obesity and its management 2016
TRANSCRIPT
OBESITY AND ITS OBESITY AND ITS MANAGEMENTMANAGEMENT
Maj Neamatullah AhmedMaj Neamatullah Ahmed PBGMS,MPH,MCPSPBGMS,MPH,MCPS
INTRODUCTIONINTRODUCTION
It produces many complications like hypertension, Diabetes Mellitus, IHD,Stroke etc.
Deadly Diseases Causing Deadly Diseases Causing Death of Millions of People Death of Millions of People
worldwide worldwide In 20th CenturyIn 20th Century Deadly infections,i.e.Deadly infections,i.e. CholeraCholera Small poxSmall pox TuberculosisTuberculosis TetanusTetanus MeaslesMeasles PneumoniaPneumonia Bird fluBird flu Other viral & bacterial Other viral & bacterial
infectionsinfections
In 21In 21stst Century Century Hypertension-CVAHypertension-CVA Heart DiseasesHeart Diseases DiabetesDiabetes CancerCancer ObesityObesity Man made Disaster-Man made Disaster-RTA, War etcRTA, War etc
Projected prevalence of obesity in adults by 2025
AIMAIM
My aim is to orient you about :My aim is to orient you about : Definition of obesityDefinition of obesity PrevalencePrevalence Reversible causes of weight gainReversible causes of weight gain Obesogenic environmentObesogenic environment Food value chartFood value chart Different exercise value chartDifferent exercise value chart Prevention strategies for obesityPrevention strategies for obesity Balanced DietBalanced Diet Therapeutic options for obesityTherapeutic options for obesity Surgical options for obesitySurgical options for obesity Danger FoodsDanger Foods Fitness PledgeFitness Pledge Prevention of obesityPrevention of obesity RecommendationsRecommendations
Abnormal growth of the adipose tissue due to enlargement of fat cell size (hypertrophic) or an increase of fat cell no (hyper plastic) or combination of both.
Desirable % Body FatDesirable % Body Fat
Men: 8-25%Men: 8-25% Women 20-35%Women 20-35%
Prevalence of ObesityPrevalence of Obesity
What is Prevalence?What is Prevalence?
New Obese / Incidence + Old ObeseNew Obese / Incidence + Old ObeseNo of Total Obese PersonsNo of Total Obese Persons
Global epidemic of Global epidemic of obesityobesity
0200400600800
1000120014001600
2000 2005
BMI>30BMI>25
Overweight and Obesity are the 5Overweight and Obesity are the 5thth leading risk of global deaths. leading risk of global deaths.At least 3.4 million adults die each year as a result of being At least 3.4 million adults die each year as a result of being overweight or obese.overweight or obese.
Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2005BRFSS, 2005
15%–19% 20%–24% 25%–29% ≥30%
India
Bangladesh Prevalence of obesity among girls & women aged
10 to 49 yrs
Sl Sl nono
BMIBMI Prevalence (%)Prevalence (%)
1.1. > 25> 25 552.2. 18.5- 24.9918.5- 24.99 5959
3.3. < 25< 25 9595
4.4. < 18.5< 18.5 3535
Source: Bangladesh demographic & health data 2004
In 2010, among college students of Dhaka City - Prevalence of obesity is 18%
United Kingdom
16% adults are obese by 199516% adults are obese by 199525% adults are obese by 201025% adults are obese by 2010
United States
68% Americans are overweight and68% Americans are overweight and 33.8% Americans are obese33.8% Americans are obese
China
Potential reversible causes of Potential reversible causes of weight gainweight gain
Endocrine FactorsEndocrine Factors HypothyroidismHypothyroidism Cushing’s SyndromeCushing’s Syndrome Hypothalamic Tumors / injuryHypothalamic Tumors / injury InsulinomaInsulinoma Drug TreatmentsDrug Treatments Tricyclic antidepressantTricyclic antidepressant SulphonylureasSulphonylureas Oestrogen-containing contraceptive pillOestrogen-containing contraceptive pill CorticosteroidsCorticosteroids Sodium valproateSodium valproate ß-blockersß-blockers NSAIDSNSAIDS Pathological Eating BehaviourPathological Eating Behaviour Binge eatingBinge eating Nocturnal eating/BulimiaNocturnal eating/Bulimia Alcohol consumption Alcohol consumption Davidson/22ndDavidson/22nd
