In today's society, leanness is often equated with beauty, success, fitness, and self-control. Obesity, on the other hand, is considered as undesirable as leanness is desirable, for reasons that are often more related to cosmetic concerns than to actual or potential medical complications.
A crash-course ED 101 for dietitians not familiar with eating disorders
- What does "normal eating" mean and when does it become "disordered eating?"
- What are the spectrum of eating disorders?
- What are the causes of eating disorders and what does treatment involve?
- What is the dietitian's role in eating disorders?
- What are some ways to screen eating disorders and obsessive/compulsive exercise?
- Why are "Health at Every Size" and "Intuitive Eating" effective approaches in preventing clinical eating disorders?
A crash-course ED 101 for dietitians not familiar with eating disorders
- What does "normal eating" mean and when does it become "disordered eating?"
- What are the spectrum of eating disorders?
- What are the causes of eating disorders and what does treatment involve?
- What is the dietitian's role in eating disorders?
- What are some ways to screen eating disorders and obsessive/compulsive exercise?
- Why are "Health at Every Size" and "Intuitive Eating" effective approaches in preventing clinical eating disorders?
Mental health issues such as depression and anxiety are NOT a normal part of aging and are hard to discuss, diagnose and treat. The good news is that there are innovative programs, tools and resources that can help.
Recently obesity is becoming one of the psychiatric disorder , we are discussing depression and ADHD associated with obesity , cognitive reconstruction and cognitive behavior therapy steps is discussed , medical therapy used in obesity
Feeding and Eating disorders are one of the devastating disorders , Anorexia is a killer disease , very common in childhood and adolescent, mainly in girls more than boys. Bulimia is charecterize by binge eating followed by compulsive purging . Binge eating disorders and night eating syndrome are becoming very prevalent
Feeding disorders as avoidant restrictive food intake disorder , rumination disorders and pica are the types of feeding disorders in infant and childhood period
psychological rehabilitation, nutritional plan and medical therapy are the most effective lines of treatment foe eating Disorders
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/12/obesity.html
obesity, causes, diagnosis, complications, treatment, prevention.
Mental health issues such as depression and anxiety are NOT a normal part of aging and are hard to discuss, diagnose and treat. The good news is that there are innovative programs, tools and resources that can help.
Recently obesity is becoming one of the psychiatric disorder , we are discussing depression and ADHD associated with obesity , cognitive reconstruction and cognitive behavior therapy steps is discussed , medical therapy used in obesity
Feeding and Eating disorders are one of the devastating disorders , Anorexia is a killer disease , very common in childhood and adolescent, mainly in girls more than boys. Bulimia is charecterize by binge eating followed by compulsive purging . Binge eating disorders and night eating syndrome are becoming very prevalent
Feeding disorders as avoidant restrictive food intake disorder , rumination disorders and pica are the types of feeding disorders in infant and childhood period
psychological rehabilitation, nutritional plan and medical therapy are the most effective lines of treatment foe eating Disorders
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/12/obesity.html
obesity, causes, diagnosis, complications, treatment, prevention.
Scrub typhus is a growing and emerging disease grossly under-diagnosed due to its non-specific clinical presentation, limited awareness, and low index of suspicion
consider as a differential diagnosis in acute febrile illness with thrombocytopenia, renal impairment, LFT abnormalities, altered sensorium,encephalitis, pneumonitis, or ARDS
WEIL FELIX test very Specific
Early diagnosis and treatment are imperative to reduce the mortality and the complications associated with the disease
Obesity – Causes and Symptoms : A condition known as obesity involves having too much body fat. Obesity is more than simply a visual issue. It is a medical condition that raises the chance of several illnesses and conditions, including heart disease, diabetes, high blood pressure, and some malignancies.
Obesity is a complex disease involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.
There are many reasons why some people have difficulty avoiding obesity. Usually, obesity results from a combination of inherited factors, combined with the environment and personal diet and exercise choices.
It's important to recognize that obesity is a complex disease with many contributing factors, and there is no one-size-fits-all solution. It's essential to work with a healthcare professional to develop a personalized plan for managing and treating obesity.
