Directory UMM :Data Elmu:jurnal:N:Nutrition And Food Science:Vol99.Issue6.1999:

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Obesity,

weight-reducing

programmes and

constipation

Elaine Anderson and

Jill Davies

The literature on obesity highlights that its prevalence is increasing, (Garrow, 1993; Campbell, 1995). It has become a serious public health problem and is associated with chronic disease and premature death

(Garrow, 1993; McIntyre, 1998). Since the health problems that are associated with overweight and obesity are increasing the Government has set a Health of the Nation target (Cowburn, 1995) ``to reduce the proportion of men and women aged 16-64 who are obese by at least 25 per cent and 33 per cent respectively by 2005 (to no more than 6 per cent of men and 8 per cent of women) (Baseline 1986/87)'' (Department of Health, 1992).

Obesity is caused by positive energy bal-ance. This means that there is higher energy input from food than output through physical activity. Energy not used is stored as fat in adipose tissue around the body. There may be many reasons for weight gain and overeating can play an important role in positive energy balance. Other areas are genetics and socio-economic circumstances. Children born to two parents that are obese have an 80 percent chance of obesity later in life. If one parent is obese then the child has a 40 percent chance. Children or adolescents that are overweight have a stronger tendency to become obese adults. Some twin studies also support genetic theories (McIntyre, 1998). Factors such as low level of education, heavy alcohol con-sumption, chronic disease, low physical activity levels and, in women, bearing chil-dren were found to increase levels of obesity in people with low socio-economic status (McIntyre, 1998; Garrow, 1993).

The prevalence of overweight and obesity in both sexes in the UK during 1980 was taken from a survey of 5,000 men and 5,000 women (Garrow, 1993). The results showed that the rates of overweight and obesity in men were 34 per cent (BMI > 25) and 6 per cent (BMI > 30) respectively. For overweight women the figure was shown to be less than men at 24 per cent (BMI > 25), and 8 per cent (BMI > 30) were found to be obese (Garrow, 1993; Campbell, 1995). Another survey using the same methodology was repeated in 1987. This survey showed a severe increase in obesity which had risen by 2 per cent in men to 8 per cent (BMI > 30) and 4 per cent in women to 12 per cent (BMI > 30) (Garrow, 1993). Obesity figures for 1997 show that the number of obese adults is still rising, the levels The authors

Elaine Andersonis a Third-year Undergraduate Student in Nutrition andJill Daviesis Head of the Nutrition Research Centre both at South Bank University, London, UK.

Keywords

Obesity, Diet

Abstract

Highlights the prevalence, causes and health risks of obesity. Then continues by looking at the health incentives of weight loss through commercial weight-reducing diets and the health problems incurred during such a diet in respect of reduced energy intake and reduction of non-starch polysaccharides which can lead to constipation and associated bowel diseases. Tips to increase the intake of non-starch polysaccharides are given in the context of weight-reduction programmes.

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Nutrition & Food Science

Number 6 . November/December 1999 . pp. 303±306

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now being 13 per cent (BMI > 30) of men and 16 per cent (BMI > 30) of women (McIntyre, 1998). Obesity has been found to reach a peak at specific times during the ageing process. In men this peak occurs between the ages of 45 and 54 and in women 65 and 74 when they are generally inclined to be more sedentary (Carlsonet al., 1997).

Morbidity can be dependent on fat distribu-tion throughout the body and the accumuladistribu-tion of fat in specific areas. The most apparent health risks are coronary heart disease, hyper-tension, hypercholesterolaemia, non-insulin-dependent diabetes mellitus (NIDDM), gall bladder disease, musculoskeletal disorders and certain types of cancer (Pi-sunyer, 1993; Campbell, 1995; Laitinen, 1998).

It has been known for centuries that obese adults die younger than their non-obese counterparts. An observation by Hippocrates (460-367BC) was that ``very stout persons'' would die suddenly as opposed to thinner people (McIntyre, 1998). This was again observed by the life insurance industry at the beginning of the century where people who were over a certain weight for their height were found to be uninsurable due to risk of premature death (Garrow, 1993).

