Let us start by having a common but useful understanding of Health. This is important because the word health can have different interpretations. In this article, Health is defined as, in accordance with the World Health Organization, “a state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity”. In other words, Health extends beyond just physical well being and mental well being but also incorporates social/environmental well-being. These aspects all inter play to facilitate total well being and disturbance in any one by itself or the inter relationship between them will lead to negative outcomes which we label as disease or abnormal.
Our body weight/mass is an important determinant of our Health: physical, mental, and social well-being. There is a bidirectional relationship between weight and health: abnormal weight can lead to abnormal health and abnormal health can lead to abnormal weight.
The standardization of what normal weight should be is still an evolving science. However, extensive research has been done and we are much more educated about the concept of “normal weight”.
The Body Mass Index (BMI) has been a useful guide for many years. It takes into account the Age, Height, Weight and Gender of the person and calculates a value based on those factors. The BMI categorizes people into the following groups: 1. Underweight (BMI of less than 18), 2. Normal weight (BMI of 18 to 24), 3. Overweight (BMI of 25 to 30) and 4. Obese (BMI of greater than 30).
However, there is criticism of the BMI scale, claiming that it does not take into consideration ethnicity/race and body type/musculature of the person.
It is a fact that muscles are heavier as well as bones. A very muscular person who may be of short stature can give a high BMI and be classified as obese, example body builders are often misclassified by the BMI system and that can affect health insurance premiums.
The Waist Hip Ratio is now augmenting the BMI scale in the search for ideal body weight /mass. This is measurement of the circumference of the waist as a ratio or proportion of the circumference of the hip. The World Health Organization advisory is: a waist /hip ratio of 0.85 or less for women and 0.9 or less for men. The waist /hip ratio is more of a measurement of fat distribution and a strong indicator of the risk of metabolic syndrome disease, which foretells Diabetes mellites, hypertension and heart disease.
Weight Control versus Weight Loss
Two out of every three persons in America are overweight or obese. This is a high prevalence of weight above normal according to the BMI scale. Using the waist to hip ratio, studies have shown a prevalence of approximately 75 percentage higher than normal. These two factors explains why the overwhelming mind set in the population is about the need to “lose weight” …..that is weight loss. Weight loss has become a catch phrase and marketing bonanza. The global market for weight loss products and services has reached an astonishing value of nearly 300 billion dollars in 2021.
It is important for us to reexamine the framing of the “problem” and use the right labels and definitions to arrive at long lasting positive outcomes. We must differentiate between weight control and weight loss. We must also understand that weight control should be our objective and not weight loss. Body weight /mass or fat distribution are tools towards health and not an end in themselves. Weight loss as a tool or a goal opens the door to the psychology of body image as the objective, in other words, people seek to lose weight to look good and not about health.
The Islamic Guideline
Most Muslims are aware of the advice of the last Messenger of God, Muhammad (peace be upon him), where he recommends filling one third of the stomach with solid, one third with liquid and leaving one third with air. There is no doubt about the scientific foundation of this advice. However, failure to follow has been on two bases: 1. How much is one third. 2. What should make up the solid and to some extent the liquid parts of the intake.
- Measuring the one third. To follow this advice of the Messenger (PBUH), we must agree on how much is one third. Nutritionists have addressed this in collaboration with anatomists and have proposed that a handful with the fingers extended upwards at almost ninety degrees is a useful guide to measure one third. It is important to note that a handful is about volume more than weight. A handful of nuts will not have the same weight as a handful of chicken. A handful of solid is the volume of all solids one eats in a meal, and not the volume of each component of the solid portion of the meal.
- The make up of the meal. They are some factors we should consider when deciding on the make up of the solid portion of the meal as well as the liquid portion. The foods we eat now as well as the geographic variations in foods versus the foods that were available and consumed by the Messenger (PBUH) forces us to utilize principles of nutritional science to fulfill the advice of the messenger (PBUH), which is directed to all, in all times. Two principles are necessary to follow: 1. The appropriate combination of food groups. 2. Caloric intake.
The general categories of food groups are Carbohydrates, proteins, and fats. Within each group there are subgroups, for example simple and complex carbohydrates. Simple carbohydrates are mostly the sugars (glucose, sucrose, fructose, lactose, and maltose) which are predigested and readily absorbed into the blood and can cause therefore a “sugar spike”. The complex carbohydrates are not readily absorbed but must be broken down by the digestive system which is a relatively slow process and so does not cause “sugar spikes”. The Glycemic Index scale is the best evaluation of the absorption rate of carbohydrates and the impact on the “sugar spike”. This scale rates carbohydrates from 1 to 100, with 100 being equal to the blood sugar level that occurs if someone ingests 100 grams of glucose. For weight control and also for diabetic patients it is important to consume carbohydrates that are complex and as a guide have a glycemic index less that 45.
Fats are also classified into subgroups such as saturated fats and unsaturated fats. In processed foods, fats are usually hydrogenated, and this is generally not good for health. Whilst we do need some saturated fats, it is better for us to include more unsaturated fats in the “fat portion” of our foods, which should stay under 30 percent of our meal.
Food Combinations: To avoid fat deposition and storage (Adipose), the right combination of the different food groups must be in the make up of the meal. The biochemical basis of fat/adipose storage depends on the availability of excess sugar in the blood (sugar spike). The synthesis of Adipose requires sugar … this is the basis of the Atkins diet that proposes a “carb free diet”. Therefore, for weight control and specifically fat storage control, the meal should follow the following combinations of food groups: (a) carbohydrates plus proteins or (b) proteins plus fats. It is important to avoid the combination of fats and carbohydrates.
It is estimated that an adult female needs about 1800 calories/day doing normal activities which include walking over the period of the day at least 2 miles and an adult male need about 2000 calories/day doing normal activities which include walking at least 2 miles over the period of each day.
It is suggested that one should keep the calorie value of each meal to approximately 600 calories. In cases of reduced physical activity then the caloric intake should be appropriately reduced, but never below 1500 calories.
Researches are now showing the great effect of fasting on weight control. Medical definition of fasting is to miss a meal. The recommended fasting of 2 days/week by the messenger (PBUH) further guides to better health of body, mind, and soul. While fasting is primarily for the health of the soul, the body also benefits as during the fast the body repairs and rejuvenates through the activation of genes that produces substances that slows the inflammatory processes and drives cell repair.
We must remember as a motivating thought that we loose weight in the kitchen (where we gained it) and maintain health in the gym or with physical activity.