The global prevalence of overweight and obesity as a public health concern is well established and reflects the overall lack of success in our ability to achieve and maintain healthy body weight. Being overweight and obese is associated with numerous comorbidities and is a risk factor for several of the leading causes of death, including cardiovascular disease, diabetes mellitus, and many types of cancer.
The foundation of treatment has been diet and exercise.
Overweight And Obesity : Proven Health Risks, We All Should KnowSanjiv Haribhakti
Overweight and obesity are defined as abnormal or excessive fat accumulation in the body that presents a risk to health. Obesity will have a negative effect on health, leading to reduced life expectancy and/or increased health problems. According to WHO, Obesity is one of the most serious public health problems of the 21st century. For more info visit :- http://gisurgery.info/player_presentation.php?id=133
Clinical Research Challenges and Best Practices in Pediatric Research in Canada - Dr. Al Wahab - 2015
Dr. Zeina AlWahab, M.D.
Prof. Peivand Pirouzi, Ph.D., M.B.A.
Protein malnutrition, also referred to as protein deficiency, is a condition that occurs when an individual's diet lacks an adequate amount of protein, leading to various negative health consequences. This form of malnutrition can manifest in different ways, with two distinct clinical presentations known as kwashiorkor and marasmus.
Kwashiorkor is a severe form of protein malnutrition often seen in children. It occurs when there is a deficiency of high-quality protein in the diet, despite an adequate caloric intake. The lack of protein results in a disruption of important physiological processes, leading to various symptoms and complications. Common signs of kwashiorkor include edema, which is the accumulation of fluid in tissues, particularly in the legs, feet, and face. Additionally, individuals with kwashiorkor may experience muscle wasting, growth stunting, and impaired immune function. Other symptoms can include thinning hair, brittle nails, poor wound healing, fatigue, and anemia.
Marasmus, on the other hand, is a form of protein-energy malnutrition that occurs when there is a severe deficiency in overall calorie intake, including both protein and energy. Unlike kwashiorkor, individuals with marasmus experience significant weight loss and muscle wasting. The body enters a state of extreme catabolism, breaking down muscle tissue to meet energy needs. The characteristic appearance of marasmus includes a "skin and bones" appearance, with prominent ribs, thin limbs, and a lack of subcutaneous fat.
Protein is essential for the growth, development, and maintenance of various body tissues, including muscles, organs, and the immune system. It plays a crucial role in the synthesis of enzymes, hormones, and antibodies, and is involved in numerous biochemical processes. Inadequate protein intake deprives the body of these vital functions, leading to the manifestations seen in protein malnutrition.
Protein malnutrition is often associated with poor dietary diversity, limited access to quality protein sources, and socio-economic factors such as poverty, famine, and humanitarian crises. Vulnerable populations, such as children and the elderly, are particularly at risk. In children, inadequate protein intake during critical growth periods can result in long-term consequences, affecting physical and cognitive development.
Diagnosis of protein malnutrition involves a comprehensive assessment of dietary history, physical examination, and sometimes laboratory tests. Medical professionals evaluate the presence of characteristic signs and symptoms, such as edema or muscle wasting, to determine the severity and type of malnutrition. Blood tests may reveal abnormal levels of proteins and other nutrients, further aiding in diagnosis and treatment planning.
The treatment of protein malnutrition involves nutritional rehabilitation, addressing both the underlying protein deficiency and overall energy intake.
Relapse – in a broader sense, is the return of signs and symptoms of a disease after a remission.
In the case of some psychiatric disorders, relapse is the worsening of symptoms or the re-occurrence of unhealthy behaviors, such as avoidance or substance use, after a period of improvement.
Relapse Prevention – A set of skills designed to reduce the likelihood that symptoms of the illness in question will worsen or that a person will return to an unhealthy behavior, such as substance use.
Skills include, for example, identifying early warning signs that symptoms may be worsening, recognizing high risk situations for relapse, and understanding how everyday, seemingly mundane decisions may put you on the road to relapse (for example, skipping lunch one day may make you more vulnerable to get in a bad mood).
Relapse can be prevented through the use of specific coping strategies, such as identifying early warning signs.