Reasons for the increase prevalence of Reasons for the increase prevalence of obesity-The ‘Obesogenic’ Environmentobesity-The ‘Obesogenic’ Environment
Increasing energy intakeIncreasing energy intake
↑↑Portion sizesPortion sizes ↑ ↑Snacking and loss of regular mealsSnacking and loss of regular meals ↑ ↑Energy-dense food (mainly fat)Energy-dense food (mainly fat) ↑ ↑AffluenceAffluence Late night sleepLate night sleep Decreasing energy expenditureDecreasing energy expenditure
↑ ↑Car ownershipCar ownership ↓ ↓Walking to school/workWalking to school/work ↑ ↑Automation; ↓manual labourAutomation; ↓manual labour ↓ ↓Sports in schoolsSports in schools ↑ ↑Time spent on video games and watching TVTime spent on video games and watching TV ↑↑Central heating( Air ConditioningCentral heating( Air Conditioning))
BAGEL
20 Years Ago Today
140 calories 3-inch diameter How many calories
are in this bagel?
BAGEL
20 Years Ago Today
140 calories 3-inch diameter
350 calories 6-inch diameter
Calorie Difference: 210 calories
Maintaining a Healthy Weight is a Balancing ActCalories In = Calories Out
How long will you have to rake leaves in order to burn the extra 210 calories?*
*Based on 130-pound person
Calories In = Calories Out
If you rake the leaves for 50 minutes you will burn the extra 210 calories.*
*Based on 130-pound person
CHEESEBURGER
20 Years AgoToday
333 calories
How many calories are in today’s cheeseburger?
CHEESEBURGER20 Years Ago Today
590 calories
333 calories
Calorie Difference: 257 calories
Maintaining a Healthy Weight is a Balancing ActCalories In = Calories Out
How long will you have to lift weights in order toburn the extra 257 calories?*
*Based on 130-pound person
Calories In = Calories Out
If you lift weights for 1 hour and 30 minutes,
you will burn approximately 257 calories.**Based on 130-pound person
Calories In = Calories Out
If you ride a bike for 1 hour and 25 minutes,you will burn approximately 500 calories.*
*Based on 160-pound person
EpidemiologyEpidemiologySex
Age
Physical Inactivity Genetic Factors
Socio-economic Status
Eating HabitPsychological Factors
Obesity can occur at any age
If obesity develops in childhood, it is likely to be followed by obesity in adult life
Women are more prone to obesity than men
Woman’s BMI increases with successive pregnancies.
Genetic factors also plays an important role
Genetic Mechanism of Obesity
Obesity is more common and prevalent in the affluent society than that of other classes.
The use of steroids, oral contraceptive pills, pain killers, Anti-hypertensives & insulin is commonly followed by obesity
The composition of diet, the periodicity with which it is eaten and the amount of energy derived from it are all relevant with obesity
Eating too Eating too little?little? Or Or
too much?too much?
Improper diet
Malnutrition
bmi>25 bmi<18.5 (Overweight) (Underweight)
Physical inactivity may cause obesity, which in turn restrict activity
Types of ObesityTypes of Obesity Apple Shape obesityApple Shape obesity
Pear Shaped ObesityPear Shaped Obesity
Partners in Global Health Education
1. How to use this module
2. Learning outcomes
3. Definition
4. Classification
5. Section 1 quiz
6. Global burden of obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
10. Effects of obesity
11. Section 4 quiz
12. Childhood obesity
13. Section 5 quiz
14. Management of obesity
15. Section 6 quiz
16. Summary
17. Information sources
tion 1
Note: Although overweight is identified by a BMI of ? 25.0 kg/m2, the risks of obesity-associated diseases, such as diabetes, hypertension and dyslipidaemia, increase from a BMI of about 21.0 kg/m2.
