about exercise and weight gain. Numerous individuals state they’ve gained weight after starting an exercise regimen.

Daniel says, “When you begin exercising, your appetite increases and your body will adjust to this change within one or two weeks. However, if you stop exercising suddenly, your increased appetite may lead to overeating, resulting in weight gain.

So, diet planning is needed to avoid gaining weight during this period, and eating more energetic foods is advised. If you continue to consume the same high-calorie foods you ate while exercising but are now at rest, your body will not burn off those calories, leading to weight gain. You do not have to eat the same calories without exercising.

Although weight loss is the primary target of obesity treatment, experts state it has side effects when it’s done too rapidly. These include dehydration, electrolyte abnormalities, hormonal disturbances, decreased athletic performance, micronutrient deficiencies, and gallstones.

Mikiyas tried to control these types of side effects during his dietary change. From his experience, he testifies that the most important factor is tracking calorie intake. He says losing so much weight at once became unhealthy, so he tried to take things slow. He gained some weight after the rapid loss, but he is now happy with his current weight and is trying to maintain it by being active. EBR

12th Year • July 2024 • No. 131