Early Intervention is simply bridging the gap between prevention and treatment. Early intervention is essential to reducing drug use and its costs to society
Medication-induced movement disorder (Extra-Pyramidal Side Effects, EPSE) occurs due to treatment with antipsychotic medications. It can also be defined as physical symptoms, including tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, and bradyphrenia, that are primarily associated with improper dosing of or unusual reactions to neuroleptic (antipsychotic) medications.
Though they are commonly caused by the typical antipsychotics, but can also be caused by the atypical.
The adverse consequences of these syndromes can be minimized by vigilant clinicians who systematically examine patients at risk for these disorders and who manage them properly when discovered.
The best management is, of course, prevention, which starts with the judicious prescription of neuroleptics, and an awareness of the potential for certain nonpsychiatric medications to cause the same movement disorders.
The gall bladder is located in the junction of the right ninth costal cartilage and lateral border of the rectus abdominis.
It is a pear shaped sac lying on the inferior surface of the liver in a fossa between the right and quadrate lobes with a capacity of about 30 to 50 mL.
Impulse-control disorders (ICDs) are psychological disorders characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or others.
The individual fails to resist performing a potentially harmful act and it is usually accompanied by a sense of tension or arousal before committing the act and a sense of relief or pleasure when it is committed.
The hallmark in describing any of the ICDs is a tendency to gratify an immediate desire or impulse regardless of the consequences to one's self or to others.
Personality disorder, as defined in the Diagnostic and Statistical Manual of the American Psychiatric Association, Fourth Edition, Text Revision (DSM-IV-TR), is an enduring pattern of inner experience and behavior that differs markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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NEUROPSYCHIATRIC & PSYCHOLOGICAL ASPECTS OF OBESITY
1. NEUROPSYCHIATRIC &
PSYCHOLOGICAL ASPECTS OF
OBESITY
Windsor University School of
Medicine
Psychiatry Rotation
Consultant Psychiatrist – Dr. Sharon Halliday
Presentation by:
OLADAPO SAMSON OLUWABUKOLA
30TH JULY, 2012
2. Overview
In today's society, leanness is often
equated with
beauty, success, fitness, and self-control.
Obesity, on the other hand, is
considered as undesirable as leanness
is desirable, for reasons that are often
more related to cosmetic concerns than
to actual or potential medical
complications.
3. Definition of terms
Obesity – is simply, excess body fat; consequences depend
not only on the absolute amount but also on the distribution
of the fat. Complications include cardiovascular
disorders, diabetes mellitus, many
cancers, cholelithasis, fatty liver and
cirrhosis, osteoarthritis, reproductive disorders in men and
women, psychological disorders, and premature death.
Diagnosis is based on Body Mass Index (BMI) – calculated
from height and weight; and waist circumference. BP, fasting
plasma glucose, lipid levels should be measured. Treatment
includes physical activity, dietary and behavioral
modification, and sometimes drug or surgery.
5. Relevant Anatomy
The adipocyte, which is the cellular basis for obesity, is increasingly found
to be a complex and metabolically active cell. At present, the adipocyte is
being perceived as an endocrine gland with several peptides and
metabolites that may be relevant to the control of body weight, and these
are being studied intensively.
The ongoing flurry of investigation into the intricacies of adipocyte
metabolism has not only improved our understanding of the pathogenesis of
obesity but has also offered several potential targets for therapy.
Among the products of the adipocyte involved in complex intermediary
metabolism are cytokines, tumor necrosis factor-alpha (TNF-
α), interleukin 6, lipotransin, monocyte chemo-attracting protein-1 (MCP-
1), plasminogen activator inhibitor-1 (PAI-1), adipocyte lipid-binding
protein, acyl-stimulation
protein, prostaglandins, adipsin, perilipins, lactate, leptin, adiponectin, mon
obutyrin, and phospholipid transfer protein.
6. Relevant Anatomy
Among critical enzymes involved in adipocyte metabolism are
endothelial-derived lipoprotein lipase (lipid storage), hormone-sensitive
lipase (lipid elaboration and release from adipocyte depots), acyl-
coenzyme A (acyl-CoA) synthetases (fatty acid synthesis), and a cascade
of enzymes (beta-oxidation and fatty acid metabolism).
