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  • Reference: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en
  • Reference: World Health Organization, Retrieved from http://www.who.int/dietphysicalactivity/childhood_consequences/en/index.html
  • This in itself is alarming…we are getting more and more overweight with most occurring in urban settings. As income rises, food intake increases. There is also a global shift in how we eat. More salt, more fat and more sugars. The more we process food, the more we change the food we eat, the less nutrient dense it is. There is a decrease in vitamins, minerals and micronutrients that help our bodies to stay healthy (WHO, Fact Sheet 311). The other issue is we exercise less than we used to. When life has many tools that can make our lives easier…we move our bodies less, we sit more, well, we do not burn calories. An increase of video games, electronics have caused kids to play less and eat more. The challenge is getting kids to get outside and play at least one hour a day.
  • With children, the challenges of obesity are even more important to recognize. When a child is overweight or obese, there is more likelihood of becoming obese as an adult….no matter where you live. More and more children are gaining too much weight. The next few slides will discuss the issues surrounding childhood obesity, starting with pregnancy and infants. How babies start in life is very important to being as healthy as possible.
  • When mothers are pregnant, it is important to be as healthy as possible. For pregnant women, it is important to be as healthy as possible before and during pregnancy with eating healthy foods, being active and getting prenatal care. Prenatal care will help to make sure mothers are gaining the right amount of weight..not too much or too little. Prenatal care is also vital to make sure mothers are as healthy as they can be during their pregnancy. In prenatal care, the mom and baby are checked, this includes weight, blood pressure, growth of the baby and how active the baby is. Providers may draw blood to check for health status as well. Prenatal care and monitoring weight gain according to Lowdermilk & Perry (2006). Progressive weight gain is critical for optimal health of both mom and baby. If a women is underweight, she needs to gain about 12.5-18 kg. For women who are of normal BMI, she should gain 11.5-16 kg and for women who are overweight: 7-11.5kg. If a woman is obese, weight gain needs to occur, but will be closer to 7 kg of gain. This covers the weight of the baby, extra fluid, changes in her body, and finally the weight of the placenta. The pattern of weight gain during pregnancy is important for the health of mom and baby….during the first trimester, most women do not gain any weight and may lose because of morning sickness and nausea. In 2nd trimester (week 13-26) and third trimester (week 27-40), women should gain 0.3 kg per week for women who are overweight or obese. When babies are breastfed, there is less chance of being overweight as a child. In a study done by Sloan, Gildea, Stewart, Sneddan and Iwaniec (2007) studied babies that are weaned before 4 months and babies weaned after 4 months. Babies that were weaned early, before 4 months and formula fed were more likely to be overweight as children. Overweight children are more likely to be overweight adults. Results of the study indicated that mothers need to strongly consider breastfeeding their babies for at least 4 months. However, longer is better. If moms can breastfeed for at least 6 months, that will help even more. The best scenario is for moms to breastfeed exclusively for 6 months, then start to supplement with other juices, water and solids. Babies can be breastfed until both mom and baby are ready to wean. Some babies and moms will breastfeed for a short time, and some moms/babies will breastfeed for several years. Each mom and baby are unique in what works best for them. The World Health Organization recommends that women breastfeed their babies for at least 6 months to help keep babies as healthy as possible. Breastfeeding helps to reduce risk of childhood obesity and reduces infant infections and death. According to WHO: Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large. Once again, exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Exclusive breastfeeding means no other source of nutrition expect breastmilk. Please keep in mind, if babies are not growing well, are dehydrated or not gaining weight may need to have other sources of nutrition in the first 6 months, such as formula. The key is to make sure babies and moms are as healthy as they can be, but babies and moms should not gain extra weight that their bodies do not need. This is a fine line and as nurses we need to make sure that both moms and babies are at a healthy weight (Lowdermilk & Perry, 2006). References: Lowdermilk, D. & Perry, S. (2006) Maternity Nursing. (7th ed). St. Louis: Mosby Sloan, S., Gildea, A., Stewart, M., Sneddon, H. & Iwaniec, D. (2007). Early weaning is related to weight and rate of weight gain in infancy. Child: care, health and development, 34:59-64. doi: 10.1111/j.1365-2214.2007.00771.xExercise: How many women in your family and community breastfeed their infants? Is breastfeeding important in your community? Why or why not?