Increased as follows:30.0Obesity, further classified as:
– Very severe
– Severe
– Moderate
Increased
Not increased
Risk of co-morbidity
40.0– Class III
35.0 - 39.9– Class II
30.0 - 34.9– Class I
25.0 - 29.9Overweight or pre-obese
18.5 - 24.9Normal
BMI (kg/m2)Classification
Source: Adapted from WHO 1997
WHO classification of obesity
Different Techniques to Measure ObesityDifferent Techniques to Measure Obesity
Body Mass Index (BMI-Kg/m2)
Waist-Hip Ratio ( WHR) Waist Circumference
Skin fold thicknessBroca Index : Height in cm – 100= Body weight in KG
Body Mass IndexBody Mass Index The new vital sign! The new vital sign!
Correlated with total body fat contentCorrelated with total body fat content Not accurate in muscular individualsNot accurate in muscular individuals Initial assessment and monitoringInitial assessment and monitoring BMI BMI
weight in lbs/(height in inches)weight in lbs/(height in inches)2 2 x 703x 703 ExampleExample
5’6” 248lb female5’6” 248lb female 248lbs / (66inches)248lbs / (66inches)2 2 x 703 = 40x 703 = 40
BMI ChartBMI Chart
Disadvantages of BMIDisadvantages of BMI
(a)
1.72metre
Ht 1.72metre
84Kg
Wt 84Kg
28.4 BMI 28.4
(b)
These men have the same height, weight and BMI, but have different percent body fat
BMI calculated as follows:
BMI = 84 = 84 = 28.4 kg/ m2
(1.72)2 2.96
Which of these Which of these men is at men is at risk of ill risk of ill health and health and why?why?
Although BMI is equally high in both men, in (a) it is due to lean body mass whereas in (b) it is due to body fat. This shows that, used alone, a high BMI is not diagnostic of obesity. BMI also varies with age and sex in those <18 years.
These are some of the disadvantages of using BMI to assess health risks.
Answer to QuestionAnswer to Question BMI = BMI = 87.387.3 kg kg = = 28.28.55 kg/m2 kg/m2 (1.(1.75 75 m)2m)2 HHis BMI lies in the “overweight range” (25 – is BMI lies in the “overweight range” (25 –
29.9 kg/m229.9 kg/m2) ) The likely reason for the increased BMI in an The likely reason for the increased BMI in an
athlete is an increase in lean muscle massathlete is an increase in lean muscle mass BMI does not distinguish between lean BMI does not distinguish between lean
body massbody mass ( (accumulation of muscle massaccumulation of muscle mass) ) and body fat. Hence, this athlete is wrongly and body fat. Hence, this athlete is wrongly classified as overweightclassified as overweight..
Waist Circumference
Android obesity or “apple-shaped”
Higher risk for morbidity and mortality
High Risk Men >102 cm (>40 in)
Women > 88 cm (>35 in)
MEASURE MENT OF SKIN FOLD THICKNESS
Skin Thickness Measurement
Male : If more Than 40mm
Female : If more than 50 mm
Relative risks associated with obesityGreatly increased (>3)Greatly increased (>3) Moderately increased (2-3)Moderately increased (2-3) Slightly increased (1-2)Slightly increased (1-2)
NIDDMNIDDM CHDCHD CANCER CANCER breast cancer (in post breast cancer (in post menopausal women), menopausal women), endometrial, colonendometrial, colon
Gallbladder diseaseGallbladder disease HypertensionHypertension Reproductive hormone Reproductive hormone abnormalitiesabnormalities
DyslipidaemiaDyslipidaemia OsteoarthritisOsteoarthritis Polycystic ovary Polycystic ovary syndromesyndrome
Insulin ResistanceInsulin Resistance
BreathlessnessBreathlessness
Sleep apnoeaSleep apnoea
Hyperuricaemia and Hyperuricaemia and goutgout
Table 4.1 WHO TRS 894 Obesity: Preventing and Table 4.1 WHO TRS 894 Obesity: Preventing and Managing the Global EpidemicManaging the Global Epidemic
Impaired fertilityImpaired fertility
Low back painLow back painAnaesthesia complicationsAnaesthesia complicationsFetal defects in maternal Fetal defects in maternal obesityobesity
CHDCHD
HypertensionHypertension
OsteoarthritisOsteoarthritisHyperuricaemia and Hyperuricaemia and goutgout
