OBESITY

Dr. SUPANTHA CHATTERJEEPGT

DEPT. OF COMMUNITY MEDICINEBURDWAN MEDICAL COLLEGE

DEFINITION

IT IS THE ABNORMAL GROWTH OF THE ADIPOSE TISSUE DUE TO AN ENLARGEMENT OF FAT CELL SIZE OR AN INCREASE IN FAT CELL NUMBER OR A COMBINATION OF BOTH.

ENLARGEMENT OF FAT CELL SIZE – HYPERTROPHIC

INCREASE IN FAT CELL NUMBER – HYPERPLASTIC

PREVALENCE

Perhaps the most prevalent form of malnutrition in present days, affecting children as well as adult.

Prevalent in both developed and developing countries.

It is estimated by the WHO that globally, over 1 billion (16%) adults are overweight and 300 million (5%) are obese.

In India the prevalence of obesity is 12.6% in women and 9.3% in men.

EPIDEMIOLOGICAL DETERMINANTS

Non-modifiable Age:

It can occur at any age The vulnerability is maximum in the middle age Infants with excessive weight gain have

increased chance of obesity in later life. Gender:

Females are more likely to be obese Women gain weight most at menopausal period

(45-49 yrs) It is claimed that women’s BMI increases with

successive pregnancies.

Genetic factors: Twin studies show that there is a close

correlation between the weights of identical twin.

Ethnicity: There are large unexplained variations in

the prevalence of obesity in the people from different ethnic groups.

Modifiable Physical Inactivity:

A vital component that keeps accumulation of fat and obesity under check.

Sedentary lifestyle brings about obesity. A major reduction in activity without the

compensatory decrease in energy intake causes increased obesity.

Physical inactivity and obesity – a vicious cycle.

Socio-economic status: There is a clear inverse relationship

between socio-economic status and obesity.

Dietary habit: A diet rich in fats, refined sugar and

carbohydrates predisposes to obesity. Consumption of as little as 100 extra

calories per day would increase the weight of an individual by 5 kg in one year.

Psychological factor: Overeating may be a symptom of

depression, anxiety, frustration and loneliness in childhood.

Family tendency: Obese parents frequently have obese

children.

Metabolic factors: Cushing’s syndrome, hypothyroidism,

growth hormone deficiency.

Alcohol: High calorific value (7kcal per gm.) in itself

is a risk factor for obesity. The snacks consumed along with an

alcoholic drink add many more calories and predisposing the individual to obesity.

Education levels : In the Indian setting, people with a higher

education level, are more likely to be obese.

In the west, however, the educated are in a better state of health i.e. less obesity.

Smoking: Smoking per se reduces the likelihood of

obesity, by virtue of nicotine being an anorexic agent.

Drugs: Use of certain drugs e.g. corticosteroid, oral

contraceptives, insulin

TYPES OF OBESITY

Gynecoid / ‘Pear shaped’ : The fat is evenly distributed (globally distributed).

Android/‘Apple shaped’ : The fat is centrally distributed or deposited

preferentially in the abdominal region. This expresses the peritoneal (visceral)

distribution of fat in the individual. Commonly seen in men of the South East Asian

region, including India. Such a distribution is a higher risk factor for

coronary artery disease. Higher waist circumference or higher WHR is a

good indicator of visceral (peritoneal) deposition of fat.

CLASSIFICATION OF OBESITY

CLASSIFICATION BMI RISK OF COMORBIDITIES

UNDERWEIGHT <18.50 LOW

NORMAL RANGE 18.50-24.99 AVERAGE

OVERWEIGHT:

PRE-OBESE

OBESE

≥ 25.00

25.00- 29.99

≥ 30.00

INCREASED

MORE INCREASED

GRADES OF OBESITY FOR SOUTH-EAST ASIANS REGION

BMI CLASSIFICATION RISK OF CO-MORBIDITIES

< 18.50 UNDERWEIGHT LOW

18.50 – 22.99 NORMAL WEIGHT

INCREASING BUT

ACCEPTABLE

23.00 - 27.50 PRE - OBESE INCREASED

>27.50 OBESE HIGH

ASSESSMENT OF OBESITY

BODY WEIGHT : In epidemiological studies it is conventional to accept +2SD from the median weight for height as a cut off point of obesity.

SOME INDICATORS TO MEASURE OBESITY

BODY MASS INDEX (BMI) PONDERAL INDEX BROCCA INDEX LORENTZ’S FORMULA CORPULENCE INDEX

Body mass index (BMI) :

Weight in kilograms divided by the square of the height in meters (kg/m²)

Weight in kg BMI = ----------------------------------------

Height in meter²

Example : Weight = 74 kg Height = 1.75 meter

74 BMI = ------------ = 24.2 1.75²

Height (cm)

Ponderal index = -----------------------------------------------

Cube root of body weight (kg)

Brocca index = Height (cm) - 100

Ht (cm) - 150

Lorentz’s formula = Ht (cm) – 100 - ------------------------------

2(women) /4(men)

Actual weight

Corpulence index = -------------------------------------

Desirable weight

SKINFOLD THICKNESS

Rapid and noninvasive method Harpenden skin callipers are used Measurement at four sites – mid-triceps,

biceps, subscapular and suprailiac regions Sum of the measurement should be –

<40 mm in boys <50 mm in girls

Main drawback – Poor repeatability

WAIST CIRCUMFERENCE AND WAIST : HIP RATIO (WHR)

Unrelated to height Approximate index for intra-abdominal fat mass

and total body fat. Reflects changes in risk factors for

cardiovascular diseases and other chronic diseases.