  • “Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally, in 2010 the number of overweight children under the age of five, is estimated to be over 42 million. Close to 35 million of these are living in developing countries. Overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases like diabetes and cardiovascular diseases at a younger age. Overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity therefore needs high priority.”WHO Fact Sheet Pediatric Obesity, Retrieved from http://www.who.int/dietphysicalactivity/childhood/enWhen talking about obesity in children, the thought is, “oh there are not that many children..and they will lose their baby fat as they grow up”. This is no longer true. Children are becoming more challenged with being overweight and obese. There are several issues to consider. According to Centers for Disease Control (2010), there are several issues that need to be addressed. The rate of childhood obesity has increased over the past 30 years. The rates of increase are alarming and need to considered carefully. What can we do to help reduce obesity in children? Well, there are many things we can do. But, first, what the numbers? Over the past 30 years, the rate of obesity in children is rising…for ages 6-11, the rate has increased from 6.5% to 19.6%. For children 12-19, the rates are about the same, in 1980, 5% were obese, now it is 18.1% and rising (Centers for Disease Control, 2010). And with the WHO estimating that 42 million children worldwide under 5 are overweight, the prognosis is not good. There are many issues that need to be considered, as this crisis is not easing off or decreasing, but increasing at fast rates all over the world. Centers for Disease Control. (2010). Health topics: Childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/obesity
  • Early in this lecture, in defining obesity, the basic premise is when someone eats more than they need for energy, the extra weight is added. This is also true for children. But, obesity is a bit more than just how many calories…there are issues surrounding genetics. Does obesity run in the family? Are there other members of the family, say the mother or father, or brothers and sisters that are also obese? If so, there is a risk of children being obese as they grow older. Because obesity is a complex condition, there are many factors to consider, one is genetics. In a study by Boutin and Froquel (2001), there is strong evidence to suggest the genetic link to obesity. The genetic codes are influenced by sedentary lifestyle, food choices and constant access to food puts stress on genes that are predisposed to weight gain. Boutin, P. & Froquel, P. (2001). Genetics of human obesity. Clinical Endocrinology and Metabolism, 15: 391-404. Retrieved from http://www.bprcem.com/article/S1521-690X%2801%2990153-8/abstractBehavioral activity needs to be considered. What kids choose to eat is learned from parents and other adults. Children are more likely to choose healthy foods if they are offered in the home. Environment. This is some things a child and their parents may not have control over. Most humans will try and live in the best place they can. To have shelter, clean water and healthy food. But this may not be possible. Sadly, food that is over processed may also be the cheapest and can be stretched further in the household budget, or perhaps there is no money for food and children eat only when they can. It may be very challenging to find healthy food. Even in America, many children do not have access to fresh fruits and vegetables. There are no grocery stores close by or there is no money to purchase fresh fruits and vegetables. Centers for Disease Control. (2010). Health topics: Childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/obesity
  • “Overweight and obesity, as well as related noncommunicable diseases, are largely preventable. It is recognized that prevention is the most feasible option for curbing the childhood obesity epidemic since current treatment practices are largely aimed at bringing the problem under control rather than effecting a cure. The goal in fighting the childhood obesity epidemic is to achieve an energy balance which can be maintained throughout the individual's life-span.” World Health Organization, Retrieved from http://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/index.htmlWhen talking about obesity in children, the thought is, “oh there are not that many children..and they will lose their baby fat as they grow up”. This is no longer true. Children are becoming more challenged with being overweight and obese. There are several issues to consider. According to Centers for Disease Control (2010), there are several issues that need to be addressed. The rate of childhood obesity has increased over the past 30 years. The rates of increase are alarming and need to considered carefully. What can we do to help reduce obesity in children? Well, there are many things we can do. Childhood obesity must be taken into consideration with short and long term issues. These include: When children are obese or overweight, they are most likely to develop high blood pressure or high cholesterol. According to the Center for Disease Control (2010) children who are overweight or obese were more likely to have more than one risk of heart disease. In a population-based study, children ages 5-17 years, 70% of the kids had at least one risk factor for heart disease. One has to consider, when the body has too much weight, there are more problems with joints, how hard the heart has to work, diabetes, sleep issues with sleep apnea. The issues behind obesity go far beyond the body…but think about self-esteem and being stigmatized. These were also studied and results are clear, obesity is more than being overweight, but it also affects how people and children view themselves and how others view them. Exercise: When you see someone who is overweight or obese…someone that you do know…what comes to your mind? How do you judge them…what thoughts do you have? http://www.cdc.gov/HealthyYouth/obesity
  • Objectives for these strategies are to: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/enAdvocate for health promotion and chronic disease prevention and controlPromote health, especially in areas of poverty and disadvantaged populationsPrevent premature deaths at all ages The reality is, we have control over this epidemic…but our work is not working as well as we might want. As nurses, we need to take an active role in helping those in our care, our communities and our families to take care of themselves. To eat as well as they can, be active and get rest. As nurses, we set the tone, we are role models. Our role is to advocate and teach our patients to take good care of themselves.
  • Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html
  • Keep in mind, that even with more fruits and vegetables in the diet, there is still need to reduce the fats, sugars and processed foods. Keep in mind that tubers, such as potatoes and cassava are not included in fruits and vegetables. Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html
  • Obesity is one the most preventable diseases. When the human body is healthy, active and eating well, most can expect to live well into their 80’s or 90’s. Obesity creates opportunity for an unhealthy life with higher risk of heart disease, diabetes type 2, cancers of the uterus, cervix and colon. Obesity, because of the extra weight makes it harder to move and increases the risk of osteoarthritis. Each one of us can make such a difference by being role models and helping others to understand why obesity rates need to be reduced.