Table 4.1 WHO TRS 894 Obesity: Preventing and Table 4.1 WHO TRS 894 Obesity: Preventing and Managing the Global EpidemicManaging the Global Epidemic
Diabetic Ulcer of FootDiabetic Ulcer of Foot
Foot ulcer in a traumatised Foot ulcer in a traumatised diabetic patientdiabetic patient
Squamous cell carcinoma Squamous cell carcinoma of fingerof finger
Cosmetic disfiguration of body Cosmetic disfiguration of body inin
obesityobesity
Food value chartFood value chart Tea/Coffee:75/110 calTea/Coffee:75/110 cal Orange juice-1cup:40 calOrange juice-1cup:40 cal Tomato juice-1cup:80calTomato juice-1cup:80cal Cold Drinks-01 glass: 100 calCold Drinks-01 glass: 100 cal Banana-01(Sagar type):100 calBanana-01(Sagar type):100 cal Cake-01:70 calCake-01:70 cal Fruit cake-01:270 calFruit cake-01:270 cal MilkMilk-01cup/-01cup/1glass:1glass:80 cal/80 cal/150cal150cal Soup-01cup:100 calSoup-01cup:100 cal Dal-01cup:75 calDal-01cup:75 cal Ruti/chapati-2small:70 calRuti/chapati-2small:70 cal Paratha-01:150 calParatha-01:150 cal Vegetable-1/2cup:70 calVegetable-1/2cup:70 cal Toast 2piece:150 calToast 2piece:150 cal
K. ParkK. Park
Rice-01cup: 170 calRice-01cup: 170 cal Salad-01cup: 56 calSalad-01cup: 56 cal Fish/Chicken-2piece:200 calFish/Chicken-2piece:200 cal Cooked veg 1cup:170 calCooked veg 1cup:170 cal Oil for cooking-3tsf:135 calOil for cooking-3tsf:135 cal Chira/muri-60gm:210 calChira/muri-60gm:210 cal Potato-01 medium:70 calPotato-01 medium:70 cal 4 biscuit(15gm):75 cal4 biscuit(15gm):75 cal Mango-medium 01:100calMango-medium 01:100cal Boiled egg-01:90 calBoiled egg-01:90 cal Omelette / fried egg-01:160 calOmelette / fried egg-01:160 cal Samosa-01:200 calSamosa-01:200 cal Ice-cream-1 cup:400 calIce-cream-1 cup:400 cal Sandesh-2 nos:140 calSandesh-2 nos:140 cal Alcohol-7 cal/gmAlcohol-7 cal/gm Carbohydrate-4cal/gmCarbohydrate-4cal/gm Protein-4 cal/gmProtein-4 cal/gm Fat-9 cal/gmFat-9 cal/gm
Exercise Value ChartExercise Value ChartFor 77kg/170lb male : cal expenditure/ half an hourFor 77kg/170lb male : cal expenditure/ half an hour
Lying/sitting idle: 51 calLying/sitting idle: 51 cal Standing idle : 57 calStanding idle : 57 cal Walking 2 miles:97 calWalking 2 miles:97 cal Running-11min/miles:315 calRunning-11min/miles:315 cal Cycling-5.5 miles/h:147 calCycling-5.5 miles/h:147 cal Boxing inside ring: 463 calBoxing inside ring: 463 cal Tennis:252 calTennis:252 cal Table tennis:156 calTable tennis:156 cal Voleyball:116 calVoleyball:116 cal Football:348 calFootball:348 cal
Basketball:318 calBasketball:318 cal Swimming: 390 calSwimming: 390 cal Boating:102 calBoating:102 cal Sweeping floor/rake Sweeping floor/rake
leaves:138 calleaves:138 cal Gardenning:231 calGardenning:231 cal Ball-dance: 117 calBall-dance: 117 cal Disco dance: 237 calDisco dance: 237 cal
Prevention Strategies for Prevention Strategies for ObesityObesity
Changes in eating behaviour :Changes in eating behaviour : Food selection, Food selection, Portion size controlPortion size control,, avoidance of snacking, avoidance of snacking, regular meals to encourage satietyregular meals to encourage satiety and and
substitution of sugar with artificial sweeteners.substitution of sugar with artificial sweeteners. Regular eating pattern: Regular eating pattern: Not to skip any mealNot to skip any meal-which will-which will↑ satiety↑ satiety Exercise Exercise should be incorporated in the daily routine .should be incorporated in the daily routine . Promoting healthy eating in schools.Promoting healthy eating in schools. Enhancing walking and cycling options for commuters.Enhancing walking and cycling options for commuters. Creation of public places to encourage physical activity and fitnessCreation of public places to encourage physical activity and fitness Rendering Rendering health educationhealth education about the benefit of having standard about the benefit of having standard
weight to the people.weight to the people. Lifestyle modification.Lifestyle modification.