Another area of active research is investigation of the cues for the
differentiation of preadipocytes to adipocytes. With the recognition that
this process occurs in white and brown adipose tissue, even in adults, its
potential role in the development of obesity and the relapse to obesity
after weight loss has become more important than before.
7. Incidence
The prevalence of obesity worldwide is increasing, particularly in
the industrialized nations of the Northern hemisphere, such as
the United States, Canada, and most countries of Europe.
Available data from the Multinational Monitoring of Trends and
Determinants in Cardiovascular Disease (MONICA) project
suggest that at least 15% of men and 22% of women in Europe
are obese.
Prevalence of obesity in the US is high and is
increasing, particularly among children and adolescents.
Prevalence is more than twice as high at age 55 as at age 20.
Obesity is twice common among women in a lower
socioeconomic group as among those in a higher group.
8. Incidence
Prevalence among black and white men does not differ
significantly, but it is higher among black women than white
women.
More than 50% of black women greater than 40 years are obese;
greater than 80% are overweight
In the US, obesity and its complications cause as many as 300,000
premature deaths each year, making it second only to cigarette
smoking as a preventable cause of death.
Within societies where food is scarce, obesity is more prevalent in
the wealthier groups. However, in areas of relative affluence and/or
westernized lifestyles, obesity is more prevalent in the lower socio-
economic classes; this social gradient is particularly strong in the
case of female obesity.
9. Risk factors
Obesity occurs basically as a result of metabolic (energy) imbalance that
is, when you eat and drink more calories than you burn through exercise
and normal daily activities. Your body stores these extra calories as fat.
Obesity usually results from a combination of causes and contributing
factors, including:
Genetics. Your genes may affect the amount of body fat you store and
where that fat is distributed. Genetics may also play a role in how
efficiently your body converts food into energy and how your body burns
calories during exercise. Even when someone has a genetic
predisposition, environmental factors ultimately make you gain more
weight.
Inactivity/sedentary lifestyle. If you're not very active, you don't
burn as many calories. With a sedentary lifestyle, you can easily take in
more calories every day than you burn off through exercise and normal
daily activities.
10. Risk factors
Familial predisposition. Obesity tends to run in families. That's not just
because of genetics. Family members tend to have similar eating, lifestyle
and activity habits. If one or both of your parents are obese, your risk of
being obese is increased.
Quitting smoking. Quitting smoking is often associated with weight
gain. And for some, it can lead to a weight gain of as much as several
pounds a week for several months, which can result in obesity. In the long
run, however, quitting smoking is still a greater benefit to your health
than continuing to smoke.
Pregnancy. During pregnancy a woman's weight necessarily increases.
Some women find this weight difficult to lose after the baby is born. This
weight gain may contribute to the development of obesity in women.
11. Risk factors
Unhealthy diet and eating habits. Having a diet that's high in
calories, eating fast food, skipping breakfast, consuming high-calorie drinks
and eating oversized portions all contribute to weight gain.
Social and economic issues. Certain social and economic issues may be
linked to obesity. You may not have safe areas to exercise, you may not have
been taught healthy ways of cooking, or you may not have money to buy
healthier foods. In addition, the people you spend time with may influence
your weight — you're more likely to become obese if you have obese
friends or relatives.
Medical problems. Obesity can rarely be traced to a medical cause, such
as Prader-Willi syndrome, Cushing's syndrome, polycystic ovary
syndrome, and other diseases and conditions. Some medical problems, such
as arthritis, can lead to decreased activity, which may result in weight gain.
A low metabolism is unlikely to cause obesity, as is having low thyroid
function.
12. Risk factors
Certain medications. Some medications can lead to weight gain if you
don't compensate through diet or activity. These medications include some
antidepressants, anti-seizure medications, diabetes
medications, antipsychotic medications, steroids and beta blockers.
Age. Obesity can occur at any age, even in young children. But as you
age, hormonal changes and a less active lifestyle increase your risk of
obesity. In addition, the amount of muscle in your body tends to decrease
with age. This lower muscle mass leads to a decrease in metabolism. These
changes also reduce calorie needs and can make it harder to keep off excess
weight. If you don't control what you eat as you age, you'll likely gain
weight.