  • Obesity

    2. 2. OVERWEIGHT & OBESITY ''abnormal or excessive fat accumulation that presents a risk to health'‘ HOW TO MEASURE difficult to develop one simple index in children and adolescents--undergo a number of physiological changes as they grow. Depending on the age, different methods available: For children aged 0-5 years  The WHO Child Growth Standards  WHO Global Database on Child Growth and Malnutrition, 0-5 years. For individuals aged 5-19 years  Growth reference data for 5-19 years  Global school-based student health survey (GSHS) GC,GGMC
    3. 3. For Adults Most commonly used measure for overweight and obesity is the Body Mass Index (BMI) – • a simple index to classify overweight and obesity in adults. • defined as the weight in kilograms divided by the square of the height in meters (kg/m2). Other approaches to quantifying obesity  anthropometry (skinfold thickness)  densitometry (underwater weighing)  CT or MRI  electrical impedance. GC,GGMC
    4. 4. The WHO definition is:  a BMI greater than or equal to 25 is overweight  a BMI greater than or equal to 30 is obesity. BMI  most useful population-level measure of overweight and obesity , same for both sexes and for all ages of adults.  considered a rough guide - may not correspond to the same degree of fatness in different individuals. GC,GGMC
    5. 5. JUST THE FACTS! According to WHO: As of 2013 :  Worldwide obesity has nearly doubled since 1980.  In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.  35% of adults aged 20 and over were overweight in 2008, and 11% were obese.  65% of the world's population live in countries where overweight and obesity kills more people than underweight.  More than 40 million children under the age of five were overweight in 2011.  Obesity is preventable GC,GGMC
    6. 6. LOW AND MIDDLE INCOME COUNTRIES According to WHO there is a “double burden” of disease  Countries that are developing are still having issues of infectious disease and under-nutrition  There is also an increase of chronic disease related to obesity…especially in urban settings  Causes inadequate prenatal care, lack of infant and child nutrition and eating high fat and high sugar foods GC,GGMC
    7. 7. Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2000 1990 2010 No Data GC,GGMC <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    8. 8. India : Double Burden of Disease  Under nutrition due to Poverty 30 % below BPL  Over nutrition and Obesity 5-7% MIG and HIG Urban area Most productive group of the country- Academic/ Planner/ Research/ Administrator/ professional SHOULD BE GIVEN PRIORITY GC,GGMC
    9. 9. Obesity Trends in India : Recent studies: Adults Author Year Country/ Criteria of used State Study Prevalence Prevalence of overof obesity weight (M/F) (M/F) Gopinath et.al 1994 Delhi BMI>25 21.3% (M) INA 33.4% (F) Singhal et al 1998 Jaipur BMI>25 14.6% (M) INA 6.6% (F) Asthana et al 1997 Varanasi BMI>25 30.2% (F) INA Chadha et al 1997 Delhi GC,GGMC BMI>25 20.7 (M) INA 32.6% (F)
    10. 10. Obesity Trends in India : Recent studies Author Year Country/ Criteria of used State Study Prevalence of overweight (M/F) BMI>23 50.9% (F) BMI>25 BMI>27 BMI>30 Singh et.al 1999 5 Cities Vasanthanani 2000 Coimbatore Mohan et al 2000 Chennai BMI>25 38.0% (M) 33.1% (F) Easwaran et al 2001 Coimbatore 2002 Jaipur BMI>27 NFHS-II 1998- India 99 36.0% (M) BMI>25 65.0% (M) BMI>24 65.0% (F) Gupta et al Prevalenc e of obesity (M/F) GC,GGMC BMI>25 8.6% MIG 27.2 HIG 24.5% (M) 30.2% (F)
    11. 11. OBESITY TRENDS IN INDIA : RECENT STUDIES CHILDREN S.No Author Name State/ country Prevalence of obesity 1.* Umesh Kapil etal, 2001 Delhi (India) 8% boys 6% girls 2.** Vedavati S etal, 1998 Chennai, India 6% obese 1.* Indian Pediatrics, 2002 May, 17: 449-452 2.** Indian Pediatrics, 2003 Aug, 40: 775-779. GC,GGMC
    12. 12. OBESITY TRENDS IN INDIA : RECENT STUDIES CHILDREN S.No Author Name State/ country Prevalence of obesity 3.* A.K.Gupta etal, 1985-86 India 7.94% boys 6.90% girls 4.** Ramachandran A etal, 2000 India 3.6% boys 2.7% girls 3.* Indian Pediatrics, 1990, Apr, 27 333-337 4.** Diabetes research and Clinical Practice 2002; 57 185-190. GC,GGMC
    13. 13. CAUSE OF OBESITY Simple equation…when you eat more than you use.It is stored in your body as “fat”. Causes  Global shift in how we eat  Western diet of processed food  Higher sugar, fat and calories in what we eat  Less nutrients  Reduced intake of vitamins and minerals GC,GGMC
    15. 15. GC,GGMC
    16. 16. GC,GGMC
    17. 17. GC,GGMC
    19. 19. ENERGY IMBALANCE EFFECTS IN THE BODY Excess energy is stored in fat cells, which enlarge or multiply. Enlargement of fat cells is known as hypertrophy, whereas multiplication of fat cells is known as hyperplasia. With time, excesses in energy storage lead to obesity. Fat cells GC,GGMC
