• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Obesity
 
  • 1,196 views

 

Statistics

Views

Total Views
1,196
Views on SlideShare
1,186
Embed Views
10

Actions

Likes
1
Downloads
76
Comments
0

2 Embeds 10

http://funweightlosshanitips.blogspot.com 8
http://funweighhanitips.blogspot.com 2

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Obesity Obesity Presentation Transcript

      • OBESITY
      • Dr. Gopalrao Jogdand, M.D. Ph.D.
      • Professor & Head
      • Department of community Medicine
    • Definition
    • Magnitude of the Problem
      • Prevalence of obesity BMI 30.0.
      • Currently the world is facing obesity epidemic.
      Country Age range Obesity prevalence Male Obesity prevalence Female U.S.A. 22-74 years 19.7% 24.7% Germany 25-69 years 17% 19% England 16-64 years 15% 16.5% Kuwait 18 + 32% 44% India 16-64 years 19.3% 25.6%
    •  
    •  
    •  
    • Classification of Overweight and Obese by Body Mass Index
      • BMI (kg/m 2 )
      • WHO guidelines Proposed Asia Pacific guidelines Underweight < 18.5 < 18.5
      • Normal 18.5-24.9 18.5-22.9
      • Overweight 25.0-29.9 > 23
      • At risk - 23-24.9
      • Obesity 30-34.9 (Class I) 25-29.9 (Class I)
      • 35-39.9 (Class II) > 30 (Class II)
      • Extremely Obese > 40 (Class III) -
      BMI = Weight (kg) [Height (m)] 2
    • Waist-to-hip ratio Ratio = WAIST HIPS TO FIND RATIO Waist: Measure at narrowest point with stomach relaxed Hips: Measure at fullest point Desired Ratio Women : < 0.8 Men : < 1.0 Risk increases if waist circumference is >94 cm in men and >80 cm in women
    • Co-morbidities risk associated with different levels of BMI and suggested waist circumference in adult Asians
      • Classification BMI Risk of co-morbidities
      • Waist circumference
      • < 90 cm (men) > 90 cm (men)
      • < 80 cm (women) > 90 cm (women)
      • Underweight < 18.5 Low Average
      • Normal range 18.5-22.9 Average Increased
      • Overweight > 23
      • At risk 23-24.9 Increased Moderate
      • Obese I 25-29.9 Moderate Severe
      • Obese II > 30 Severe Very severe
    • Obesity – An imbalance in energy intake and energy expenditure Proteins (20%) BMR (60-65%) ENERGY INTAKE ENERGY EXPENDITURE Carbohydrates (55%) Physical activity (25-30%) Fats (25%) Thermic effect of food (10%)
    • Role of hypothalamus in mediation of hunger and satiety Thalamus Paraventricular HO conserv Oxytocin rel. 2 Anterior hypothalamic Body temp Optic tract Arcuate Neuroendocrine Fornix Rage, Hunger Supraoptic Vasopresin rel. Dorsomedial GI stimuli Periventricular Neuroendocrine Ventromedial Satiety Lateral hypothalamic Hunger, thirst
    • Classification of obesity as per fat distribution
      • Android (or abdominal or central, males)
      • Collection of fat mostly in the abdomen (above the waist)
      • apple-shaped
      • Associated with insulin resistance and heart disease
      • Gynoid ( below the waist, females)
      • Collection of fat on hips and buttocks
      • pear-shaped
      • Associated with mechanical problems
    • Diseases and conditions for which obesity is a risk factor
      • Coronary artery disease**
      • Type II Diabetes Mellitus***
      • Hypertension**
      • Dyslipidemia***
      • Respiratory disease***
      • Gout**
      • Reflux disease
      • Psychological problems
      • Gallbladder disease***
      • Osteoarthritis**
      • Infertility*
      • Venous circulatory disease
      • Increased anaesthetic risk*
      • Low back pain*
      • Polycystic ovary disease*
