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  1. 1. OBESITY <ul><li>Abnormal growth of the adipose tissue due to enlargement of fat cell size or increase in fat cell number. </li></ul><ul><li>Android Obesity (Central Obesity-Apple type) </li></ul><ul><li>Gynaeoid Obesity (Peripheral Obesity-Pear type) </li></ul><ul><li>Most prevalent form of Malnutrition. </li></ul><ul><li>20-40% of adults & 10-20% of children(5% of Indian Population). </li></ul><ul><li>Punjab(34%), Goa, Tamilnadu, Kerala, Andhra Pradesh (20%, Male-17%,Female-22%). </li></ul>
  2. 2. CHILDHOOD OBESITY(RISK FACTORS) <ul><li>33% of obese adults are so since childhood. </li></ul><ul><li>Obesity in one/both parent(s). </li></ul><ul><li>Infant of Diabetic mother. </li></ul><ul><li>Child of single parent family. </li></ul><ul><li>Child from family with fewer children. </li></ul><ul><li>Higher birth weight & rapid growth in infancy. </li></ul><ul><li>Formula feeding / no breast feeding. </li></ul>
  3. 3. CHILDHOOD OBESITY(RISK FACTORS) <ul><li>Smoking by mother during pregnancy. </li></ul><ul><li>Sedentary life style(less outdoor game, computer </li></ul><ul><li>games, increased TV viewing) </li></ul><ul><li>Junk Food- increased consumption of sugar sweetened drinks, soda, snacks/ chips/salted crisps and energy dense fast foods like burger/ pizza/ chowmin. </li></ul>
  4. 4. DETERMINANTS OF OBESITY <ul><li>1. Age - No age is escapable. </li></ul><ul><li>Infants with excess weight gain have greater chance to develop obesity. </li></ul><ul><li>33% of adult obese are so since childhood. </li></ul><ul><li>2.Sex- Women of higher prevalence than men. </li></ul><ul><li>Men gain wet more between 29-35 and Women from 45-49. </li></ul><ul><li>3-Genetic Factors - Identical twins have obesity. </li></ul><ul><li>Obese parents have obese children. </li></ul>
  5. 5. DETERMINANTS OF OBESITY <ul><li>4.Ethnicity- Ethnic groups with affluent life style in industrialized countries suffer more. </li></ul><ul><li>5.Education- Inverse relation between obesity and educational status. </li></ul><ul><li>6. Socio-economic status- In affluent countries it is found more among lower SES group. In developing countries found more among high SES . </li></ul><ul><li>7.Psychosocial Factors - Frustration, anger & loneliness in childhood, Depression, Anxiety lead to social withdrawal, secret eating, binge eating & overeating. </li></ul>
  6. 6. DETERMINANTS OF OBESITY <ul><li>8.Endocrine Factors- Cushing Syndrome, Growth Hormone deficiency and Hypothyroidism. </li></ul><ul><li>9.Drugs- Corticosteroids, Antipsychotics, Insulin, Contraceptives, Pizotifen, Progestagens, β -blockers, Cyproheptadine lead to weight gain. </li></ul><ul><li>10. Alcohol- Direct relationship between alcoholism and obesity among men and inverse relationship in women. </li></ul><ul><li>11.Smoking- Causes weight loss among recent smokers and gain among old smokers. </li></ul><ul><li>12.Physical Inactivity- </li></ul>
  7. 7. ASSESSMENT OF OBESITY <ul><li>1. The Active Body mass : (muscle, liver, heart) </li></ul><ul><li>2. The fatty mass : (Fatty tissue) </li></ul><ul><li>3. The extracellular fluid: (blood, lymph, edema in CHF, Cirrhosis of liver) </li></ul><ul><li>4. The Connective tissue mass: (skin, bone, fascia, connective tissue) </li></ul>
  8. 8. MEASUREMENT OF OBESITY <ul><li>1.BODY WEIGHT: </li></ul><ul><li>(i) Body Mass Index (Quetelet’s Index): Weight(kg)/(Height) 2 (m 2 ) [ 18.5-24.99kgm -2 ] </li></ul><ul><li>2 . Broca Index (Ideal Body Weight) = { Height(cm) ▬ 100} </li></ul><ul><li>3. Lorentz Formula: </li></ul><ul><li>{Height(cm) ▬ 100} ▬ {Height(cm) ▬ 150}/ 2(women) or 4(men) </li></ul><ul><li>4.Corpulence Index- </li></ul><ul><li>(Actual Weight/Desirable Weight) ≤1.2 </li></ul><ul><li>5. Ponderal Index- Height(cm)/ (Weight) 1/3 </li></ul>