    20. 20. FAT CELL ENLARGEMENT HYPERTROPHY Enlarged fat cells produce the clinical problems associated with obesity, due to the following: • The weight or mass of the extra fat • The increased secretion of free fatty acids and peptides from enlarged fat cells. GC,GGMC
    21. 21. FACTORS RELEASED BY THE ADIPOCYTE THAT CAN AFFECT PERIPHERAL TISSUES  Complement factors : factor-D, adipisin  Hormones: Leptin Adiponectin Resistin  Cytokines: TNF-α IL-6  Substrate: Free fatty acid Glycerol GC,GGMC  Enzymes: Aromatase 11-β-HSD-1  Others: PAI-1 Angiotensinogen RBP-4
    22. 22. MORTALITY AND MORBIDITY ASSOCIATED WITH OBESITY  The effects of excess weight on mortality and morbidity recognized for more than 2,000 years.  Hippocrates -- recognized that “sudden death is more common in those who are naturally fat than in the lean.” Today, obesity is increasing rapidly. Research shows that many factors related to obesity influence mortality and morbidity. GC,GGMC
    23. 23. MORTALITY WEIGHT, FAT DISTRIBUTION, AND ACTIVITY The following factors have been shown to increase mortality in individuals: • • • • GC,GGMC Excess body weight Regional fat distribution Weight gain patterns Sedentary Lifestyle
    24. 24. MORTALITY EXCESS BODY WEIGHT Mortality associated with excess body weight increases as the degree of obesity and overweight increases. It is estimated that 280,000 to 325,000 deaths a year can be attributed to obesity in the United States, more than 80% of these deaths occur among individuals with a BMI greater than 30 kg/m2. GC,GGMC
    25. 25. MORTALITY REGIONAL FAT DISTRIBUTION Android Gynoid Regional fat distribution can contribute to mortality. This was first noted in the beginning of the 20th century. Obese individuals with an android (or apple) distribution of body fat are at a greater risk for diabetes and heart disease than were those with a gynoid distribution (pear). Android fat distribution results in higher free fatty acid levels, higher glucose and insulin levels and reduced HDL levels. It also results in higher blood pressure and inflammatory markers.
    26. 26. MORTALITY WEIGHT GAIN In addition to overweight and central fatness, the amount of weight gain after ages 18 to 20 also predicts mortality. The Nurses’ Health Study and the Health Professionals Follow-up Study showed that a marked increase in mortality from heart disease is associated with increasing degrees of weight gain.
    27. 27. MORTALITY SEDENTARY LIFESTYLE Sedentary lifestyle is another important component in the relationship of excess mortality to obesity. A sedentary lifestyle increases the risk of death at all levels of BMI. Obese men with a high level of fitness had risks of death that were not different from fit men with normal body fat. GC,GGMC
    28. 28. MORBIDITY ASSOCIATED WITH OBESITY Overweight affects several diseases, although its degree of contribution varies from one disease to another. Additionally, the risk of developing a disease often differs by ethnic group, and by gender within a given ethnic group.
    29. 29. MORBIDITY ASSOCIATED WITH OBESITY Individuals who are obese are at a greater risk of developing: Obstructive sleep apnea Osteoarthritis Endometrial, prostate and breast cancers Cardiovascular disorders Complications of pregnancy Gastrointestinal disorders Menstrual irregularities Metabolic disorders Psychological disorders GC,GGMC
    30. 30. CARDIOVASCULAR DISORDERS ASSOCIATED WITH OBESITY Obese individuals are at a greater risk of developing these cardiovascular disorders: Hypertension Stroke Coronary Artery Disease GC,GGMC
    31. 31. HYPERTENSION Hypertension (HTN) is the term for high blood pressure. Hypertension is identified when a blood pressure is sustained at ≥140/90 mmHg. High blood pressure is referred to as the “silent killer,” since there are usually no symptoms with HTN. Some individuals find out that they have high blood pressure when they have trouble with their heart, brain, or kidneys. GC,GGMC
    32. 32. HYPERTENSION THE DANGERS Failure to find and treat HTN is serious, as untreated HTN can cause: The heart to get larger, which may lead to heart failure. Small bulges (aneurysms) to form in blood vessels. Blood vessels in the kidney to narrow, which may lead to kidney failure. Arteries in the body to harden faster, especially those in the heart, brain, kidneys, and legs. This can cause a heart attack, stroke, kidney failure, or can lead to amputation of part of the extremities. • Blood vessels in the eye to burst or bleed. This may cause vision changes and can result in blindness. • • • • GC,GGMC
    33. 33. HYPERTENSION Blood pressure is often increased in overweight individuals. Estimates suggest that control of overweight would eliminate 48% of the hypertension in Caucasians and 28% in African Americans. Overweight and hypertension interact with cardiac function, leading to thickening of the ventricular wall and larger heart volume, and thus to a greater likelihood of cardiac failure. GC,GGMC J La State Med Soc .2005; 157 (1): S42-49.