Lack of sleep. Not getting enough sleep at night can cause changes in
hormones that increase your appetite. You may also crave foods high in
calories and carbohydrates, which can contribute to weight gain.
13. Etiology
Almost all cases of obesity result from a combination of
genetic predisposition and a chronic imbalance between
energy intake, energy utilization for basic metabolic
processes, and energy expenditure from physical activity.
The etiology of obesity is far more complex than the simple
paradigm of an imbalance between energy intake and energy
output. Although this concept allows easy conceptualization of
the various mechanisms involved in the development of
obesity, obesity is far more than simply the result of too much
eating and/or too little exercise.
14. Etiology – Biological
Genetic factor – heritability of BMI is about 66%. Genetic
factors may affect the many signaling molecules and receptors used
by parts of the hypothalamus and GI tract to regulate food intake .
Rarely, obesity results from abnormal levels of peptides that
regulate food intake (e.g. leptin) or abnormalities in their
receptors (e.g. melanocortin-4 receptor)
Genetic factors also regulate energy expenditure, including
BMR, diet-induced thermogenesis, and non-voluntary activity-
associated thermogenesis. Genetic factors may have a greater effect
on the distribution of body fat, particularly abdominal fat than on
the amount of body fat.
15. Etiology – Biological
Certain medications. Some medications can lead to weight gain
if you don't compensate through diet or activity. These medications
include some antidepressants, anti-seizure medications, diabetes
medications, antipsychotic medications, steroids and beta
blockers.
Medical problems. Obesity can rarely be traced to a medical
cause, such as Prader-Willi syndrome, Cushing's
syndrome, polycystic ovary syndrome, and other diseases and
conditions. Some medical problems, such as arthritis, can lead to
decreased activity, which may result in weight gain. A low
metabolism is unlikely to cause obesity, as is having low thyroid
function.
16. Etiology – Psychological
At least 2 pathologic eating patterns may be associated with obesity
Binge eating disorder is consumption of large amounts of food quickly
with a subjective sense of loss of control during the binge and distress after
it. This disorder does not include compensatory behaviors, such as vomiting.
Prevalence is 1 to 3% among both sexes and 10-20% among people entering
weight reduction programs. Obesity is usually severe, large amounts of
weight are frequently gained or lost, and pronounced psychologic
disturbances are present.
Night-eating syndrome consists of morning anorexia, evening
hyperphagia, and insomnia. At least 25-50% of daily intake occurs after the
evening meal. About 10% of people seeking treatment for severe obesity may
have this disorder. Rarely, a similar disorder is induced by use of a hypnotic
such as zolpidem.
Eating Disorders Not Otherwise Specified (EDNOS), probably
contribute to excess weight gain in more people. For example nocturnal
eating contributes to excess weight gain in may people who do not have
night-eating syndrome.
17. Etiology – Social
Social factors in Etiology include:
Level of activity
Behaviour
Race, sex, and age factors
Ethnic and cultural factors
Socioeconomic status
Dietary habits
Smoking cessation
19. Pathways regulating food intake
Preabsorptive and postabsorptive signals from the GI tract and changes in
plasma nutrient levels provide short-term feedback to regulate food intake:
GI hormones (eg, glucagon-like peptide 1 [GLP-1], cholecystokinin [CCK])
reduce food intake.
Ghrelin, secreted primarily by the stomach, increases food intake.
Leptin, secreted from adipose tissue, informs the brain as to how much fat is
stored; high leptin levels correlate with increased body fat.
The hypothalamus integrates various signals involved in the regulation of
energy balance and then activates pathways that increase or decrease food
intake:
Neuropeptide Y (NPY), agouti-related peptide (ARP), α-melanocyte-
stimulating hormone (α-MSH), cocaine- and amphetamine-related transcript
(CART), orexin, and melanin-concentrating hormone (MCH) increase food
intake.
Corticotropic hormone (CRH) and urocortin decrease it.
21. Pathophysiology
Obesity is an exaggeration of normal adiposity and is a central
player in the pathophysiology of diabetes mellitus, insulin
resistance, dyslipidemia, hypertension, and atherosclerosis, largely
due to its secretion of excessive adipokines.