Therapeautic Options for Therapeautic Options for ObesityObesity
40 Surgery 35
30 Drugs 27
Supervised low-calorie diet
↑exerciseEating behaviour modification
25Treat cardiovascular risk factors 25
BMI cut-offs in absence of BMI cut-offs in absence of comorbiditycomorbidity
BMI cut-offsBMI cut-offs In presence of comorbidityIn presence of comorbidity
APPETITE SUPPRESSANTTHERMOGENIC
FAT ABSORPTIONINHIBATOR
Drug Drug TherapyTherapy Fat absorption InhibitorFat absorption Inhibitor
Orlistat(Orlistat(Slimfast-120mgSlimfast-120mg) 1 ) 1 cap with each main mealcap with each main meal
Loose stool,oily Loose stool,oily spotting,faecal spotting,faecal urgency,flatus,vit -urgency,flatus,vit -
malabsorptionmalabsorption Wt lossWt loss~3kg/6months~3kg/6months
Appetite SupressantAppetite Supressant Sibutramine(Sibutramine(Obenil-Obenil-
5mg5mg) 5/10/15 mg once ) 5/10/15 mg once daily with / without fooddaily with / without food
Dry mouth,constipation,Dry mouth,constipation, insomnia,insomnia,↑HR,HTN↑HR,HTN Wt loss : 3-5kg/6 monthsWt loss : 3-5kg/6 months
JAW WIRING GASTIC BYPASS GASTROPLASTY GASTRIC BALLOON FAT SUCTION
SURGICAL TREATMENT
Types Of ExerciseTypes Of Exercise
Aerobic ExerciseAerobic Exercise : running, swimming, : running, swimming, walking etc.walking etc.
Anaerobic ExerciseAnaerobic Exercise : Weight lifting, : Weight lifting, sketing ,Yoga, exercise with dumble etc.sketing ,Yoga, exercise with dumble etc.
Shape UpShape Up
Find out more at http://www.Powerhealths.com
1. Running burns calories hence it’s a great way to lose extra weight.
2. Running is a great cardio-vascular exercise that will keep our heart strong and healthy. Jogging reduces the risk of heart attack by strengthening the heart
and lowering blood pressure.
Facts about Running:
Find out more at http://www.Powerhealths.com
3. Running if done regularly, according to Mayo Clinic, can
ease symptoms of depression and anxiety.
Find out more at http://www.Powerhealths.com
4. A study research performed in Japan, Nihon Fukushi University
in Handa showed that jogging increase mental sharpness.
5. Running improves coordination and makes us more alert.
Find out more at http://www.Powerhealths.com
6. Running makes us happier. While running the body
released a hormone known as endorphins that create a
sense of euphoria.
