Living with obesity

The gym at the Domenico Diluca Community Centre in Toronto is filled to bursting and buzzing with at least 300 Diluca Seniors’ Club members bent over bingo cards, swapping news and gossip, while they wait for club president Julie Diluca to slip behind the mike and begin the game.Neatly attired in a flattering dark blue suit, Diluca mounts the dais, moving with the deceptive grace some heavy people have, and sits behind the tray of numbered balls. Picking up the mike, she cracks a joke, introduces the first game and launches into the familiar rhythm: ” N – 42. G – 58. B-9.”

^Between games, she exchanges warm greetings, hugs and handshakes with a succession of friends. Any self-consciousness she may feel about her weight is not apparent. Diluca is impeccably dressed, her auburn hair piled high.

“I’ve always been self conscious about the way I look,” she says. “I’ve never worn pants; I’m too self conscious. I won’t go out of the house unless I have my makeup on and my nylons. Everything has to be just so. Otherwise I won’t go out because I feel that everybody’s waiting to find fault. You know, ‘what’s wrong with that lady?’ I’ve always been like that.”

She cnot hide her obesity-and she is technically obese-but being visibly overweight here at the club, where there are several over large bodies, doesn’t carry the same stigma as it might in other places.

New epidemic
Obesity researchers at Laval University in Quebec City say that “the prevalence of obesity is approaching epidemic proportions in both developed and less developed countries around the world. In the last decade, the prevalence of obesity seen in the majority of European countries has increased from 10 to 40 per cent.” 

Obesity is defined by a body mass index (BMI) equal to or more than 27. BMI is calculated as a person’s weight in kilograms divided by his or her height in metres squared.

In North America, an estimated 50 to 75 million adults load the scales at more than 20 per cent over their desirable weight. The National Population Health Survey in 1994-95 revealed that 31 per cent of Canadians between the ages of 20 and 64 are obese, based on a BMI of 27 or greater.

Staggering costs
In a study published in the Canadian Medical Association Journal in early 1999, Dr C. Laird Birmingham and colleagues at the University of British Columbia and St Paul’s Hospital in Vancouver looked at the medical costs of obesity. They estimated the total direct cost in Canada in 1997 was more than $1.8 billion. This represents 2.4 per cent of the total healthcare costs for all diseases in Canada that year.

Obesity is a big factor for a host of serious and costly illnesses-from osteoarthritis and diabetes to hypertension and cardiovascular disease. The costs of treating these secondary illnesses ranges from $657 million for high blood pressure and $423 million for type 2 diabetes to $346 million for coronary heart disease.

The causes
Sandy Skrzypczyk, a public health dietitian with the Social and Public Health Department in Hamilton, Ont., explains the complexity of obesity.

“We can’t say that it’s because of X or Y that obesity occurs. But it does involve social, behavioural, cultural, physiological, metabolic and genetic factors. If you have overweight parents, it does place you at higher risk of being obese, and it’s environmental because you grow up with the same lifestyle as your parents.”

Like her mother, Julie Diluca has diabetes and, like many members of her family, problems with her heart. Both of her parents and her older brother have suffered heart attacks. Julie has angina and arthritis in her knees.

“Every doctor I go tells me I should lose weight, and I know they’re right because when I got down to 135 from 260, I used to go up and down stairs like nothing,” she says.

Harms knees
For people with osteoarthritis (OA), extra weight makes a difference. Every pound of body weight you carry adds six times the amount of force across your knees and three times the amount across your hips than normal weight bearing.

So if you put on 10 pounds of extra weight, that’s really 60 pounds of extra force across your knees with every step you take. The good news is that if you lose 10 pounds, you cut your risk of developing OA in half.

If you’re a high-risk candidate for OA- over 50, with a family history of OA, knee injuries from a sport or accident in your youth or have any kind of misalignment-it’s wise to keep your weight down.

If you already have OA, the disease will progress faster if you’re overweight, and you may not be considered an appropriate candidate for a prosthetic replacement.

Positive news
Juli Diluca has her own take on why she puts on the pounds and can’t keep them off. She says she was a big baby and has always loved to eat.

“I don’t drink, so it can’t be alcohol. So it has to be what I eat. And you know, Italians cook with a lot of oils. And when you make lasagna, you can’t be satisfied with a little square. You’ve got to have a second square. So it’s not just the quality of food. It’s the quantity, too, because we’re used to it and you didn’t know better when you were younger, so now you just continue the same routine.”

While being overweight shortens life expectancy up to age 75, after that it doesn’t make much difference unless someone is extremely obese, according to a 1999 report in the Journal of the American Medical Association. For healthy older people, carrying a bit of weight provides a nutritional reserve in times of stress and may help in surviving acute illnesses.

However, eating a balanced diet and participating in regular exercise still is key in preventing or delaying certain diseases as we age.