Indicates increased risk for metabolic complications if the waist circumference – ≥ 102 cm in men ≥ 88 cm in women

Indicates abdominal fat accumulation if WHR – > 1.0 in men > 0.85 in women

METHODS USED IN DETERMINING OBESITY IN CHILDREN

WEIGHT TO HEIGHT TABLES –

Indian Council of Medical Research gives general ranges for healthy weight for a child's height.

However, the child’s age and growth pattern also has to be considered.

Generally a child is considered obese if the weight is 20 percent or more what is recommended as healthy range for the height and body type.

BODY MASS INDEX –

This measure is used to assess weight relative to height. Most of the studies use BMI as a measure of obesity in children. The Centers of Disease Control and Prevention suggests two levels of concern for children based on the BMI-for-age charts.

A child with a BMI of ≥ 85th percentile for age and sex is

considered at risk of being overweight ≥ 95th percentile for age and sex is

considered obese.

RELATIVE RISK OF HEALTH PROBLEMS ASSOCIATED WITH OBESITY

GREATLY INCREASED MODERATELY INCREASED

SLIGHTLY INCREASED

NIDDM CHD CANCER (BREAST CA,ENDOMETRIAL CA,

COLON CA)

GALLBLADER DISEASE HYPERTENSION REPRODUCTIVE HORMONE

ABNORMALITIES

DYSLIPIDEMIA OSTEOARTHRITIS (KNEE) PCOS

INSULINE RESISTANCE HYPERURICAEMIA & GOUT

IMPAIRED FERTILITY

BREATHLESSNESS LOW BACK PAIN DUE TO OBESITY

SLEEP APNEA • INCREASED RISK OF ANAESTHESIA COMPLICATION

Prevention and control

Indicated prevention

Individuals who are already overweight or showing biological markers associated with excessive fat stores but who are not yet obese.

Indicated prevention strategies usually involve working with patients on a one-to-one basis or, alternatively, through the establishment of special groups to provide guidance and support.

Primary objectives of this preventive strategy are restricted to preventing further weight gain and reducing the number of people who develop obesity-related comorbidities.

Selective prevention

Aimed at sub-groups of the population who are at a high risk for the development of obesity.

Selective prevention is concerned with improving the knowledge and skills of groups of people to allow them to deal more effectively with the factors which put them at a high risk of developing obesity.

High risk groups - Genetically susceptible individuals,

certain ethnic groups, socially or economically disadvantaged, Recent successful weight reducers, Recent past smokers, Patients who have been prescribed certain drugs that, promote weight gain

Vulnerable period – Adolescence, Early adulthood,

Pregnancy, Menopause

Universal or public health prevention

Population or community as a whole regardless of their current level of risk.

Where the prevalence of the condition is already extremely high, universal approaches have the potential to be the most cost effective form of prevention, to reduce the incidence as well as the prevalence of obesity.

Other objectives of universal prevention include a reduction in weight-related ill health, improvements in general diet and exercise levels and a reduction in the level of population risk of obesity.

WAYS TO PREVENT OBESITY

DIETARY THERAPY Restrictions of calories represent the first line therapy in all

cases

Low calorie diets (LCD), which provide 1000–1500 kcal/day, resulted in weight loss of 8% of baseline body weight over six months

Very low calories diets (VLCD), which provide 300–800 kcal/day, can be useful in severely obese patients . They are found to produce 13% weight loss over six months.

Meal replacement programmes and formula diets can be used as an effective tool in weight management.

Fat substitutes like Olestra (Olean), which is a non-digestible, non-caloric fat, can be used in food preparations taken by obese patients.

PHYSICAL ACTIVITY

Physical activity, which increases energy expenditure, has a positive role in reducing fat storage and adjusting energy balance in obese patients.

Various exercises preceded and followed by short warm up and cool down sessions help to decrease abdominal fat, prevent loss of muscle mass.

Patients who exercise regularly had increased cardio vascular fitness along with betterment in their mental and emotional status.

A minimum of 30 minutes exercise is recommended for people of all ages as part of comprehensive weight loss therapy.

BEHAVIOUR THERAPY

Patients need to be trained in gaining self-control of their eating habits.

Behaviour modification programmes which seek to eliminate improper eating behaviour include individual or group counseling of patients.

Self-help groups (weight watchers) use a program of diet, education and self-monitoring like maintenance of logbook, keeping an account of food intake etc. are beneficial.

OTHER MEASURES

Appetite suppressing drugs can be used.

Surgical treatment for controlling obesity e.g. gastric bypass, gastroplasty, jaw wiring, liposuction etc.

Take appropriate measures to prevent childhood obesity

Health education

THANK YOU