      • Cancer* (ovarian, breast, endometrial, gallbladder, prostate, colon)
    • Prevalence of overweight and obesity in different income groups of Delhi (Nutrition Foundation of India Study)
      • Prevalence (%)
      • Slums Middle-Class Total
      • Overweight (BMI > 25)
      • Males ND ND 19.6 Females ND ND 44.5
      • Obesity (BMI > 30) Males 1 32.3 ND Females 4 50 ND
      • Abdominal obesity Males ND 49.7 ND Females ND 34.9 ND
      • ND: Not determined
      http://www.nutritionfoundationin.org/NEW/OBESITY.HTM
    • The Five City Study
      • n=3257; aged 25-64 yrs
      • Cities: Moradabad (n=902), Trivandrum (n=760), Calcutta (n=410), Nagpur (n=405), Bombay (n=780)
      • Social Class BMI>27 WHR>0.85 Sedentary life style
      • I (n=985) 21.2% 96.9% 92.2%
      • II (n=790 16.4% 57.2% 71.4%
      • III (n=674) 8.9% 39.3% 42.3%
      • IV (n=602) 3.0% 11.9% 14.9%
      • V (n=206) 3.8% 8.7% 8.7%
      • Int J Cardiol 1999;69:139-147
    • Treatment goals
      • Prevention of further weight gain
      • Weight loss to achieve a realistic target BMI
      • Long-term maintenance of a lower body-weight
    •  
    • Approaches to obesity management Diet Activity Drugs VLCD Surgery BMI 23-25 No risk factors DM/CHD/HT/HL     -  BMI 25 – 30 No risk factors DM/CHD/HT/HL      (consider)  BMI > 30 No risk factors DM/CHD/HT/HL        ( in  severe )  ( conside r  in severe )
    • How much weight loss is significant?
      • A 5-10% reduction in weight (within 6 months) and
      • weight maintenance should be stressed in any weight
      • loss program and contributes significantly to
      • decreased morbidity
    • Advantages of weight loss
      • Weight loss of 0.5-9 kg (n=43,457) associated with 53% reduction in cancer-deaths, 44% reduction in diabetes-associated mortality and 20% reduction in total mortality
      • Survival increased 3-4 months for every kilogram of weight loss
      • Reduced hyperlipidemia, hypertension and insulin resistance
      • Improvement in severity of diseases
      • Person feels ‘fit’ and mentally more active
      •  
    • Drug therapy
      • Appetite suppressants
      • Adrenergic agents (e. g. amphetamine, methamphetamine, phenylpropanol amine, phentermine)
      • Serotonergic agents (ex.. fenfluramine, dexfenfluramine, SSRIs like sertraline, fluoxetine)
      • Thermogenic agents
      • ephedrine, caffeine
      • New ones
      • Sibutramine ; Orlistat
      • STORM: Sibutramine trial on obesity reduction and maintenance.
    • Sibutramine inhibits serotonin and noradrenaline reuptake Noradrenaline Serotonin
    • STORM Study : Effect of sibutramine on weight loss 98 104 102 100 96 94 92 90 0 12 22 24 20 18 16 14 10 8 6 4 2 Placebo Sibutramine Month Weight loss Weight maintenance Bodyweight (kg) Lancet 2000; 356:2119-2125
    • STORM Study: Mean Weight Loss at Two Years Mean Weight Loss (Kg)
    • STORM Study : Proportion of patients maintaining at least 5% and 10% weight loss 100 20 40 60 80 0 6 12 18 24 6 12 18 24 5% responders 10% responders Sibutramine Placebo Lancet 2000; 356:2119-2125 Proportion of patients (%)
    • STORM Study: Effect on Waist Circumference and Waist/Hip Ratio Decrease in waist circumference (cm) Change (a) Waist Circumference (b) Waist/Hip Ratio
    • STORM Study : Effects on lipids 5 0 -5 -10 -15 -20 -25 Placebo Sibutramine Triglycerides % c h a n g e 0 0 24 18 12 6 5 0 -5 -10 -15 -20 -25 Placebo Sibutramine VLDL cholesterol 18 0 24 12 6 % c h a n g e Lancet 2000; 356:2119-2125