    34. 34. HYPERTENSION PREVALENCE IN THE OVERWEIGHT 35 32.7 Prevalence of HTN 30 25 27.0 27.7 Age-adjusted prevalence of hypertension in overweight U.S. adults 22.1 20 14.9 15.2 15 BMI < 25 BMI > 25 & < 27 BMI > 27 & <30 10 5 0 Males GC,GGMC Females Adapted from: http://www.obesityinamerica.org/trends.html
    35. 35. STROKE A stroke occurs when the blood supply to part of the brain is suddenly interrupted by a blocked vessel or when a blood vessel in the brain bursts. Once their supply of oxygen and nutrients from the blood is cut off to the brain cells, they die. GC,GGMC
    36. 36. STROKE The symptoms of a stroke include: Sudden numbness or weakness, especially on one side of the body Sudden confusion or trouble speaking or understanding speech Sudden trouble seeing in one or both eyes Sudden trouble with walking, dizziness, or loss of balance or coordination Sudden severe headache with no known cause GC,GGMC
    37. 37. STROKE There are two forms of stroke: ischemic and hemorrhagic. Ischemic stroke occurs when an artery to the brain is blocked. Overweight and obesity increase the risk for ischemic stroke in men and women. With increasing BMI, the risk of ischemic stroke increases progressively and is doubled in those with a BMI greater than 30 kg/m2 when compared to those having a BMI of less than 25 kg/m2. Hemorrhagic strokes occur when a blood vessel in the brain erupts. Overweight and obesity do not increase the risk for hemorrhagic strokes. GC,GGMC J La State Med Soc .2005; 156 (1): S42-49.
    38. 38. CORONARY ARTERY DISEASE Coronary artery disease (CAD) is a type of atherosclerosis that occurs when the arteries supplying blood to the heart muscle (coronary arteries) become hardened and narrowed. This hardening and narrowing is caused by plaque buildup. As the plaque increases in size, the insides of the coronary arteries get narrower, and eventually, blood flow to the heart muscle is reduced. This is critical because blood carries much-needed oxygen to the heart. GC,GGMC
    39. 39. CORONARY ARTERIES BLOOD FLOW When the heart muscle is not receiving the amount of oxygen that it needs, one of two things can happen: • Angina • Heart Attack GC,GGMC Angina This is the chest pain or discomfort that occurs when the heart is not getting enough blood. Heart attack This is what happens when a blood clot develops at the site of the plaque in a coronary artery. The result is a sudden blockage, which may block all or most of the blood supply to the heart muscle. Because cells in the heart muscle begin to die when they are not receiving adequate amount of oxygen, permanent damage to the heart muscle can occur if blood flow is not quickly restored. I
    40. 40. CORONARY ARTERY DISEASE Over time, CAD can weaken the heart muscle and contribute to: • Heart Failure • Arrhythmias GC,GGMC Heart Failure In this condition, the heart can’t pump blood effectively to the rest of the body. Heart failure does not mean that the heart has stopped nor does it mean that it is about to. It means that the heart is failing to pump blood the way that it should. Arrhythmias Arrhythmias are changes in the normal beating rhythm of the heart. They can be either faster or slower than normal. Some arrhythmias can be quite serious.
    41. 41. CORONARY ARTERY DISEASE Obesity is associated with an increased risk for CAD. Abdominal fat distribution is believed to be related as well. Data from the Nurses Health Study illustrated that women in the lowest BMI but highest waist-to-hip circumference ratio had a greater risk of heart attack than those in the highest BMI but lowest waist-to-hip circumference ratio. Regional fat distribution appears to have a greater effect on CAD risk than BMI alone. GC,GGMC J La State Med Soc .2005; 156 (1): S42-49.
    42. 42. GASTROINTESTINAL DISORDERS ASSOCIATED WITH OBESITY Obese individuals are at greater risk of developing these gastrointestinal disorders: Colon Cancer Gall stones GC,GGMC
    43. 43. COLON CANCER Colorectal cancer is a term used to refer to cancer that develops in the colon or the rectum. The colon (a.k.a. the large intestine) is about 5 feet long and its role in the digestive system is to continue to absorb water and mineral nutrients from food. Once this process of absorption is complete, waste matter (feces) remains. The rectum is the final 6 inches of the digestive system. Feces are passed from the large intestine to the rectum, to exit the body through the anus. GC,GGMC
    44. 44. COLON CANCER Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. It is estimated to cause about 55,170 deaths during 2006. GC,GGMC
    45. 45. COLON CANCER FINDINGS RELATING TO OBESITY Colon cancer has been shown to occur more frequently in people who are obese than in people who are of a healthy weight. An increased risk of colon cancer has been consistently reported for men with high BMIs. Women with high BMI are not at increased risk of colon cancer. There is evidence that abdominal obesity may be important in colon cancer risk. GC,GGMC
    46. 46. GALLBLADDER DISEASE Cholelithiasis is the primary hepatobiliary pathology associated with overweight. Cholelithiasis is a condition characterized by the presence or formation of gallstones in the gallbladder or bile ducts. Normally, a balance of bile salts, lecithin, and cholesterol keep gallstones from forming. However, if there are abnormally high levels of bile salts or, more commonly, cholesterol, then stones can form. GC,GGMC .