Weight-reduction programmes

According to many sources weight reduction is the answer to reducing morbidity and de-creasing mortality rate (Garrow, 1993; Pi-Sunyer, 1993; McIntyre, 1998). With a weight loss of 10kg, total mortality is reduced by more that 20 per cent. The rates of NIDDM and obesity-related cancer also decrease by 30 per cent and 40 per cent respectively. A weight loss of 5 to 10kg could assist in relieving problems such as back and joint pain, lung function and sleep apnoea (McIntyre, 1998). For an obese person to lose weight they would need either to reduce their energy intake from food, thereby inducing negative energy balance, or to in-crease their physical activity level or both. It is reported that during weight loss both fat and protein are lost: fat from adipose tissue (fat) and protein from lean tissue (fat-free mass) (Garrow, 1993). McLaren (1981) reports that the reduction due to energy intake over the first few days is a loss of fat-free mass rather than fat from adipose tissue. Garrow (1993) informs us that fat-free mass will be lost during a weight-reducing diet if the calorific value is

found to be less than 1,000 kcal/day. A diet so low in calories would also restrict the intake of essential nutrients (Garrow, 1993). Diets available are many and varied such as those provided by primary health care teams and commercial weight-reducing clubs such as

Weight Watchers, Slimming World,Slimming

Club Magazineplus others.

Commercial weight-reducing diets provided by clubs such as Weight Watchers have changed over the years (McLaren, 1981). Since Weight Watchers began almost 30 years ago it claims to have helped nearly 25 million people (Hicks, 1997). In September 1996 a new diet regimen was launched that offers slimmers a daily points system that is dependent on gender, age, and weight at membership. This has put a stop to laboriously weighing foods and counting calories. Club members can now choose from a range of foods provided by Marks & Spencer and Boots. The diet places an emphasis on eating fruit and vegetables and reducing the intake of foods containing satu-rated fat (Hicks, 1997). Weight loss at Weight Watchers is aimed at 2-3lbs/week at first then reduces to 1.5-2lbs/week (Hicks, 1997). This amount of weight loss per week is also suggested by Garrow (1993) who has calcu-lated that the reduction in energy intake would be between 500-1,000kcal (2-4MJ)/day and still provide essential nutrients.

Slimming World is another weight-reducing club established 30 years ago. In its booklet

Personal Passport to Successit offers a weight loss programme, weekly classes, support and dietary advice. It also informs its club members of the need to eat more fruit, vegetables, reduce intakes of saturated fat and the need for high fibre foods. However, free will prevails and the day's food choice is still the respon-sibility of the club member.

Foods not to be restricted are fruit, vege-tables and whole grain cereals as these foods are necessary to provide the body with micro-nutrients and non-starch polysaccharides (NSP). A diet containing high amounts of NSP prevents constipation and bowel diseases (Department of Health, 1991; Garrow, 1993).

Constipation

When energy intake is reduced NSP intake is also reduced (Garrow, 1993). Pi-Sunyer (1993) reports that one of the problems of weight loss is constipation and Cummings (1993) has

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Obesity, weight-reducing programmes and constipation Elaine Anderson and Jill Davies

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stated that ``complaints of constipation are common in people on low-fibre diets''.

Constipation is classified by ``infrequent bowel habit of less than three times per week, transit time of five days or more and stool weight below 50g/day'' (Department of Health, 1991). Presently in the UK 1 per cent of the population visit their general practitioner because of constipation, while up to 12 per cent feel they have symptoms of constipation and 10 per cent of the adult population actually suffer from constipation. This figure increases after the age of 60 years to above 20 per cent (Department of Health, 1991; Garrow, 1993). The Department of Health (1991) report that ``median stool weight in the UK is about 100g/d, 95 per cent of the adult population passes between 30 and 260g/d, 46 per cent less than 100g/d and 18 per cent less than 50g/d''. It was also found that more women suffered from constipation and had lower stool weights in comparison with men.

The current intake of NSP in the UK is 13.9g/day (Ministry of Agriculture Fisheries and Food, 1995) which is marginally above the Dietary Reference Value of the individual minimum of 12g/day (individual maximum

being 24 g/day) (Department of Health, 1991). Of these values 50 per cent of total NSP intake is provided by vegetables, whilst 40 per cent is provided by cereals (Depart-ment of Health, 1991). The role of NSP in the diet is to add bulk to faeces (Ministry of Agriculture Fisheries & Food, 1995). This occurs when dietary NSP remains intact after passing through the stomach and small intestine (Department of Health, 1991). However, it must be pointed out that not all NSP have the same effect on stool weight and bowel habit. Therefore bowel habit responses are highly variable when faced with soluble and insoluble NSP fractions (Department of Health, 1991). Since each NSP fraction has a different effect on bowel habit it is important that the diet contains a variety of foods that are able to provide both soluble and insoluble NSP ``as a naturally integrated component'' (Department of Health, 1991).

