is the form of
tissue that fat
takes in the
beneath the skin
or between other
organs such as
the muscles and
dietary fats can
into fatty acids
and stored as
adipose tissue in
on your body,
Expansion of the adipose tissue during weight gain leads tissue
undergoes a continuous remodeling process that normally
maintains tissue health, but may spin out of control and lead to
adipocyte death in association with the recruitment and
activation of macrophages, and systemic insulin resistance.
Adipose tissue located beneath the skin
(subcutaneous fat), around internal organs (visceral
fat), in bone marrow (yellow bone marrow) and in
Adipose depots in different parts of the body have
different biochemical profiles.
Under normal conditions, it provides feedback for
hunger and diet to the brain.
Diseased fat tissue surrounding various organs can
Aromatase which is involved in sex hormone metabolism.
TNF Alpha, IL-6 and leptin which are collectively termed
„cytokines‟ and are involved in sending messages between cells.
Plasminogen activator inhibitor-1 which is involved in the clotting
Angiotensin which is involved in blood pressure control.
Adiponectin which improves the body‟s sensitivity to insulin and
so helps to protect against developing type 2 diabetes.
Lipoprotein lipase and apolipoprotein E which are involved in
storage and metabolism of fat to release energy.
Type 2 diabetes
Body mass index
BMI : BW / H2
BW = Body Weight (kilograms)
H = Height (meters)
Measure waist circumference
Apple shape ( risk of DM, CVD,
Waist larger than 40 inch men
Waist larger than 35 inch women
Highly ineffective rate 95 % long term failure
Often result in increase weight than before diet
Slow weight loss – stable
Rapid weight loss – gain weight
Rapid weight loss – increase risk of gallstones
Low calorie step 1 diet
1000 – 1200 kcal/day 1200-1600 kcal/day
Male Age 20-49 2900 calories/day
50 + 2500 calories/day
Female Age 20-49 2300 calories/day
50 + 1900 calories/day
Guideline Daily Amount Values
Typical values Women Men
Calories 2,000 kcal 2,500 kcal 1,800 kcal
Protein 45 g 55 g 24 g
Carbohydrate 230 g 300g 220 g
Sugars 90 g 120 g 85 g
Fat 70 g 95 g 70 g
Saturates 20 g 30 g 20 g
Fibre 24 g 24 g 15 g
Salt 6 g 6 g 4 g
Integral part of weight loss
Increase activity never loss weight
Sustained activity does prevent weight regain
Reduces risk of getting HD & DM
A) Sibutramine(Serotonin Nor-epinephrine Reuptake Inhibitor) :
initial dose 10mg/day, max 20mg/day. Reduces food intake,
increase HR and BP.
Lipase inhibitor : 120mg PO TID. Alters metabolism, dec
absorption of dietary fat.
Keep a journal of diet/diary
Set spesific goals
Keep track of improvement
Vertical band gastroplasty
Roux-en-y gastric bypass
“Sebab mulut badan binasa” – “Body perish
because of the mouth”
obesity is best tackled at home through improved
self involvement, increased physical exercise,
better diet and restraint from eating.
Ismail MN. The nutrition and health transition in Malaysia.
Public Health Nutrition 2002; 5: 191–195.
World Health Organization. Obesity: Preventing and Managing
the Global Epidemic. WHO Obesity Technical Report Series
no. 894. WHO: Geneva, 2000.
Ismail MN, Tan CL. Prevalence of obesity in Malaysia. In:
Inoue & Zimmet (eds). The Asia–Pacific Perspective: Redefining
Obesity and its Treatment. WHO(WPRO)/IASO/IOTF: Health
Communications Australia, 2000 pp 10–13.
Ismail MN, Vickneswary EN. Prevalence of obesity in
Malaysia: data from three ethnic populations. In: Inoue & Zimmet
(eds). The Asia – Pacific Perspective: Redefining Obesity and its
Treatment. WHO (WRRO)/IASO/10TF: Health Communication