    47. 47. GALLSTONES FINDINGS RELATED TO OBESITY Obesity appears to be associated with the development of gallstones. More cholesterol is produced at higher body fat levels. Approximately 20 mg of additional cholesterol synthesized for each kg of extra body fat. High cholesterol concentrations relative to bile acids and phospholipids in bile increase the likelihood of precipitation of cholesterol gallstones in the gallbladder. GC,GGMC
    48. 48. GALLSTONES FINDINGS RELATED TO OBESITY In the Nurses’ Health Study, when compared to those having a BMI of 24 or less, • Women with a BMI > 30 kg/m2 had a 2-fold increased risk for symptomatic gallstones. • Women with a BMI > 45 kg/m2 had a 7-fold increased risk for symptomatic gallstones. The relative increased risk of symptomatic gallstone development with increasing BMI appears to be less for men than for women. GC,GGMC
    49. 49. GALLSTONES FINDINGS RELATED TO OBESITY Ironically, weight loss leads to an increased risk of gallstones-- because of the increased flux of cholesterol through the biliary system. Diets with moderate levels of fat that trigger gallbladder contraction and subsequent emptying of the cholesterol content may reduce the risk of gallstone formation. Bile acid supplementation can be used to lower ones risk for gallstone formation. GC,GGMC
    50. 50. METABOLIC DISORDERS ASSOCIATED WITH OBESITY Obese individuals are at greater risk of developing these metabolic disorders: Diabetes Mellitus Dyslipidemia Liver Disease GC,GGMC
    51. 51. DIABETES MELLITUS Type 2 diabetes mellitus (DM) is strongly associated with overweight and obesity in both genders and in all ethnic groups. The risk for Type 2 DM increases with the degree and duration of overweight in individuals. The risk for Type 2 DM also increases in individuals with a more central distribution of body fat (abdominal). GC,GGMC
    52. 52. OBESITY AND TYPE 2 DM IN THE UNITED STATES 15% 55% GC,GGMC 30% BMI < 25 BMI > 25 or BMI < 30 BMI > 30 Among people diagnosed with Type 2 diabetes, 55 percent have a BMI ≥ 30 (classified as obese), 30 percent have a BMI ≥ 25 or ≤30 (classified as overweight), and only 15 percent have a BMI ≤ 25 (classified as normal weight). Adapted from: http://www.obesityinamerica.org/trends.html
    53. 53. DIABETES MELLITUS FINDINGS RELATED TO OBESITY The Nurses’ Health Study demonstrated the curvilinear relationship between increasing BMI and the risk of diabetes in women: • Women with a BMI below 22 kg/m2 had the lowest risk of DM • At a BMI of 35 kg/m2, the relative risk of DM increased 40-fold or 4,000% The Health Professionals Follow-up Study demonstrated a similar relationship between increasing BMI and the risk of diabetes in men: • Men with a BMI below 24 kg/m2 had the lowest risk of DM • At a BMI of 35 kg/m2, the relative risk of DM increased 60-fold or 6,000% GC,GGMC
    54. 54. DIABETES MELLITUS FINDINGS RELATING TO WEIGHT LOSS Weight loss reduces the risk of developing diabetes. In the Health Professionals Follow-up Study, a weight loss of 5-11 kg decreased the relative risk for developing diabetes by nearly 50%. Type 2 DM was almost nonexistent with a weight loss of more than 20 kg (44 lbs) or in those with a BMI below 20. GC,GGMC
    55. 55. DYSLIPIDEMIA Dyslipidemia is defined as abnormal concentration of lipids or lipoproteins in the blood. As BMI increases, there is an increased risk for heart disease. This is because a positive correlation between BMI and triglyceride (TG) levels has been demonstrated. GC,GGMC
    56. 56. DYSLIPIDEMIA FINDINGS RELATED TO OBESITY An inverse relationship between HDL cholesterol and BMI has been noted. HDL This relationship may be more important than the relationship between BMI & TG levels. Low level of HDL carries more relative risk for developing heart disease than do elevated triglyceride levels. Central fat distribution also plays an important role in lipid abnormalities. Excessive body fat in the abdominal region leads to increased circulating triglyceride levels. GC,GGMC
    57. 57. LIVER DISEASE Nonalcoholic fatty liver disease (NAFLD) is the term given to describe a collection of liver abnormalities that are associated with obesity. In a cross-sectional analysis of liver biopsies of obese patients, it was found that the prevalence of steatosis, steatohepatitis, and cirrhosis were approximately 75%, 20%, and 2% respectively. GC,GGMC
    58. 58. LIVER DISEASE FATTY LIVER Steatosis is the term for “fatty liver” and it is not actually a disease, but rather a pathological finding. Most cases of fatty liver are due to obesity. Other causes of fatty liver include: • • • • • • Diabetes Certain drugs Intestinal bypass operations Starvation Protein malnutrition Alcoholism GC,GGMC
