The document discusses obesity, defining it as an abnormal growth of adipose tissue due to an enlargement of fat cell size or an increase in fat cell number. It describes several ways to measure obesity, including BMI, waist-to-hip ratio, and skin fold thickness. Obesity is a chronic disease that is increasing globally and contributes significantly to illness and mortality. Lifestyle modifications including a calorie-controlled diet, increased physical activity, and behavior therapy are recommended for obesity management.

1. OBESITY
Dr. Jasminkumar Viramgami
Reader & H.O.D.,
Dept. of Swasthavritta,
Govt. Akhandanand Ayurved College, Ahmedabad, Gujarat

2. Latin word “OBESUS” meaning stout, fat, plump.
• It is defined as a state of excess adipose tissue.
Obesity may be defined as-
an abnormal growth of the adipose tissue
(hypertrophic obesity)
• due to an enlargement of fat cell size or
an increase in fat cell number
(hyper-plastic obesity) or
a combination of both.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

3. Obesity v/s Overweight
Overweight – Fat
Fluid
Muscle mass
Bone
Tumours
Obesity – Fat ( adipose tissue )
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

4. Obese individuals differ
• in the amount of excess fat that they store,
• also in the regional distribution of the fat
within the body.
• The distribution of fat affects the risks
associated with obesity, and the kind of
disease that may results.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

5. Classification of Obesity (shape)
Apples- Android
• central abdominal obesity
• clinically more important
• disease are more correlated with this
abdominal fat
Pears – Gynecoid
• accumulation of fat around hip and buttocks.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

6. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

7. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

8. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

9. Prevelence
• a chronic disease
• most prevalent form of malnutrition.
• in both developed and developing countries
• Once a high-income country problem, now rising
in low-and middle-income countries,
particularly in urban settings
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

10. affects children as well as adults
(childhood Obesity)
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

11. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

12. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

13. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

14. Altitude of Problem
• It is extremely difficult to assess the size of
the problem
• one of the most significant contributors to ill
health.
• obesity is a key risk factor in natural history of
other chronic and NCDs
• 44 % of the DM, 23 % of IHD and 7 to 41 % of
certain cancer are attributable to overweight
and obesity.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

15. • Overweight and obesity are the 5th leading risk
of global deaths.
• Obesity is the leading cause of preventable
death, next to smoking
• At least 3.4 million adults die each year as a
result of being overweight or obese
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

16. Epidemiological determinants
aetiology of obesity is complex,
and is one of multiple causation
AGE : at any age, generally increases with age.
SEX : Women generally have higher rate.
woman's BMI increases with successive
pregnancies.
GENETIC FACTORS : amount of abdominal fat
was influenced by a genetic component.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

17. SOCIO-ECONOMIC STATUS : clear inverse
relationship between socio-economic status and
obesity.
FAMILIAL TENDENCY : runs in families , but not
necessarily.
PSYCHOSOCIAL FACTORS : emotional disturbances,
anxiety, frustration, loneliness. Overeating may
be a symptom of depression. secret eaters.
ENDOCRINE FACTORS : may be involved, e.g.
Cushing's syndrome, growth hormone
deficiency.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

18. EATING HABITS : e.g., eating in between meals,
sweets, refined foods and fats.
• The composition of the diet, the periodicity and
the amount of energy are all relevant.
• fast food of energy-dense, micronutrient poor
food and beverages.
PHYSICAL INACTIVITY : sedentary lifestyle
• particularly sedentary occupation and inactive
recreation such as watching television
• physical activity and physical fitness are
important modifiers of obesity.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

19. ALCOHOL : relationship between alcohol
consumption and adiposity
EDUCATION : inverse relationship between
educational level and prevalence of overweight
ETHNICITY : may be due to a genetic
predisposition to obesity when exposed to a
lifestyle
DRUGS : Use of certain drugs can promote weight
gain (cortico-steroids, contraceptives, insulin, P-
adrenergic blockers etc).
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