  9. 9. MEASUREMENT OF OBESITY <ul><li>2. Skinfold Thickness: </li></ul><ul><li>Mid-triceps+ mid-biceps+ subscapular + suprailiac = 50mm in women or 40 mm in men. </li></ul><ul><li>Impossible in Extreme obesity </li></ul><ul><li>Poor repeatability </li></ul><ul><li>3.Waist Circumference and Waist-Hip Ratio(WHR): </li></ul><ul><li>≤ 102 cm (Men) </li></ul><ul><li>≤ 88 cm (Women) </li></ul><ul><li>WHR : ≤1 (Men) and ≤ 0.85 (Women) </li></ul><ul><li>4.Measurement of Total Body Water, Total Fat Cells. </li></ul>
  10. 10. CLASSIFICATION OF BMI Classification BMI(kgm -2) Underweight < 18.5 Normal 18-5 ---24.99 Overweight ≥ 25 Pre-Obese 25.00 --- 29.99 Obese Class I 30.00 --- 34.99 Obese Class II 35.00 --- 39.99 Obese Class III ≥ 40
  11. 11. HAZARDS OF OBESITY 1. INCREASED MORBIDITY: Very High Moderate High NIIDM(DM-T-2) HPTN Cancers GB Disease CHD Reproductive Disorders Dyslipidemia OA Varicose Veins Insulin Resistance Psychological stress Obstructive Sleep Apnoea Increased Surgical Risk Breathlessness
  12. 12. 1. INCREASED MORBIDITY: <ul><li>The risk of HPTN, DM, Dyslipidemia increases with BMI >21 kg/m -2 </li></ul><ul><li>Cancers (men-esophagus, colon, rectum, pancreas, liver and prostate/ women-gallbladder, bile ducts, breasts, endometrium, cervix, and ovaries). </li></ul><ul><li>Reproductive Disorders- (Male hypogonadism, Gynaecomastia) </li></ul><ul><li>Female- Oligomenorrhoea, polycystic ovarian syndrome (PCOS) (anovulation  low fertility) </li></ul>
  13. 13. HAZARDS OF OBESITY <ul><li>1. Increased Mortality: </li></ul><ul><li>HPTN  CVA </li></ul><ul><li>HPTN  CHD (70% of CHD due to obesity) </li></ul><ul><li>HPTN  CRD(ESRD) </li></ul>
  14. 14. PREVENTION & CONTROL <ul><li>Health Promotion </li></ul><ul><li>Health & Nutrition Education in early childhood. </li></ul><ul><li>Balanced Diet(C-60%+F-30%+P-10%+ vitamins+ minerals) </li></ul><ul><li>1000 Kcal daily model for adult. </li></ul><ul><li>Dietary Pattern: (Avoid simple carbohydrates & Fats, Avoid Junk Food, More fibres in diet). </li></ul><ul><li>Lifestyle Changes- Physical Aerobic Exercise:(30 min /day for 5 days per week) </li></ul><ul><li>Say “No” to Alcohol. </li></ul>
  15. 15. EXERCISES <ul><li>Walking(4km/hr)- 160kcal/hour- 20 gm weight loss </li></ul><ul><li>Running(6km/hr)- 350kcal/hour- 45 gm ,, ,, </li></ul><ul><li>Running(8km/hr)- 525kcal/hour- 65 gm ,, ,, </li></ul><ul><li>Running(10km/hr)- 655kcal/hour- 85 gm ,, ,, </li></ul><ul><li>Table Tennis - 250kcal/hour- 32 gm ,, ,, </li></ul><ul><li>Badminton - 350kcal/hour- 45 gm ,, ,, </li></ul><ul><li>Tennis - 400kcal/hour- 52 gm ,, ,, </li></ul><ul><li>Dancing - 375kcal/hour- 49 gm ,, ,, </li></ul>
  16. 16. PREVENTION & CONTROL <ul><li>Early Diagnosis & treatment- Diet & Exercise are not enough. </li></ul><ul><li>Antiobesity Drugs: (Orlistat / Sibutramine / </li></ul><ul><li> Metformin with treatment of co-morbidities </li></ul><ul><li>(antihypertensive, hypolipidemic drugs). </li></ul><ul><li>Surgical T/t: - Gastric Bye pass / Gastroplasty / Jaw wiring. </li></ul><ul><li>Disability Limitation & Rehabilitation- Liposuction. </li></ul>
  17. 17. ANTIOBESITY DRUGS: <ul><li>Age- 18-75 years. </li></ul><ul><li>BMI: >30kg m -2 </li></ul><ul><li>BMI: >27kg m -2 with co-morbidities like HPTN, OSA, DM, CHD etc. </li></ul><ul><li>Failure of supervised diet, exercise & behavior modification after 3 months. </li></ul><ul><li>Stop if weight loss is 0%/<5% after 12 weeks of use. </li></ul><ul><li>Shouldn’t be used for more than a year. </li></ul>