    59. 59. LIVER DISEASE FATTY LIVER A gradual weight reduction can help to reduce the enlargement of the liver due to fat, and it can normalize the associated liver test abnormalities. It is important to limit the amount of alcohol consumed in the diet. Alcohol can decrease the rate of metabolism and secretion of fat in the liver. GC,GGMC
    60. 60. OTHER DISORDERS ASSOCIATED WITH OBESITY Obese individuals are at greater risk of developing these metabolic disorders: Obstructive sleep apnea Osteoarthritis Endometrial, prostate, and breast cancers Complications of pregnancy Menstrual irregularities Psychological disorders GC,GGMC
    61. 61. OBSTRUCTIVE SLEEP APNEA Obstructive sleep apnea is caused by repetitive upper airway obstruction during sleep as a result of narrowing of the respiratory passages. Patients having the disorder are most often overweight with associated peripharyngeal infiltration of fat and/or increased size of the soft palate and tongue. GC,GGMC
    62. 62. OBSTRUCTIVE SLEEP APNEA Common complaints are loud snoring, disrupted sleep, and excessive daytime sleepiness. Individuals with sleep apnea suffer from fragmented sleep and may develop cardiovascular abnormalities because of the repetitive cycles of snoring, airway collapse, and arousal. Because many individuals are not aware of heavy snoring and nocturnal arousals, obstructive sleep apnea may remain undiagnosed. GC,GGMC
    63. 63. OBSTRUCTIVE SLEEP APNEA FINDINGS RELATING TO OBESITY Obstructive sleep apnea affects around 4% of middle-aged adults. Individuals having a BMI of at least 30 are at greatest risk for sleep apnea. Weight loss has been shown to improve the symptoms relating to sleep apnea. GC,GGMC
    64. 64. OSTEOARTHRITIS Osteoarthritis (OA) is the most common type of arthritis 40 million Americans currently have osteoarthritis. It is a degenerative disease which frequently leads to chronic pain and disability. For individuals over the age of 65, it is the most disabling disease. Currently, only the symptoms of OA can be treated; there is no cure. GC,GGMC
    65. 65. OSTEOARTHRITIS FINDINGS RELATING TO OBESITY The incidence of OA is significantly increased in overweight individuals. OA that develops in the knees and ankles is probably directly related to the trauma associated with the degree of excess body weight. Osteoarthritis in other non-weight bearing joints suggests that there must be some component of the overweight syndrome responsible for altering cartilage and bone metabolism, independent of the actual stresses of body weight on joints. Areas of the body most commonly affected by OA GC,GGMC
    66. 66. CANCER FINDINGS RELATING TO OBESITY Overweight and obesity are associated with an increased risk of: esophageal, gallbladder, pancreatic, cervical, breast, uterine, renal, and prostate cancers. Obesity and physical inactivity may account for 25 to 30 percent of several major cancers, including--- colon, breast (postmenopausal), endometrial, kidney, and cancer of the esophagus. GC,GGMC
    67. 67. ENDOCRINE CHANGES Changes in the reproductive system are among the most common. Irregular menses and frequent anovular cycles are common. Rates of fertility may also be reduced. GC,GGMC
    68. 68. ENDOCRINE CHANGES ASSOCIATED WITH OBESITY Common hormonal abnormalities associated with obesity Increased cortisol production Insulin resistance Decreased sex hormone-binding globulin in women Decreased progesterone levels in women Decreased testosterone levels in men Decreased growth hormone production GC,GGMC
    69. 69. PSYCHOLOGICAL DISORDERS ASSOCIATIONS WITH OBESITY Obesity is associated with an impaired quality of life. Higher BMI values are associated with greater adverse effects. When compared to obese men, obese women appear to be at a greater risk for psychological dysfunction. This may be due to the societal pressure on women to be thin. GC,GGMC
    70. 70. PSYCHOLOGICAL DISORDERS WEIGHT LOSS Intentional weight loss has been consistently associated with improved quality of life. Severely obese patients who lost 43 kg through gastric bypass demonstrated improved quality of life scores to such an extent that their postweight loss scores were equal to or even better than population norms. GC,GGMC
    71. 71. IN CONCLUSION The following conditions have been found to be associated with obesity: Diabetes mellitus Hypertension Psychosocial Function Gallbladder Disease Obstructive Sleep Apnea Liver Disease Osteoarthritis Cancer Coronary Artery Disease Cerebrovascular disease (stroke) Endocrine Changes GC,GGMC These diseases have been found to be associated with increased metabolic activity (secretion) of fat cells in obesity These diseases have been found to be associated with increased fat mass
    72. 72. GC,GGMC
    73. 73. WHAT ABOUT CHILDREN? When children are overweight, they are more likely to be overweight and obese as adults. How can children avoid being obese? • This starts as soon as we are born…. GC,GGMC
