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Scientists now realize that both environmental and genetic factors play a role in determining whether a person becomes obese. New therapy could be on hand to help tailor the treatment for each individual.

Wouldn't it be great if you could flick a switch or press a button and undo obesity? Those years of over-indulgence could be slowly rewound and life could go on. Well, although personalized obesity therapy does not claim to be a magic button, it could be the only chance for some people to lose weight which has stubbornly hung around for years.

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What is Obesity?

The last thing any of us ever wants to hear are those painful words: Your BMI is over 30, you have become obese. But what is BMI? The Body Mass Index – BMI formula is very well known to dieters and doctors and everyone else.

It is calculated by using the following equation:  Mass (kg) : (Height (m))2

For a normal, sedentary person – i.e. someone who is not very active BMI scores mean:

  • Less than 18.5   Underweight
  • 18.5 – 25            Ideal weight
  • Over 25              Over weight
  • Over 30              Obese
  • Over 40              Morbidly Obese

But it has recently been found that the BMI can be deceptive. This is because BMI was never intended to be used as a diagnostic tool. It was only supposed to be a way to classify body profile so that some researchers could tell if they were studying similarly shaped people.

Where Does BMI Go Wrong?

BMI measurements are not perfect. An unusually tall person will have a completely inaccurate BMI because tall people are not just ‘scaled up’ versions of short people. Also, athletic people are often classified obese in BMI tests because their extra muscle mass pushes them into the category, even though they are healthy.

But I think we all know when we are nudging into the wrong category, right? It is quite easy to spot the difference between a fit rugby player and a couch potato.

Are you TOFI? Thin Outside, Fat Inside?

The key lies in what is happening inside the body. In recent times, with improved ways of assessing the body, it is possible to look inside using MRI and CT scanners. Now we know that what is more important than just the physical measurement, is the amount of fat in the body cavities and even more important than that, is the way that the fat is distributed around the organs.

Someone can be what is known as a TOFIThin Outside, Fat Inside.

This person would have a completely normal BMI and think that they are extremely healthy. They may watch what they eat and exercise too. But, they have been dealt a bad hand by genetics.

They may be predisposed to accumulating fat deposits around their vital organs – the heart, lungs, liver – and this will, in effect, shorten their life beyond expectations. 

In the normal scheme of things, someone with a TOFI body shape will not put themselves on alert and neither will they trigger any alarm bells with their doctor because, on the outside, they look healthy and happy. But purely because of the distribution of fat deposits, they may have a high risk of atherosclerosis, transient ischaemic attacks and even heart attacks.

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