Dr. Laxmikanta Say
DEFINITION
• A state of excess adipose tissue mass
- Male - > 25% or greater body fat
- Female - >35%
PATHOPHYSIOLOGY
• Greater energy intake than expenditure
- Body wt.
- Excess energy stored as fat.
• For each 9.3 Calories...
PATHOPHYSIOLOGY cont…
• ChildrenHYPERPLASTIC OBESITY
- number of adipocytes, small increase in size.
• AdultHYPERTROPHIC O...
ETIOLOGICAL CLASSIFICATION
SIMPLE OBESITY

SECONDARY OBESITY

1- Physical inactivity

1- Hypothyroidism

2- Eating habits
...
NEUROGENIC ABNORMALITIES

POMC Nv

AgRP/ NPY

α-MSH

MCR-4 in neurons
of PVN of hypothalamus
Food intake
Energy expenditur...
GENETIC FACTOR
•
•

•

20-25%
Genes contribute by causing abnormality of
i)One or more pathway that regulate feeding cente...
Gene

Gene Product

Mechanism

Lep (ob)

- a fat-derived hormone

- Mutation prevents leptin
from delivering satiety signa...
RISKS A/W OBESITY
- CAD

- Cholelithiasis

- Type 2 DM

- Hypertension

- Sleep apnoea
syndrome
- Osteoarthritis

- Stroke...
DIAGNOSIS
•
•
•
•

Body mass index (BMI).
Ideal body weight for height.
Skin fold thickness.
Waist circumference and waist...
1. BMI (Quetele’s Index)
Weight in Kg/ (Height in m)2

WHO standards
Classification

BMI (Kg/m2)

Risk of
Comorbidity

Und...
2. IDEAL BODY WEIGHT FOR HEIGHT
(Ht in m)2 X 22.5

• Brocca Index (FAO/WHO)
= Height in Cm – 100.
• Overweight: >10% of id...
3. SKIN FOLD THICKNESS
•
Callipers
•
Measured over- Triceps, biceps,
Subscapular & Suprailiac region.
•
Normal tricep skin...
4. WAIST CIRCUMFERENCE & WAIST-TOHIP RATIO• Waist circumference - >88 cm in female Abdominal
>102 cm in male

obesity

• H...
TREATMENT
DIETARY
THERAPY

PHYSICAL
EXERCISE

OBESITY

BARIATRIC
SURGERY

PHARMACO
THERAPY
1. DIETARY THERAPY• LOW FAT DIETFor Over wt or Moderately heavy person (BMI >25 but <35 kg/m2) - 500 K Cal/day
- Wt loss o...
2.

PHYSICAL EXERCISE- 30-45 min/day, 3-5 days a week.

3.

PHARMACOTHERAPYi) BMI > 30kg/m2
ii) a/w risk factors- a) Asian...
Obesity
Obesity
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Obesity

