1. LACK OF CONSCIOUSNESS
One does not become as heavy as a quintal overnight. It is the ignorance of people that is responsible for high incidence of this problem. Excepting for a young unmarried lady for cosmetic reason, no one else realizes that obesity is a disease until one develops painful knees, sugar problem or high blood pressure. Should one wait unit the family doctor or Cardiologist points out to shed off some weight to solve the backache or to lower the high blood pressure to normal?

2. SEDENTARY LIFE
Has anyone ever thought how much physical activity one puts in, within 24 hours of daily routine? Just attending to house hold work or going to the office and attending to few phone calls and looking info few files, makes people think that they have had enough of physical activity. For this type of exertion, just a breakfast in divided quantities should be sufficient to meet one's physical activities of 24 hours. Lack of exercise is one of the important factors contributing to the problem of obesity. "We do not have time for exercise", is the common complaint.

But when one has the first attack of chest pain around the age of 35, it is seen that the importance of exercise is realized. I find many middle-aged men trying to walk briskly in their new shorts and tennis shoes early in the morning. 80% of these people either have Diabetes. M. or Hypertension or Ischaemic Heart Disease. Could they have not avoided the chest pain had they thought of the exercise a few years earlier? Can one afford to be labeled as a heart patient?

3. RICH FOOD
Many people think food and nutrition are synonymous. One is not nourished by the quantity and quality of food one eats, but in proportion to the amount one is able to digest and assimilate. If the food assimilated is not oxidized with sufficient physical activity, i.e., burnt to give energy, it accumulates as fat in adipose tissue. Chocolates, softies, ice creams, oily spicy foods, food concentrates, tinned and stored foods have become the order of the day in all urban affluent families.

DO YOU KNOW HOW MUCH WE OVEREAT AND HOW LESS WE EXERT UNKNOWINGLY ? Look at the following tables:

Some of the 200 Calories Snacks in our daily life

2 slices of plain bread without butter and jam
2 medium size apples
53 pea nuts
24 ounces of Beer
2 1/4 bottle of soft drink
2 cups of instant coffee with sugar

Some of the 200 Calories Snacks in our daily life

12 minutes of jogging
1 ½ hour swim
1 hour walking
3 hours of singing
4 hours dish washing
14 hours of T.V. Watching

SOME OF THE HIGH CALORIC FOODS IN OUR DAILY LIFE ONE SHOULD BE AWARE OF:

100 Gms. of edible portion each of the following items and the caloric value.

Daily calorie requirements of an urban dweller - Man - 2400 Calories & Woman - 2000 Calories.

4. ALCOHOL
In our country, alcoholic beverages are becoming more and more popular even among youngsters. The executives and businessmen have to host or to attend to parties almost every alternate day. Alcohol itself gives calories and its intoxicating effect causes loss of control over the quantity of food taken. If one does not eat well particularly high protein diet while having alcohol, one is heading for liver damage. And if one eats well, one is heading for over weight, high cholesterol, Diabetes. M, Hypertension and Ischaemic Heart Disease. Between the deep sea and the devil, the choice becomes difficult!

5. LACK OF POST DELIVER CARE
In women this is one of the most important factors resulting is obesity. A lady puts on almost 15 to 20 Kgs. in excess by the time she delivers one or two children. Some of the traditional methods prevalent in India and else where for post delivery care are -small quantities of food, hot spicy food, regular massages with hot water baths and certain do's and dont's is foods, avoiding afternoon sleep, etc. are practiced for eight weeks after each delivery. In western countries too, the hospitals advise diet and exercise to mothers who have delivered recently.

The educated young mothers in India are neither sticking to the traditional way of post delivery care nor following the modern methods practiced elsewhere. What is happening is, they are indulging in over eating, no exercise, excessive sleep, not attending to household work. The grandmother's tips of postnatal care are meant to remove water logging in the body existing even after delivery due to hormonal changes during the pregnancy.

7. M R & ABORTIONS
For spacing children in family planning, barrier method like use of condom with safe period method and IUD are best, till the couple has two children. In suitable cases only, copper - T can be used. Later, a permanent sterilization by way of tubectomy or vasectomy is the best. Due to failure of contraception ladies are going frequently for a procedure known as menstrual regulation (M.R.) i.e., D&C (Dilatation & Curettage) immediately after 40 days from last menstrual period. If the lady has conceived and goes through D&E, it amounts to abortion, Even if one is 6 weeks pregnant and goes through M.R. requires same care as a post-delivery patient which most of the women are not aware. During consultations, I find that most women, who have borne children, mention about 2 or 3 medically induced abortions.

8. OVER CARE AFTER SURGERY
Even for a minor surgical procedure, self-prescribed bed-rest for long period over-eating of food, use of tonics result in obesity in some people.

9. MEDICATION
Certain medication like contraceptive pills, cortisone group of drugs, antihypertensives and anti-inflammatory drugs, powerful antibiotics disturb the delicate balance of the hormonal system which regulates fat metabolism and this causes water retention in the body and triggers fat production and accumulation.

10. CERTAIN DISEASES
Diseases like Hypothyroidism, Cushing's syndrome, Sheehan's Syndrome etc., are again related to hormonal disturbance and are only important from clinical (Doctor's) point of view. In these cases the obesity is secondary to the disease proper.

11. PSYCHOLOGICAL FACTORS
Mind has an important bearing on food intake. Many people do not know what is a real appetite. One eats because it is breakfast time, lunch time or dinner time even though there is no real hunger. Urban dwellers are almost eating 4 times a day apart from sips of coffee, tea, soft drinks and biscuits in between. One does not allow one self to feel hungry at any stage.

Some people, when they are tense or upset, eat more. Housewives do not allow the food to go waste. They simply consume the left over food because if it is given to the servant maid she would get used to or the food is such that it cannot be preserved in the fridge. These are psychological factors in our day-to day life.

Do you know that?
A man who eats once a day ......... is a Yogi (A Sage)
A man who eats twice a day ......... is a Bhogi (A Worldly Man)
A man who eats thrice a day ......... is a Rogi (A Sick Man)
A man who eats for four times a day ......... has his one foot already in the Grave!

12. HEREDITARY CONSTITUTIONAL TENDENCY
We have deliberately put this at the end of the list of cause because there is a tendency on the part of the obese patient to compromise by saying "Oh I can't help it, it is my constitution that has caused overweight in me. "It is said that the number of fat cells in every individual is predetermined. The average non-obese individual has approximately 3 X 10 10 adipose (fat) cells in the body. It is believed that in people who become obese through their formative years, there is an increase in the number of fat cells, And people who become obese after 25-30 years of age, there is more accumulation of fat in the cells, i.e., fat cells do not increase by multiplication. Whatever may be the reason, since one cannot choose one's own parents, it is left for one to see that more fat does not accumulate in the same number of cells or in more number of cells. Therefore, one need not compromise by saying that the fat cells in the body are predetermined.