Obesity-definition,diagnosis,

complication,Bangladesh & Global context – Metabolic Syndrome

DR. TASNIM ARA JHILKY MD(PART-I) PHASE -A STUDENT DEPARTMENT OF BIOCHEMISTRY SIR SALIMULLAH MEDICAL COLLEGE

Introduction of obesityObesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health.

It is a leading preventable cause of death worldwide.

This excess accumulation is the result of a positive energy balance where caloric intake exceeds caloric expenditure.

With increasing prevalence in adults and children, the authorities view it as one of the most serious public health problems of the 21 century.

Definition of obesity

It is a condition having body weight of an individual 20% or more than 20% above the standard weight for people of same age & sex.

It happens due to excessive fat storage in adipoge tissue.The fat content in a non obese adult individual is about14kg,but in obese individual it is usually more than28kg

Obesity is increasing in industrialized countries because of a reduction in daily energy expenditure and an increase in energy intake resulting from the increasing availability of palatable, inexpensive foods

Obesity Con…………Obesity, the accumulation of excess body fat, results when energy (caloric) intake exceeds energy expenditure

The body mass index (BMI) is easy to determine and highly correlated to body fat

Nearly two thirds of U.S. adults are overweight (BMI ≥ 25 kg/m2) and more than one third of this group are obese (BMI ≥ 30 kg/m2).

Energy Balance

Intake….Output

..

Some scenario……

Causes of obesity

Etiology con.At an individual level, a combination of excessive caloric intake and a lack of physical activity. Is the major cause of obesity

Cortisol and other glucocorticoids.Sulfonylurea. Antidepressants.Antipsychotics, e.g. MAOIs, Risperidone. Oral contraceptives.Insulin.

Con………….

Diagnosis of obesity It is done by anthropometric measurements and body

fat content Body Mass Index (BMI) is a simple index of weight-for-

height that is commonly used to classify overweight and obesity in adults– It is defined as a person's weight in kilograms divided by the

square of his height in meters

Classification of obesity

Waist hip ratioA measurement of waist to hip ratio (WHR) is an appropriate method of identifying patients with abdominal fat accumulation.

The waist is measured at the narrowest point and the hips are measured at the widest point.

A high WHR is defined as:

*>( 0.95 )1.0 in men.

*>( 0.85 )in women.

Measurement of body fat content

Computed axial tomographyscan

MRI

Dual energy x rayabsorptiometry

In adult ,body fat content>28kgis usually diagnostic of obesity.

Complication of obesity

Global contextAccording to WHO: As of 2015

4.6 billion adults (over 15 years old) are overweight

900 million are obese Projects by 2025, 6.3

billion will be overweight and 1.5 billion obese

Low and middle income coun.

Double Burden of Disease

According to WHO there is a “double burden” of disease

Countries that are developing are still having issues of infectious disease and under-nutrition

There is also an increase of chronic disease related to obesity…especially in urban settings

Causes inadequate prenatal care, lack of infant and child nutrition and eating high fat and high sugar foods

Metabolic changes in obesity

The primary metabolic effects of obesity includedyslipidemias, glucose intolerance and insulin resistanceThese metabolic abnormalities reflect molecular signals originating from the

increased mass of adipocytesdyslipidemias, glucose intolerance and insulin resistanceThese metabolic abnormalities reflect molecular signals originating from the

increased mass of adipocytes

Metabolic syndrome Abdominal obesity is associated with a cluster of metabolic abnormalities that is referred to as the metabolic syndrome and includes

◦ glucose intolerance (hyperglycemia but not yet diabetes)◦ insulin resistance with hyperinsulinemia◦ dyslipidemia (low levels of HDL but elevated TAGs)◦ hypertension

m…s…

m..s…Also associated with a state of low-grade, chronic systemic inflammation that contributes to the pathogenesis of insulin resistance and atherosclerosisAdipocytes release proinflammatory mediators IL-6 Low levels of hormone adiponectin that normally

suppress inflammation and sensitizes tissues especially the liver to insulin may contribute to the metabolic syndrome & stimulate the risk of T2DM and heart disease.

Metabolic syndrome is a combination of factors that multiply a person's risk for heart disease, diabetes and stroke

Almost 34% of American adults are affected

Treatment of obesity Lifestyle change through

Dietary change

Physical exercise

Antiobesity drug:sibutramine,orlistat

Surgical treatment

A Healthy DietA Healthy Diet

Emphasizes fruits, vegetables, whole grains, fat-free Emphasizes fruits, vegetables, whole grains, fat-free or low-fat milk, & milk products; or low-fat milk, & milk products;

Includes lean meats, poultry, fish, beans, eggs, and Includes lean meats, poultry, fish, beans, eggs, and nutsnuts

Is low in saturated fats, Is low in saturated fats, transtrans fats, cholesterol, salt fats, cholesterol, salt (sodium), and added sugars.(sodium), and added sugars.

Balanced, low-calorie diets. Very low-calorie diets. ( No carbohydrates) Low-fat diets. Low-carbohydrate diets. Midlevel diets.

Physical exerciseIt is recommended that;-- At least 150mins aerobic exercise or 75mins resistant exercise per week , - At least 30 mins per day for 5 days a week- week- Not more than 2 exercise free days in a week

- SURGICAL TREATMENT- Bypass of major absorptive portion of small intestine- Adjusttable gastric banding

Who strategy WHO Strategy for preventing overweight and obesity

◦ Adopted by World Health Assembly in 2004 and WHO Global Strategy on Diet, Physical Activity and Health◦ Four objectives

◦ Reduce risk factors of chronic disease◦ Increase awareness and understanding◦ Implement global, regional, national policies actions plans◦ Monitor science and promote research

Lets talk to everyone… Reduce risk factors for chronic disease

◦ To reduce, there needs to be more exercise and better eating habits

Increase awareness and understanding◦ To understand the influence of diet and

why physical activity makes a difference

And the last two… To develop and implement global, regional, national policies and action plans

◦ Work to improve diets and definition of physical activity

Monitor Science and promote research◦ On how diet affects the body, how to influences ◦ How much physical activity is best for most

FRUITS AND VEGETABLES

WHO states: ◦ Fruits and vegetables need to be part of the daily diet to

prevent disease such as obesity and noncommunicable disease

◦ The statistics are startling◦ Lack of enough fruits and vegetables cause

◦ 19% of GI deaths◦ 31% of Ischemic heart disease◦ 11% of stroke

LAST SLIDE It is well known that obesity is preventable. It is caused by eating more than we need…so how can we prevent obesity?

◦ Each of us can…according to WHO◦ Have a balance of energy and healthy weight◦ Limit how much fat we eat…we need to eat some..but not too much. ◦ Increase fruits and vegetables◦ Limit sugars◦ Increase exercise to at least 30-60 minutes per day on most days!

THANKS