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Obesity

  1. 1. Dr. Laxmikanta Say
  2. 2. DEFINITION • A state of excess adipose tissue mass - Male - > 25% or greater body fat - Female - >35%
  3. 3. PATHOPHYSIOLOGY • Greater energy intake than expenditure - Body wt. - Excess energy stored as fat. • For each 9.3 Calories of excess energy approx. 1 gm of fat stored. (S.C tissue & Intraperitoneal cavity).
  4. 4. PATHOPHYSIOLOGY cont… • ChildrenHYPERPLASTIC OBESITY - number of adipocytes, small increase in size. • AdultHYPERTROPHIC OBESITY - number of adipocytes (from fibroblast like preadipocyte) - size of pre-existing adipocytes. • Life style and environmental factors > Genetic factor
  5. 5. ETIOLOGICAL CLASSIFICATION SIMPLE OBESITY SECONDARY OBESITY 1- Physical inactivity 1- Hypothyroidism 2- Eating habits •Industrialized countries. •Childhood over nutrition. 3- Psychological factors 2- Cushing syndrome 4- Neurogenic abnormalities 5-Genetic factors 4- Type 2 DM 3- Hypothalamic disorder
  6. 6. NEUROGENIC ABNORMALITIES POMC Nv AgRP/ NPY α-MSH MCR-4 in neurons of PVN of hypothalamus Food intake Energy expenditure NTS Sympathetic discharge Energy expenditure
  7. 7. GENETIC FACTOR • • • 20-25% Genes contribute by causing abnormality of i)One or more pathway that regulate feeding center ii)Energy expenditure & fat storage. Monogenic causes of obesity SATIETY SIGNAL
  8. 8. Gene Gene Product Mechanism Lep (ob) - a fat-derived hormone - Mutation prevents leptin from delivering satiety signal LepR (db) POMC - Leptin receptor - Same as above - a precursor of several hormones & - Mutation prevents synthesis neuropeptides of melanocyte-stimulating hormone (MSH), MC4R (Most common) - Type 4 receptor for MSH - Mutation prevents reception of satiety signal from MSH PC-1 - Prohormone convertase 1, - a processing enzyme - Mutation prevents synthesis of neuropeptide, probably MSH TrkB - a neurotrophin receptor - Hyperphagia due to uncharacterized hypothalamic defect
  9. 9. RISKS A/W OBESITY - CAD - Cholelithiasis - Type 2 DM - Hypertension - Sleep apnoea syndrome - Osteoarthritis - Stroke - Deep vein thrombosis - Breast, Endometrial & Colon Ca. - Varicose vein - Depression - Dyslipidemia
  10. 10. DIAGNOSIS • • • • Body mass index (BMI). Ideal body weight for height. Skin fold thickness. Waist circumference and waist-to-hip ratio.
  11. 11. 1. BMI (Quetele’s Index) Weight in Kg/ (Height in m)2 WHO standards Classification BMI (Kg/m2) Risk of Comorbidity Underweight < 18.50 Low Normal 18.50 – 24.99 Avg. Overweight ≥ 25.00 - Pre-Obese 25.00 -29.99 Increased - Obese Class-I 30.00 – 34.99 Mod. -Obese Class-II 35.00 – 39.00 Severe - Obese Class-III ≥ 40.00 Very severe
  12. 12. 2. IDEAL BODY WEIGHT FOR HEIGHT (Ht in m)2 X 22.5 • Brocca Index (FAO/WHO) = Height in Cm – 100. • Overweight: >10% of ideal body weight • Obesity: >20% of ideal body wt • Underweight: < 20% of ideal body weight
  13. 13. 3. SKIN FOLD THICKNESS • Callipers • Measured over- Triceps, biceps, Subscapular & Suprailiac region. • Normal tricep skin fold thickness - Male- 12.5 mm - Female- 16.5 mm
  14. 14. 4. WAIST CIRCUMFERENCE & WAIST-TOHIP RATIO• Waist circumference - >88 cm in female Abdominal >102 cm in male obesity • Hip measurement • Normal Waist hip ratio- <0.8 (male) and < 0.9 ( female) • obese - >0.8 (male) and > 0.9 ( female)
  15. 15. TREATMENT
  16. 16. DIETARY THERAPY PHYSICAL EXERCISE OBESITY BARIATRIC SURGERY PHARMACO THERAPY
  17. 17. 1. DIETARY THERAPY• LOW FAT DIETFor Over wt or Moderately heavy person (BMI >25 but <35 kg/m2) - 500 K Cal/day - Wt loss of 1 pound/ week. For Morbid obese (BMI >35kg/m2) - 500 -1000 K Cal/d - Wt loss 1- 2pounds/week. • ATKINS DIET - Very low carbohydrate diet with normal or high saturated FA. Work similar to Low fat diet. SE- LDL cholesterol rise by 2-3 % Constipation. • HIGH PROTEIN DIET Protein with decrease carbohydrate & fat. Protein has satiating effect. Not used in person with renal ds. SE- Colorectal Ca
  18. 18. 2. PHYSICAL EXERCISE- 30-45 min/day, 3-5 days a week. 3. PHARMACOTHERAPYi) BMI > 30kg/m2 ii) a/w risk factors- a) Asian ethnicity b) Type 2 DM, Obstructive sleep apnoea, etc. e.g.- Sibutramine (NSRI) Orlistat Rimonabant (Endocannabinnoid- CB (1) blocking drug) 4. BARIATRIC SURGERY BMI > 35-40 kg/m2 i) Jejuno ileal shunts ii) Gastroplasty iii) Gastric bypass by retrocolic gastrojejunostomy iv) Laparoscopic Adjustable Gastric banding v) Liposuction
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