Obesity is a major contributor to the metabolic dysfunction
involving lipid and glucose, but on a broader scale, it influences
organ dysfunction involving
cardiac, liver, intestinal, pulmonary, endocrine, and reproductive
functions.
Inflammatory, insulin-resistant, hypertensive, and thrombotic-
promoting adipokines, which are atherogenic, are counterbalanced
by anti-inflammatory and anti-atherogenic adipocyte hormones
such as adiponectin, visfatin, and acylation-stimulating
protein, whereas certain actions of leptin and resistin are pro-
atherogenic.
22. Pathophysiology
The changes in adipocyte activity can be considered genetic and/or
environmental. Overeating or experimental obesity studies have found
that most of these changes can be included with deliberate overeating to
achieve excess body fat.
Although leptin increases in overweight and obesity, it appears to
decrease function. For, example, the hypothalamus becomes resistance
to leptin. Thus, the signal for satiety is not recognized; neither are the
signals for other endocrine functions which affect the
Hypothalamic-pituitary-adrenal axis
Hypothalamic-pituitary-thyroid axis
Hypothalamic-pituitary- gonadal axis
The leptin resistance may be found more in the central nervous
system than in the peripheral organs (pancreas, liver & muscle).
23. Clinical Features
Most patients recognize their own problems, although often they are
unaware of the main foods that cause obesity. Many symptoms are related
to psychological problems or social pressure, such as the woman who
cannot find fashionable clothes to wear.
In most patients, the presentation of obesity is straightforward, with the
patient indicating problems with weight or repeated failure in achieving
sustained weight loss. In other cases, however, the subject may present
with complications and/or associations of obesity.
When asking a patient about his or her history, investigate whether the
rest of the patient's family has weight problems, inquire about the
patient's expectations, and estimate the patient's level of motivation.
Also, determine if any of the comorbidities related to obesity, including
the following have occurred:
24. Clinical Features
Respiratory - Obstructive sleep apnea, greater predisposition to
respiratory infections, increased incidence of bronchial asthma, and
Pickwickian syndrome (obesity hypoventilation syndrome)
Malignant - Association with
endometrial, prostate, colon, breast, gall bladder, and, possibly, lung
cancer
Psychologic - Social stigmatization and depression
Cardiovascular - Coronary artery disease, essential hypertension, left
ventricular hypertrophy, cor pulmonale, obesity-associated
cardiomyopathy, accelerated atherosclerosis, and pulmonary
hypertension of obesity
Central nervous system (CNS) - Stroke, idiopathic intracranial
hypertension, and meralgia paresthetica
25. Clinical Features
Obstetric and perinatal - Pregnancy-related hypertension, fetal
macrosomia, and pelvic dystocia
Surgical - Increased surgical risk and postoperative
complications, including wound infection, postoperative
pneumonia, deep venous thrombosis, and pulmonary embolism
Pelvic - Stress incontinence
Gastrointestinal (GI) - Gall bladder disease
(cholecystitis, cholelithiasis), nonalcoholic steatohepatitis
(NASH), fatty liver infiltration, and reflux esophagitis
Orthopedic - Osteoarthritis, coxa vera, slipped capital femoral
epiphyses, Blount disease and Legg-Calvé-Perthes disease, and chronic
lumbago
26. Clinical Features
Metabolic -Type 2 diabetes mellitus, insulin
resistance, hyperinsulinemia, and dyslipidemia (characterized by high
total cholesterol, high triglycerides, low high-density
lipoprotein, normal or elevated low-density lipoprotein)
Reproductive - Anovulation, early
puberty, infertility, hyperandrogenism and polycystic ovaries (in
women), and hypogonadotropic hypogonadism (in men)
Cutaneous - Intertrigo (bacterial and/or fungal), acanthosis
nigricans, hirsutism, and increased risk for cellulitis and carbuncles
Extremity - Venous varicosities, lower extremity venous and/or
lymphatic edema
Miscellaneous - Reduced mobility and difficulty maintaining
personal hygiene
28. Differential diagnosis – Psychiatric
Primary Depression (Depression not secondary to Obesity)
Fatigue
29. Investigations
Full lipid panel
At minimum, test fasting cholesterol, triglycerides, and high-density
lipoprotein cholesterol (HDL-C) levels. These levels may be normal, or
the typical dyslipidemia associated with cardiometabolic syndrome may
be found. This dyslipidemia is characterized by reduced HDL-C and
elevated fasting triglyceride concentrations; however, increased low-
density lipoprotein cholesterol (LDL-C) and normal to marginally
increased total cholesterol are not uncommon among obese
individuals.