In order to ensure NSP intakes meet the DRV of 18g/day (Department of Health, 1991) people on weight-reducing pro-grammes would be well advised where possible to opt for ``high fibre'' varieties of foods (Table I). However, caution will be

Table IEnergy and NSP content of selected food portions

Food Portion size (g) Energy (kcall) NSP (g)

Bread

Wholemeal 36 77 2.1

Granary 36 85 1.5

Brown 36 78 1.3

White 36 85 0.5

White, aerated, slimmers 15 37 0.3

Pasta (boiled)

Wholemeal 220 249 7.7

White 220 229 2.6

Rice (boiled)

Brown 180 254 1.4

White 180 248 0.2

Breakfast cereals

Bran flakes 30 95 3.9

Shredded wheat 45 146 4.4

Cornflakes 30 108 0.3

Pulses

Baked beans, heated 135 113 5.0

Chick peas, canned, reheated (tbsp) 35 40 1.4

Lentils, red split, dried, boiled (tbsp) 40 40 0.8

Vegetables

Potatoes, baked, flesh and skin 180 245 4.9

Potatoes, baked, flesh only 160 123 2.2

Notes:Average weights are shown in grams unless otherwise stated. Portion sizes, calorific and NSP information taken from CompEat 5 (Nutrition Systems, London, 1998)

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needed in order to balance the energy intake against NSP intake.

People on weight-reducing programmes need to be aware of the need to balance energy intake against that of NSP in order to reduce the likelihood of developing constipa-tion. Furthermore, individuals who are on such programmes for long periods may be increasing their risk of bowel-related disorders such as haemorrhoids, varicose veins, hiatus hernia and diverticular disease if attention is not given to NSP.

References

Campbell, K. (1995), ``Defining the issues in prevention and management'',Obesity in Primary Health Care, A Literature Review, Health Education Authority, London, pp. 9-19.

Carlson, K.J., Eisenstat, S.A. and Ziporyn, T. (1997), ``Obesity'',The Women's Concise Guide to a Healthier Heart, Harvard University Press, London, pp. 77-82.

Cowburn, G. (1995),Obesity in Primary Health Care, A Report of the Proceedings of Workshops held in Autumn 1994, Health Education Authority, London, p. 7.

Cummings, J.H. (1993), ``Nutritional management of diseases of the stomach and bowel'', in Garrow, J.S.

and James, W.P.T. (Eds),Human Nutrition and Dietetics, Churchill Livingstone, London, pp. 480-506.

Department of Health (1991), ``Non-starch polysacchar-ides'',Dietary Reference Values for Food Energy and Nutrients for the United Kingdom, HMSO, London, pp. 61-71.

Department of Health (1992),Health of the Nation, HMSO, London, p. 20.

Garrow, J.S. (1993), ``Obesity'', in Garrow, J.S. and James, W.P.T. (Eds),Human Nutrition & Dietetics, Churchill Livingstone, London, pp. 465-79. Hicks, C. (1997), ``The truth about weight watchers'',

Health Independent Newspapers, Fenwood (CD-ROM), 21 January.

Laitinen, J. (1998), ``Obesity is a health problem'', International Journal of Circumpolar Health, Vol. 57, pp. 104-8.

McIntyre, A.M. (1998), ``Burden of illness, review of obesity: are the true costs realised?'',The Journal of the Royal Society of Health, Vol. 118 No. 2, pp. 76-84.

McLaren, D.S. (1981), ``Obesity'',Nutrition and its Disorders, 3rd ed., Churchill Livingstone Medical Text, London, pp. 154-65.

Ministry of Agriculture, Fisheries and Food (1995),Manual of Nutrition, 10th ed., HMSO, London, pp. 7-11. Pi-Sunyer, X.F. (1993), ``Short-term medical benefits and

adverse effects of weight loss'',Annals of Internal Medicine, Vol. 119 No. 7, pp. 722-7.

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