BONE TO PICK

Dr Jonas Fernandez is an Orthopaedic and Sports Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ).

As we wandered around Japan , my wife turned to me and highlighted different types of change in “ scenery ”. No , it wasn ’ t the snow-capped mountains or the delightful Japanese culture . It was the people of this land . They seemed a lot more lean and in shape . We didn ’ t think much of it and continued about our holiday .

We did , however , begin to notice overweight people again at the tail-end of our trip . Yup , at the very end , as we were getting ready to board the plane . Not much to our surprise , these people were boarding the plane with us , all bearing red-coloured passports . Yes , they were Malaysians .

Recently , BBC reported that according to the British Medical Journal , Malaysia is the “ most obese Asian country ”. They went on to elaborate that more than half of Malaysians are overweight . That ’ s some pretty damning statistics - more than half .

Obesity is calculated using one ’ s weight and height , using a formula to come up with the body mass index ( BMI ). To put it into perspective , let ’ s assume the average female in Malaysia is around 160cm and the average man is around 170cm .

As a female 160cm , if you weigh over 65kg or 75kg , you would be categorised as either overweight or obese respectively . For men measuring around 170cm , these numbers would be around 75kg or 85kg for overweight or obese .

Is obesity a medical concern ? Yes , definitely . A person with obesity is more predisposed to numerous medical conditions , such as :

CARDIOVASCULAR

One of the most well-documented effects of obesity is its contribution to cardiovascular disease , including heart disease , high blood pressure ( hypertension ), and stroke . Obesity raises levels of LDL cholesterol (“ bad ” cholesterol ) and lowers HDL cholesterol (“ good ” cholesterol ), contributing to the build-up of plaque in the arteries . This increases the risk of heart attacks and stroke .

DIABETES

Obesity is a significant risk factor for Type 2 diabetes , a condition where the body becomes resistant to insulin or

doesn ’ t produce enough . Extra fat , especially visceral fat ( fat around internal organs ), can interfere with the body ’ s ability to use insulin effectively , leading to higher blood sugar levels . Over time , this can cause permanent damage to organs like the kidneys , heart , and nerves .

SLEEP APNEA

Obesity is strongly associated with obstructive sleep apnea , a condition where the airway becomes blocked during sleep , causing pauses in breathing . Extra fat , especially in the neck and throat area , can obstruct the airways , leading to interrupted sleep and lower oxygen levels in the blood . Sleep apnea increases the risk of high blood pressure , heart disease , and stroke .

CANCER

Obesity is linked to an increased risk of several types of cancer . Excess fat tissue can affect hormone levels , which can increase the risk of hormone-related cancers , including breast cancer , colon cancer , and endometrial and oesophagal cancer .

REPRODUCTIVE HEALTH ISSUES

Obesity can affect reproductive health in both men and women . In women , excess body fat can disrupt the hormonal balance , leading to conditions like polycystic ovary syndrome ( PCOS ), irregular menstrual cycles , and infertility . In men , obesity can lower testosterone levels , which can decrease fertility and sexual drive .

BONES AND JOINTS

As an orthopaedic surgeon , it is not unusual to encounter obesity in my dayto-day practice . There are many adverse effects on the health of the bones and joints . One of the most immediate and apparent effects of obesity on joints is the increased mechanical load placed on weight-bearing joints such as the hips , knees , and spine .

The added body weight exerts tremendous pressure on these joints , accelerating wear and tear . As a result , the cartilage - the smooth tissue that cushions joints - can break down more quickly .

In fact , studies show that for every one kg of excess weight , the knee joint experiences an additional four kgs of force with each step . Over time , this extra stress can lead to the degeneration of the cartilage , resulting in conditions like osteoarthritis ( OA ).

While osteoporosis is often associated

with low body weight or malnutrition , research has shown that obesity can also have an impact on bone health . Obesity can lead to an imbalance in bone remodelling , a process in which old bone tissue is replaced with new bone tissue .

The excess fat tissue in obese individuals can produce hormones such as leptin and adiponectin , which can interfere with the normal regulation of bone metabolism . Over time , this may result in bone loss and decreased bone quality , increasing the risk of fractures .

Obesity not only increases the risk of developing joint and bone diseases but also directly impacts an individual ’ s ability to engage in physical activity . As joints become more painful and less mobile due to conditions like OA , individuals may reduce their physical activity levels .

This reduction in activity can create a vicious cycle : less movement leads to weaker muscles and joints , further increasing the risk of injury and exacerbating pain . This reduced activity can also negatively affect bone health by limiting the benefits of weight-bearing exercises , which are crucial for maintaining bone density and joint function .

MENTAL HEALTH ISSUES

The psychological effects of obesity can be profound . There is a well-established link between obesity and depression . The social stigma associated with being overweight can lead to feelings of low self-esteem and poor body image , which may contribute to depression .

Obesity can be associated with anxiety , particularly in social situations or when dealing with the stigma of being overweight .

I recognise that this can be a very sensitive topic and one that I have hesitated to write about for a long time . While I believe there is no space in society for bodyshaming of any sort , be it in obesity or the other end of the spectrum , one ’ s health should take precedence over all else .

The fact of the matter is that being in decent shape has its upsides physically , mentally and emotionally . That ’ s a goal always worth striving for . – The HEALTH