    74. 74. HEALTHY STARTS Before we are born Mothers who: • • • • Normal BMI during pregnancy Eat healthy and exercise moderately Gain 11.5-16 kg Prenatal care When we are babies GC,GGMC • Study shows babies weaned before 4 months gained more weight than recommended • According to WHO: Breastfeed for at least 6 months exclusively and beyond if possible
    75. 75. CHILDHOOD OBESITY  Rates of childhood obesity are alarming  Problem is worldwide  Estimated in 2010, 42 million children under age 5 are considered overweight  Tripled in past 30 years • Age 6-11 • Age 12-19 GC,GGMC 6.5% to 19.6% 5.0% to 18.1%
    76. 76. CHILDHOOD OBESITY Genetic Link • Multifactorial condition related to sedentary lifestyle, too much good intake and choice of foods actually alter genetic make-up, creating higher risk of obesity Behavioral • Children will more likely choose healthier foods if they are offered to them at young ages and in the home Environment • In homes where healthy food is not available, or the food choices are not healthy, Obesity can occur . GC,GGMC
    77. 77. CHILDHOOD OBESITY Why does this matter? • Premature death • Developing heart disease at younger ages • Developing diabetes type 2 at younger ages What can be done? • Childhood obesity is preventable • Role of the schools • Role of health care professionals GC,GGMC
    78. 78. WHO STRATEGY WHO Strategy for preventing overweight and obesity Adopted by World Health Assembly in 2004 and WHO Global Strategy on Diet, Physical Activity and Health • • • • GC,GGMC Four objectives Reduce risk factors of chronic disease Increase awareness and understanding Implement global, regional, national policies actions plans Monitor science and promote research
    82. 82. AHA GUIDELINES FOR HEALTHY DIETS Protein: 15-20% of calories not excessive (50-100g/d) proportional to carbohydrate and fat Carbohydrates: ~55% of calories Minimum of 100g/d Fat: ~30% of calories, <10% sat fat Protein foods should not contribute excess total fat, sat fat or cholesterol Diet should provide adequate nutrients and support dietary compliance GC,GGMC
    83. 83. FRUITS AND VEGETABLES WHO states: • Fruits and vegetables need to be part of the daily diet to prevent disease such as obesity and noncommunicable disease The statistics are startling Lack of enough fruits and vegetables cause • 19% of GI deaths • 31% of Ischemic heart disease • 11% of stroke GC,GGMC
    84. 84. HOW MUCH FRUIT IS ENOUGH? WHO recommends at least 400 gms of fruit and vegetables each day… This will prevent chronic disease related to overweight and obesity • Heart disease • Diabetes • Cancers GC,GGMC
    85. 85. OBESITY DRUGS Appetite suppressants Noradrenergic (Schedule IV) • Phentermine (Adipex, Fastin) • Diethylpropion (Tenuate) Noradrenergic (Schedule III) • Benzphetamine (Didrex) • Phendimetrazine (Bontril) Serotonergic • Fenfluramine, dexfenfluramine Mixed Noradrenergic & Serotonergic • Sibutramine (Meridia) Nutrient absorption reducers Lipase inhibitor • GC,GGMC Orlistat (Xenical)
    86. 86. SIBUTRAMINE (MERIDIA) Contraindicated: CAD, CHF, cardiac arrhythmias or stroke Side Effects: hypertension, arrhythmia, tachycardia pulse and BP should be checked before treatment and every 2 weeks in the 1st 3 months and every 1-3 months thereafter GC,GGMC
    87. 87. SIDE EFFECTS Common • • • • Headache Dry mouth Constipation Insomnia Stop treatment in patients who experience: • an increase in heart rate of 10 beats/min • an increase in either SBP or DBP of >10 mmHg in 2 consecutive visits GC,GGMC
    88. 88. ORLISTAT Lipase inhibitor that reduces fat absorption by ~30% resulting in reduction in energy intake Inhibits digestion of dietary triglycerides, decreases absorption of cholesterol and lipid-soluble vitamins Side Effects GI side effects due to inhibition of fat absorption • pain, fecal urgency, liquid stools, flatulence with discharge, oily spotting Multivitamin recommended because of reduction in absorption of fat soluble vitamins (esp. A & E) GC,GGMC
    89. 89. SURGERY 2001 -- 47,000 2002 -- 63,000 2003 -- 98,000 NIH Criteria: Well informed and motivated patient BMI>40 or BMI>35 with co-morbidities Mortality: 1-2% Effectiveness: >50% excess weight loss at 14 years GC,GGMC
    90. 90. ESSENTIAL UNDERSTANDINGS It is well known that obesity is preventable. It is caused by eating more than we need…so how can we prevent obesity? Each of us can…according to WHO • Have a balance of energy and healthy weight • Limit how much fat we eat…we need to eat some..but not too much. • Increase fruits and vegetables • Limit sugars • Increase exercise to at least 30-60 minutes per day on most days! GC,GGMC
    91. 91. Reversing the obesity epidemic is a shared responsibility. Social and environmental changes are influenced by the efforts of many… GC,GGMC
    92. 92. ACKNOWLEDGEMENT  WORLD HEALTH ORGANISATION  CDC, ATLANTA, USA  Ministry of health and family welfare, New Delhi  All India Institute of Medical Sciences, New Delhi GC,GGMC
    93. 93. GC,GGMC