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OBESITY

Nutrition departmentMedical school

University of Sumatera Utara

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Globesity: a worldwide problem

0

5

10

15

20

25

Global Least developed Developing Transition Developed

BMI < 17

BMI > 30

In 1995 WHOestimated there were200 million obesepeople

In 2000 more than300 million peoplewere estimated to beobese

132 million indeveloped countries

170 million in othercountries

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What is Obesity?

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Obesity: Definition

Excess body fatFat cells function to store and releaseenergy

Normal body fat is 10 to 20 kgObese body fat is 40 to100 kg

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Levels of Body Fatness

Men WomenEssential fat 5% 10%Borderline 5-9% 10-16%High performance 5-15% 10-23%Good fitness health 10-20% 17-28%Marginal fitness 21-25% 29-35%Overfatness > 25% > 35%

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Etiology

1. Genetics factor- contribute to ones predisposition to or

protection from obesity- include determinations of RMR, where fat isstored, physiologic response to overfeeding,eating behavior

- Ob gene produce leptin- -3adrenoreceptor gene regulate

RMR & fat oxidation

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2. Neuroendocrine syndrome (

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3. Environmental factor primary causesDietary excess

- active- passive

Physical inactivity

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Decreases with Education

0

5

10

15

20

25

30

1991 2000

< HSHSSome CollegeCollege +

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Body CompositionAssessment

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Body Composition AssessmentTechniques

Underwater weighingTechnological assessmentsSkinfold techniqueAnthropometric measurements

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Underwater Weighing Technique

The

" G o l d

S t a n d a r d "

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Technological Assessmentsof Body Composition

Bioelectric impedance

Infra-red spectroscopy Ultrasound Imaging techniques (DEXA, MRI)

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Bioelectric Impedence(Measurement Issues)

Based on resistance to current flowLean tissue has more water - less resistance

Fat tissue has less water - more resistanceGeneral conclusions

Overestimates lean / underestimates obese

Practical, but expensive measure for generalpopulation

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Infrared Spectroscopy(Measurement Issues)

Based on differential absorbance ratesLean tissue has a different energy absorption and

reflectance pattern than fat tissueSources of error

Validity of absorbance readings is questionable!

General findingsNOT a valid measure!

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Ultrasound(Measurement Issues)

Based on reflection of soundFat content increases the time is required for

sound to reflect off of bone and muscle.General conclusions

Highly accurate measure of body fat - especially forobeseExpensive and not practical for most applications

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Imaging Techniques(Measurement Issues)

Based on imaging of body tissuesBased on cross sectional area measurescalculated at different levels of the body

General conclusionsVery precise measure of body composition

Expensive and not practical measure for mostuses

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Anthropometric Measurements

Body Mass Index (BMI)

Waist to Hip Ratio (WHR)Circumference measures

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Body Mass Index (kg/m 2)

Dose - Response Risk RelationshipUnderweight < 18.5

Normal 18.5 - 25Overweight 25 - 30Obese > 30

Class I 30 - 34.9Class II 35 - 39.9Class III >40

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Body Mass Index (kg/m 2) in adult Asians

Dose - Response Risk RelationshipUnderweight < 18.5

Normal 18.5 22.9Overweight 23

- At risk 23 24.9

- Obese I 25 29.9- Obese II 30

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Regional Fat Deposition

Abdominal body fat poses greater health risks than fat stored in other areas

Males store more fatcentrally and haveincreased healthrisks associatedwith body fatness

Higher health riskLower health risk

Male (apple) Female (pear)

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Regional Fat DepositionVisceral Fat

Visceral body fat poses greater health risks because thisfat is more labile and has greater access to thecirculation.

The accumulation of visceral body fat is typical of theandroid (male) fat pattern

males: visceral accounts for 10-35% of total fatfemales: visceral accounts for 8-13%of total fat

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WOMENMENHigh Risk

Moderate RiskLow Risk

> 1.0 > .85

.90 -1.0 .80-.85

HEALTH RISK

< .90 < .80

Waist to Hip Ratio (WHR)

Waist to Hip Ratio is an effective way toexamine regional fat distribution.

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Tipe buah Pear(Obesitas Ginecoid)

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Tipe buah Apel(Obesitas Android)

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