Food Guide Pyramid for a Food Guide Pyramid for a balanced dietbalanced diet
Measurement Of ServingsMeasurement Of ServingsBread,Cereal,Rice ,PastaBread,Cereal,Rice ,Pasta
& Vegetable & Vegetable & Fruit& Fruit 2 slice Bread/0.5 cup Rice=1 2 slice Bread/0.5 cup Rice=1
Serving70 Cal(6-11 Serving70 Cal(6-11 servings:420-770Cal)servings:420-770Cal)
1 cup leaves/0.5 cup other 1 cup leaves/0.5 cup other vegetables/0.75 cup vegetables/0.75 cup vegetable soup=1 Serving28 vegetable soup=1 Serving28 Cal(3-5 servings:84-140Cal)Cal(3-5 servings:84-140Cal)
1 apple/1 banana/1 mango/1 1 apple/1 banana/1 mango/1 orange/0.5 cup fruit juice=1 orange/0.5 cup fruit juice=1 Serving100Cal(2-4 Serving100Cal(2-4 serving:200-400Cal) serving:200-400Cal)
Milk,yogurt,cheese &Milk,yogurt,cheese & Meat,poultry,fish,eggs,dry beans,nutsgroupMeat,poultry,fish,eggs,dry beans,nutsgroup &Fats,oils,sweets&Fats,oils,sweets
2 cup milk/yogurt=1 2 cup milk/yogurt=1 Serving160Cal(2-3 Serving160Cal(2-3 servings:320-480Cal)servings:320-480Cal)
30 gm fish/meat=1 30 gm fish/meat=1 Serving100Cal(2-3 Serving100Cal(2-3 servings:200-300Cal)servings:200-300Cal)
Fats ,Oils ,Sweets should be Fats ,Oils ,Sweets should be used sparingly.Oil=1 used sparingly.Oil=1 tsf(5gm)=1 Serving=45 Caltsf(5gm)=1 Serving=45 Cal
1224-2090 Cal + 1224-2090 Cal + Fat/Oil/SweetFat/Oil/Sweet
Composition of Balanced Composition of Balanced DietDiet
Protein : 10-15%Protein : 10-15%
Fat : 15-30%Fat : 15-30%
Carbohydrate : Rest of the foodCarbohydrate : Rest of the food
Be Fit but not Fat.Be Fit but not Fat.
If you are fit you are a hit.If you are fit you are a hit.
Fitness PledgeFitness Pledge
My body is the only place I have to live.My body is the only place I have to live.
I am proud to be gifted this wonderful creation.I am proud to be gifted this wonderful creation. I shall always strive to keep it healthy and fit.I shall always strive to keep it healthy and fit. I shall give all my body systems respect and treat I shall give all my body systems respect and treat
them with courtesy.them with courtesy. To my body and my health , I pledge my care and To my body and my health , I pledge my care and
consideration.consideration. In body’s well-being and fitness - lies my happiness.In body’s well-being and fitness - lies my happiness.
Balanced Lifestyle
Energy Intake
Energy Expenditure
RECOMMENDATIONS
Obesity
Dietary Recommendations(Take everything u like but with less amount, Avoid starvation Dieting-Free fatty acids)
Physical Activity (5 days in a week)
Behavior Modification
Psychological Intervention(Strong mental
desire)
??
Interaction with others atInteraction with others at meetings like this, is one ofmeetings like this, is one of the the best waysbest ways to be updated to be updated
ReferencesReferences www.powerhealth.com www.pubmed.com Murtagh’s general practice 5Murtagh’s general practice 5thth Edition Edition Davidson’s principles & practice of Medicine, 22Davidson’s principles & practice of Medicine, 22ndnd Edition Edition Current Medical Diagnosis & Treatment-2015Current Medical Diagnosis & Treatment-2015 Park’s Textbook of Preventive & Social Medicine-23Park’s Textbook of Preventive & Social Medicine-23rdrd Edition Edition Kumar & Clark’s Clinical Medicine -8Kumar & Clark’s Clinical Medicine -8thth Edition Edition
“ See each patient as if He is your first patient,He is your last patient’
He is your only patient.”
“It does not matter how much you do ( for others ) butis a matter that - how much
LOVE you put into doing that.”Mother Teressa
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