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If you’ve ever faced the prospect of having to lose even a few kilos, you’ll understand what a daunting task it can be. Obese people, who are often called upon to lose the equivalent of an average person’s entire body weight, can find the situation hopeless.

“Urban obesity in our country is a growing problem," says Banshi Saboo, director of Diacare, a diabetes care and hormone clinic in Ahmedabad, and president of the All India Association for Advancing Research in Obesity (Aiaaro). As a nation that has traditionally battled malnutrition and poverty for decades, it can be surprising that we must now contend with an issue that’s on the opposite end of the spectrum. India has the second highest number of obese children (14.4 million) in the world, according to a study published in June in The New England Journal of Medicine. A study published in October in The Lancet established that worldwide, the numbers of obese children and adolescents was 10 times higher in 2016 than in 1975.

There is no single cause for obesity in urban India. Understanding the many complexities that have created the condition are important, says Dr Saboo. One of the root causes is the way our cities are designed. “We can’t rely on public transport (which would require some activity on our part) and our cities aren’t conducive for walking either," he says. As a result, our lives are largely sedentary. Also, our nutritional choices are largely dictated by economics. “When a vada-pav is available at a much cheaper price than healthy fruits like apple, making the right nutritional choices can often be expensive. We need greater awareness about these lifestyle factors that are driving our obesity," he says.

While surgical intervention is an option, it is beneficial for patients with a high BMI (between 35-40 kg/m2 and weighing 120-150kg). “Surgery is an option only when other weight-loss efforts (including medication) fail," says Anoop Misra, endocrinologist and chairman of the Fortis Centre for Diabetes, Obesity and Cholesterol, Delhi.

A complex problem like obesity requires a multipronged approach. So if you or someone you love is battling it, here is a guide to help you navigate this difficult territory.

Get active, gradually

One of the biggest mistakes obese people make is to start too vigorous or intense a training programme, which leads to quick burn-out, says Vinata Shetty, a Mumbai-based trainer, certified by three US-based agencies, and managing partner at the Fitness India Academy. A better strategy, she says, would be to build up stamina gradually. “Focus on growing more active, naturally. Do chores around the house, walk in short bursts. Even if you’re exercising only 10 minutes a day, it’s a start," she says. Once you’re ready for a more intensive routine, select your exercises carefully. Since the excess body weight puts immense pressure on the joints, opt for exercises that won’t damage them—such as swimming and walking.

After three months, when you’ve lost a few kilos, incorporate weight training into your workout. “As we grow older, our bodies start losing muscle and gaining fat. Weight training, at least thrice a week, can help stop muscle and bone loss," says Shetty.

Eat right

Just increasing your intake of fruits and vegetables can be a critical change, experts say. “Include at least two servings of fruits and three servings of vegetables every day," says Dr Saboo, who also recommends limiting carbohydrate intake. “For instance, if you eat idli-sambhar for breakfast, decrease the number of idlis and have more protein-rich sambhar instead," he says.

Even though many weight-loss diets call for severe restrictions, demonizing a particular food group, even when you’re obese, isn’t recommended, says Nupur Krishnan, a clinical nutritionist and director of the Mumbai-based Biologics Nutrition Clinic, which focuses on nutrition and diet management. “Water, carbohydrates, proteins and fats are the basic building blocks of a good diet," she says. “By choosing the healthiest form of each of these nutrients, and eating them in the proper balance, you enable your body to function at its optimal level. Severe fasting only helps the body lose water, not fat."

Don’t skip meals and eat freshly prepared food at regular intervals.

Eat mindfully

How you eat is as important as what you eat, says Dr Krishnan. Inculcate the habit of eating mindfully. “Don’t combine eating with other activities, such as reading or watching television," she says. “Serve your food on a smaller plate and divide a single portion into two, so that it will seem like you’re eating more. Pause for 2-3 minutes during a meal and converse with others. Leave the table as soon as eating is done. Postpone your eating of a desired snack by 10 minutes and, often, you’ll find that the craving goes away."

Get enough rest

Our hunger mechanism is controlled by two important hormones—ghrelin and leptin. “When energy levels are low, ghrelin is secreted in the stomach and upper intestine, which induces hunger signals in the hypothalamus of our brain," Dr Krishnan explains. As we eat, the secretion of leptin indicates that we’re full. However, one of the easiest ways to throw these hormones off kilter is to not get enough rest. “A lack of adequate sleep and overtraining—working out for too long and too much—can make you feel hungrier," says Shetty.

The journey to good health involves striking the right balance in your diet, and being persistent and positive in your weight-loss efforts.

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