20. Obesity
How do we measure If someone is obese?
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

21. Measurement Of Obesity
• BMI
• Waist hip ratio
• Skin fold thickness
• Biometric impedance
• Ultrasound
• CT / MRI
• DEXA (Dual Energy Xray Absorptiometry)
• Air displacement Plethysmography
• Total body electrical conductivity
• Hydro-densometry (most accurate)Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

22. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

23. Body Mass Index (BMI)
• BMI measures individual’s total weight relative
to his height.
• Correlation btwn rise in BMI and Complications.
BMI may be misleading in certain cases
• BMI may be high in a muscular person
• For similar BMIs, women have greater fat mass
than their male counterparts
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

24. Category BMI Weight of a person
with this BMI(Kg)
Severely underweight Less than 16.5 Less than 53.5
Underweight 16.5 to 18.5 53.5 to 60
Normal 18.5 to 25 60 to 81
Overweight 25 to 30 81 to 97
Obese I 30 to 35 97 to 113
Obese II 35 to 40 113 to 130
Severely Obese 40 to 45 130 to 146
Morbid Obese 45 to 50 146 to 162
Super Obese 50 to 60 162 to 194
Hyper Obese Above 60 Above 194Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

25. Classification of Obesity (BMI)
• Underweight - BMI < 18.5
• Normal weight - BMI between 18.5 to 24.9
• Overweight - BMI between 25.0 to 29.9
• Obese grade I - BMI between 30.0 to 34.9
• Obese grade II - BMI between 35.0 to 39.0
• Obese grade III - BMI ≥ 40
( morbid obese)
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

26. Waist To Hip Ratio (WHR)
• Central or abdominal obesity
• associated with more co-morbid conditions.
• So measuring central obesity is of greater
significance
• W/H ratio is taken by a simple measure tape
• in men > 102 cm (40 inch) /90
• in women > 88 cm (34 inch) /80
High WHR ( > 1.0 in men and > 0.85 in women)
indicates abdominal fat accumulationDr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

27. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

28. Skin fold thickness
• Harpenders callipers / MRNL callipers
• measured at biceps/triceps/illiac and
interscapular.
• Total of all four sites is considered
15-45 mm – 8-22 % of total body fat
46-75 mm – 23-30 % “
76-150 mm – 31-40 % “
151-170 mm – 41-45 % “
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

29. Classification of Obesity (FAT)
Upto 22% it is normal (males)
Upto 30% it is normal (females)
• Body fat 25% in men obese
• Body fat 30% in women obese
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

30. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

31. Biometric Impedance analysis (BIA)
• a commonly used method for estimating body
composition, and in particular body fat.
• used to calculate an estimate of total body
water (TBW).
• Radio frequency current is introduced in body
through electrodes
• Fat has less number of electrolytes
• Water is less conductive
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

32. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

33. CT/MRI
• They can differentiate subcutaneous from
visceral fat
• so are important in research purposes.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

34. A DEXA scan is a special type of X-ray that
measures bone mineral density (BMD).
DEXA (Dual Energy Xray Absorptiometry)
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

35. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

36. Air displacement Plethysmography
• a recognized and
scientifically
validated densito-
metric method
• to measure
human body
composition.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

37. Total body electrical conductivity
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

38. Hydro-densitometry
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

39. Adverse Effects of Obesity
The first adverse effects to emerge in population
are
• hypertension,
• hyper lipidaemia and
• glucose intolerence
CHD and the long-term complications begin to
emerge several years (or decades) later
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

40. Co morbidities of Obesity
• Insulin resistance & Type II DM
• Reproductive disorders
• Cardiovascular disorders
• Pulmonary disorders
• Gastrointestinal diseases
• Renal diseases
• Cancers
• Bone, joint and cutaneous diseases
• Retinal diseases
• Psychological problems
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

41. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

42. Obesity and Cardiovascular disease
• W/H ratio may be the best predictor
• BMI > 29…..3 fold rise in MI
• Obesity is responsible for 17% of all CVD
• Angina increases by 1.8 times
• MI increases by 3.2 and 1.5 fold in woman and
men respectively.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

43. Obesity and Cancers
• Obesity is the biggest preventable cause of
Cancer after smoking.
• Accounts for 14% of cancer deaths in Men and
20% in women.
Males :
Esophagus
Colon
Rectum
Pancreas
Liver
Prostrate
Females :
Gall bladder
Bile ducts
Breasts
Endometrium
Cervix
Ovaries
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

44. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

45. Obesity and Orthopaedic Disease
• OA
• Hyper Uricemia
• Gout
• Accidental injury
• decrased mobility
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

46. Obesity and Psychological problems
Are obese people more jolly?
NO
Obesity  psychological problems
Psychological problems  obesity
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

47. Obesity and Psychological problems
• 50% overweight lack self confidence
• Depression
Obesity has more risk of depression in Women
• More physical and sexual abuse
• Lack of attention
• Low education
• Low self esteem
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

48. Management of Obesity
It is a chronic medical
condition
Aim of successful treatment:
• Attainment of normal
weight
• No treatment induced
morbidity
This is rarely achieved in
clinical practice.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

49. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

50. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

51. Life Style Modification
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

52. Diet
• Low calorie diet
• Low saturated fats
• Normal protein intake
• Increased fibers in diet
• Low density foods
• 1000 K cal deficit produces 1 kg wt loss per week
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

53. Low Calorie Diet
• 800-1000 Kcal
• Applicable to most of the patients
• Fewer restrictions than VLCD.
• Supplementation of vitamins and minerals is
required
• Over a year there is reduction of 6 to 7 kgs.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

54. Very Low Calorie Diet
• 400 – 600 calorie diet.
• Even below one’s basal metabolic rate
• Used for period of 1 to 2 months
• under medical supervision
• 45 to 70 % protein
• 30 to 50 % carbohydrates
• 2g fat
• Supplemented with vitamins, minerals and
trace elements
• Greater wt loss compared to restrictive diets
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

55. Very Low Calorie Diet
• Complications -fatigue, hair loss, dry skin,
dizziness difficulty concentrating,
cholelithiasis, pancreatitis, gall stones.
• Contraindications – pregnancy, cancer, MI,
hepatic disease, CV Stroke.
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

56. Total Fasting
• Not recommended
• There is diuresis, natriuresis
• All deficiencies
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

57. Fat Intake
Decreased fat intake without decreased calories is
of no use
• Because if fat is replaced by carbohydrates
there is rise in triglycerides.
• Instead saturated fats should be replaced by
MUFA or PUFA
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

58. Physical Activity
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

59. Bariatric surgical techniques
Divided into two groups
Mal-absorptive procedures –
• Induce decreased absorption of nutrients
• by shortening the functional length of the small
intestine
Restrictive procedures –
• Reduce the storage capacity of the stomach
• as a result early satiety arises,
• leading to a decreasedcaloric intake
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

60. Mal-absorptiveprocedures
• Jejuno-ileal
bypass
• Bilio-
pancreatic
diversion
• Bilio-
pancreatic
diversion
with
duodenal
switch
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

61. Restrictive procedures
• Vertical banded gastroplasty
• Laparoscopic adjustable gastric band
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

62. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

63. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

64. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

65. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

66. Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

67. IF
THEY
CAN,
SO
CAN
YOU
Dr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC

68. THANK YOU
Follow us:
Facebook:
• https://fb.me/SwasthavrittaGAAC
Youtube:
• https://www.youtube.com/channel/UCPvrBlyheQcqwBXs1egxzWw
SlideShare:
• https://www.slideshare.net/SwasthvrittaAkhandanDr. Jasminkumar M Viramgami, Reader,
Swasthavritta, GAAC