Get to that perfect balance | Sunday Observer

Get to that perfect balance

18 July, 2021

In a world consumed by Covid-19 with increasing deaths recorded, many have turned their attention to healthy living and healthy diet to boost the immune system to fight diseases.

Many of the Covid-19 deaths are due to complications especially among patients suffering from non-communicable diseases.

The main reason for non-communicable diseases is unhealthy lifestyles and obesity resulting from unhealthy food.

To address growing concerns among the public on ways to achieve a healthy lifestyle and general welfare, the Visakha Vidyalaya Old Girls’ Association, Colombo conducted a webinar recently titled ‘You are what you eat’ with experts from the medical profession, moderated by Senior Registrar in Venereology Dr. Udari Gallage.

The excessive amount of body fat is not only a cosmetic concern but gives rise to complex diseases.

It is a medical problem that increases the risk of diseases such as heart disease, stroke, type 2 diabetes, high blood pressure, and certain cancers leading to premature death.

According to a 2019 study in Sri Lanka that used the Asian Body Mass Index (BMI) cutoff, the prevalence of obesity in the urban areas was as high as 31.2 percent, which is an alarming rate, Dr. Gallage said.


Consultant Physician Dr. Nilangika Sandakumari explained that the BMI is calculated according to height and weight.

The waist-hip ration can also give an indication of obesity, done by measuring the waist just under the lowest rib, and the hips at the widest portion of the buttocks and dividing the waist measurement by hip measurement.

For women, the ratio should be less than 0.86 and for men it should be less than 0.95.

“If most of the fat is around the waist rather than at the hips, the person is at a higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men,” she said.

The lack of physical activity or sedentary lifestyle, family history, unhealthy food with high calories, and hormonal disease are some of the main reasons for obesity.

Dr. Sandakumari said that energy balance is necessary to maintain a healthy weight i.e. the energy taken in should be spent in equal amount. If the energy input is higher than the energy expenditure, it will result in weight gain.

Emotional problems

Consultant Physician Dr. Lushanthi Kannangara explained the emotional and physical problems that come with obesity.

Obese persons can develop emotional problems such as depression, anxiety, feeling of helplessness, negative self-worth from being stigmatised, self-consciousness and isolation in society. “When we assess the problem and start treatment, we especially consider the emotional aspects too.

There are symptoms that doctors could observe to decide on medical intervention.

Blood pressure higher than 130 over 85, fasting blood sugar over 100, a waist larger than 40 inches for men or 35 inches for women, HDL cholesterol under 40 for men and under 50 for women, and triglycerides over 150 are some of the symptoms.

“If there are three of these symptoms, it could lead to heart problems, liver problems, blocked vessels and strokes etc. It can also cause artheritis leading to joint deformity.

Other complications could also develop such as varicose veins, subfertility, sexual problems, high death date and complications in dengue and Covid-19, and physical disability.

It can also lead to cancers such as colon, breast (after menopause), endometrium, kidney and oesophagus.

Around 10 percent of all cancer deaths a year are related to obesity,” she said.


Dr. Kannangara explained other indications in the body to assess obesity.

‘Acanthosis Nigricans’ is a black velvety appearance especially around the neck or armpits which is a feature of metabolic syndrome, diabetes and some cancers. This is common among obese people.

Stretch marks (purple stripes), excessive hair, neck lump and white patches around the eye or small lumps over the joint areas indicate that the body’s lipid levels are high.

This can be seen in obese individuals with familial tendency, she said.

Doctors carry out various tests for obesity and related problems. A full blood count to see the red blood cells, fasting blood sugar, HbA1C, lipid profile cholesterol, TSH, cortisol and liver function are some of the basic tests conducted.

Dietary changes and exercise are the main management methods.

Behavioural therapy, prescription medication and if necessary weight-loss surgery are other interventions. “We recommend 150 to 250 minutes of moderate intense activity every week. This can be walking, swimming, running and cycling which are the most effective means of exercises to reduce body fat.

0.5-1kg weight loss per week is safe at the beginning.” To address psychological problems, counselling and support groups are recommended.

Anti-obesity pills are used to suppress appetite, inhibiting fat absorption, increasing energy consumption and metabolism, and thermogenesis. This should be prescribed by a doctor as they can cause high blood pressure, faster heart rate, palpitation, glaucoma, restlessness, agitation, insomnia, steatorrhea, oily stools, stomach pains, flatulence among other unwanted effects, she added.

Weight-loss management

Speaking on the methods to lose weight, Registrar in Clinical Nutrition Dr. Virajini Rathnayake highlighted the dos and don’ts.

“We need to create a negative energy balance in the body by reducing the energy intake i.e. cut down excess calories in the diet and increase the energy expenditure or step up your level of physical activities,” she said.

She outlined the dangers of fad diets which are promising and popular diets with rapid weight loss which includes ketogenic diet, intermittent fasting, low carb diet, fruit diet and modified atkins diet.

She said that although some fad diets are advantageous as they reduce body fat, increase insulin sensitivity, control blood sugar levels and reduce bad cholesterol, fad diets are unhealthy in many ways.

They can incur remarkable loss of muscle mass, have practical barriers in continuing long term, have adverse health outcomes such as low energy, headache, concentration issues, muscle cramps, kidney stones, vitamin and mineral deficiencies, weight gain once back on normal diet etc. “Therefore, rather than fad diets, medical professionals always promote a nutritionally balanced diet without depriving food groups. It is sustainable and it is a family meal where even children can have the food items,” Dr. Rathnayake said.

“The target should be loosing 10 percent of the weight in 3-6 months with 500g of weight loss in a week,” she said, explaining the method to count calories and recommended intake.

To cut down about 500 kilocalories per day, a person can avoid unhealthy food they usually consume, such as chocolate biscuits and chocolate cake which has 110kcal (2 pieces) and 350 kcal.

One and a half teacup of rice, pasta or noodles contain 180kcal while an average tea bun and fish bun contain 120 kcal and 220 kcal respectively. “Such food can be easily removed or reduced to achieve the target of cutting down 500 kcal per day.

Healthy food

“So make up your mind to have three healthy main meals, three healthy snacks of fruits (without fruit juice), reduce thick coconut milk, coconut oil, butter and margarines, avoid deep fried food, take meat and fish grilled or baked without frying, cut down on added sugar in tea, try green tea and drink two litres of water. This way you don’t need to go for extreme diet plans,” she said.

Dr. Rathnayake said that it is very important to incorporate adequate proteins in the diet i.e. 8–9 protein servings a day to improve satiety and maintain muscles. She stressed the importance of restricting saturated fat and incorporating healthy fats such as peanuts, and almonds; fish such as salaya, hurulla, tuna, salmon, and mackerel; seeds such as pumpkin seeds, kottan, chia seeds, and flax seeds; and oils such as olive oil and canola oil. She also urged to select high fiber options always.

She also gave some thoughtful tips to make the weight-loss plans more manageable such as using a smaller plate, avoiding watching TV during meals, improving variety, not skipping meals, reading food labels for nutritional information, no stocking energy dense foods, and stepping up physical activity.

As important as it is to develop healthy dietary habits to prevent diseases and boost immunity, it is also important that we think of the next generation and transfer healthy habits to them. This would definitely help in the long run, to be prepared if the world is hit with another brand new disease.