    • STORM Study : Effects on lipids (Contd.) 18 0 24 12 6 25 20 15 10 5 0 HDL cholesterol % c h a n g e Sibutramine Placebo Month of assessment Weight loss Weight maintenance Lancet 2000; 356:2119-2125 30
    • STORM Study : Effect on Insulin and HbA 1c Month of Assessment Placebo Sibutramine Lancet 2000; 356:2119-2125 % Change HbA 1c . Month of Assessment Placebo Sibutramine % Change Insulin
    • STORM study: Other metabolic effects
      • Variable Baseline Month 6 Month 24
      • SIB PLAC SIB PLAC SIB PLAC
      • Uric acid 0.32 0.33 0.29 0.30 0.30 0.32
      • Glucose 5.20 5.11 5.07 5.01 5.13 5.17
      • Insulin 17.7 16.7 12.7 12.4 13.8 16.2
      • C-peptide 3.21 3.05 2.54 2.46 2.38 2.69
      • HbA 1c 5.86 5.75 5.56 5.50 5.56 5.66
    • STORM study: Conclusions
      • Almost all patients who persist with a weight management program consisting of sibutramine, diet and exercise can achieve at least a 5% weight loss with sibutramine
      • Over half can lose more than 10% weight within 6 months
      • Weight loss was sustained in most patients continuing therapy for two years
    • Sibutramine vs. Dexfenfluramine - 3.2 - 4.5 -5 -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 Weight loss (kg) Sibutramine 10 mg Dexfenfluramine 30 mg n=226; 12 wks Int J Obes 1995; 19. Suppl 2: 144
    • Adverse effects occurring in >5% of patients treated with Sibutramine compared with placebo
      • Sibutramine % Placebo % Adverse Effects Incidence (n=2068) Incidence (n=884)
      • Headache 30.3 18.6
      • Dry Mouth 17.2 4.2
      • Anorexia 13.0 3.5
      • Constipation 11.5 6.0
      • Insomnia 10.7 4.5
      • Dizziness 7.0 3.4
      • Nausea 5.9 2.8
      • Nervousness 5.2 2.9
      • Dyspepsia 5.0 2.6
      Ann Pharmacother 1999;33:968-978
    • Sibutramine: Safety
      • Discontinuation rates: 9% with placebo and 7% with sibutramine
      • Has been associated with a mean increase in BP and heart rate of approximately 1-3mmHg and 4-5 beats/min
      • Cardiac side effects viz. hypertension, tachycardia and palpitations < 2.6% vs 0.6-0.9% in placebo group
      • Caution to be exercised in patients with history of hypertension and should not be given to patients with uncontrolled or poorly controlled hypertension
      • Not associated with cardiac valve abnormalities or primary pulmonary hypertension
    • STORM Study : Withdrawals due to BP increase
      • Dose of Sibutramine % patients who withdrew due to increase in BP
      • 10 mg 1%
      • 15 mg 2%
      • 20 mg 3%
      Lancet 2000; 356:2119-2125
    • Indications & Dosage
      • Recommended for obese patients with a BMI > 30 kg/m 2 or > 27 kg/m 2 in the presence of other risk factors (e.g. hypertension, diabetes, dyslipidemia)
      • In Indian patients, sibutramine could be considered in patients with BMI > 25 kg/m 2 or those with BMI of 23 kg/m 2 with co-morbid conditions
      • Recommended starting dose is 10 mg once daily.
      • If there is inadequate weight loss, the dose may be titrated after four weeks to a total of 15 mg once daily.
      • The 5 mg dose should be reserved for patients who do not tolerate the 10 mg dose.
      • Surgical intervention: Measures like liposuction.
    • Prevention and Control
      • Weight reduction: Initial goal is to reduce the weight by 5-10% in 6 months period
      • Dietary changes: Low calorie diet is recommended, calorie intake is modeled to 1000 Kcal/day diet
      • Increased physical activity to burn the excess body fat.
    •  
    •  
    • Thank You