I was sitting in my local cafe and couldn't help but notice the number of people with varying degrees of obesity walking through the shopping centre. It is estimated that a third of the Australian population has a BMI over 30, excluding those with a large muscle mass, such as body builders and professional athletes.

A study published in 2015 in the American Journal of Public Health examined the probability of an obese person attaining normal body weight. This study reviewed close to 177,000 people over a nine year period, studying those with a BMI of 30-35-moderate obesity and also a BMI of 40-45-considered morbid obesity.

If you’re in the moderately obese range, one in 210 males and one in 124 females were able to achieve normal body weight which is a BMI between 20-25. But, in the morbidly obese people, a dismal one in 1,290 males and one in 677 females were able to achieve normal body weight.

The data was somewhat more encouraging showing that with morbid obesity, 1 in 8 males and 1 in 7 females could lose 5% of their weight. Unfortunately, this is too little, typically, too late.

It appears that people in the morbidly obese range have an estimated loss of life of up to around 14 years and in some cases even 20 years.

When you think about obesity, you typically associate this with diabetes and all forms of cardiovascular disease. But, the studies clearly show a strong link between obesity and all of our modern killers including cardiovascular disease, cancer and Alzheimer's disease.

There are really only 5 choices for the obese person:

1. Stay as they are and expose themselves to these tremendous health risks.
2. Drastically change their life, which includes a significant reduction in caloric intake, reduction in refined carbohydrates and alcohol. It also involves a regular graded exercise habit achieving somewhere between 3 to 5 hours per week of a combination of aerobic exercise along with strength and resistance training.
3. Have a lifelong commitment to point 2 above but add some supplements with a reasonable evidence base, such as the bergamot derivatives with BPF99 extract.
4. Maintain 2 and 3 above but also add one of the newer agents known as GLP1 agonists, which involve a weekly injection. The GLP1 agonist, semaglutide has been shown recently in a New England Journal of Medicine article to help obese people achieve up to 15 kg weight loss. This was in a group of non-diabetics, despite the fact that these drugs were initially developed for the management of Type 2 Diabetes.
5. The final choice is some form of gastric surgery such as gastric bypass, gastric banding or the favoured technique in Australia, gastric reduction surgery.

In the USA, the most commonly performed procedure is the gastric bypass procedure. A recent study has shown a significant reduction in obesity related cancers in people undergoing this operation.

Obesity related cancers include breast and prostate cancer, colorectal cancer, pancreatic, endometrial and thyroid cancers along with liver cancer and multiple myeloma. In this particular study 98,000 individuals aged between 18 to 64 were diagnosed with severe obesity and varying degrees of non-alcoholic fatty liver disease. Over a 10-year period, a third had bariatric surgery. Those who underwent the surgery had an 18% reduction in all cancers and up to a 25% reduction in obesity related cancers. When the group was divided into varying degrees of fatty liver disease in some cases the reduction in obesity related cancer was 50%.

The message is very clear – if your body mass index (weight-kg/height-metres2) is above 30 you need to seriously start thinking about the long-term health consequences. Not only is the evidence clear that you will reduce your lifespan, you may be spending the last 20 years of your life battling with either cardiovascular disease, cancer or even Alzheimer's disease.

I say to all of my patients that life is not about making the big decision to be healthy but making 30 to 50 small decisions every day such as I won't eat that biscuit; I won't have that extra glass of wine; I'll take the stairs rather than use the escalators.

Although you will see no major change acutely from these small decisions, over time you will reap the enormous health benefits of losing weight & being much more healthy.