Hepatic panel
This test is expected to yield normal results, but findings may be
abnormal (eg, elevated transaminase levels in the setting of NASH or
fatty infiltration of the liver).
30. Investigations
Thyroid function tests
The results are typically normal, but checking them to detect primary
hypothyroidism (characterized by increased serum thyrotropin and
normal or reduced levothyroxine and/or triiodothyronine levels) is
worthwhile.
Screening with a serum thyrotropin level is usually sufficient. Of
importance, hypothyroidism itself rarely causes more than mild
obesity.
24-Hour urinary free-cortisol test
This test, used for screening purposes, is needed only when Cushing
syndrome or other hypercortisolemic states are clinically suspected.
Approximately 4% of patients with Cushing syndrome have normal
urinary free-cortisol values.
31. Investigations
Fasting glucose and insulin test
Obesity is associated with insulin resistance and increased fasting
insulin and c-peptide serum levels; however, insulin levels are normal
in many persons who are obese. In persons with impaired fasting
glucose, the fasting plasma glucose level is higher than 100 mg/dL.
Histological findings
Hypertrophic obesity characterized by enlarged fat cells is typical of
android abdominal obesity. Hypercellular obesity is more variable than
hypertrophic obesity. Hypercellular obesity is typical of obesity with an
onset in childhood or adolescence, but it is also invariably found in
subjects with severe obesity.
32. Investigations
Evaluation of degree of fat
Among the various procedures relevant to the treatment of patients
who are obese are those to estimate percent body fat and the degree of
visceral and subcutaneous fat. Procedures used for measuring total
body fat include the BMI, caliper-derived measurements of skin-fold
thickness, dual-energy X-ray absorptiometry (DEXA), bioelectrical
impedance analysis, ultrasonography to determine fat thickness, and
underwater weighing. The criterion standard techniques for measuring
visceral fat are MRI and CT scanning. Cheaper techniques for direct
measurement of visceral fat include abdominal ultrasonography and
abdominal bioelectrical impedance.
33. Diagnosis
Diagnostic criteria include:
BMI
Body Fat percentage
Waist circumference
Sometimes body composition analysis
34. Body Mass Index (BMI)
In adults, BMI, defined as weight (kg) divided by the square of the
height (m2), is used to screen for overweight or obesity. BMI of 25
to 29.9 kg/m2 indicates overweight; BMI ≥ 30 kg/m2 indicates
obesity
35. Body Mass Index (BMI)
BMI (kgm-2) Definition
<18.5 Underweight
18.5-24.9 Ideal Weight
25-29.9 Overweight
30-39.9 Obese
40-49.9 or 35-49.9 with Morbidly Obese
obesity-related
comorbidity
50-59.9 Super Obese
60-69.9 Super Super Obese
>70 Hyper Obese
36. Body Mass Index (BMI)
Limitations of BMI
Not a direct measure of adiposity
No account of fat distribution
No account of duration of obesity
Inaccurate at extremes of height
Inaccurate with extremes of lean body mass (e.g.
athletes, elderly)
Waist or collar circumference more predictive of cardio-
respiratory co-morbidity
37. Body Fat Percentage
The body fat percentage can be indirectly estimated by using the
Deurenberg equation, as follows:
Body fat percentage = 1.2(BMI) + 0.23(age) - 10.8(sex) -
5.4, with age being in years and sex being designated as 1 for males
and 0 for females. This equation has a standard error of 4% and
accounts for approximately 80% of the variation in body fat.
For men, a percentage of body fat greater than 25% defines
obesity, with 21-25% being borderline. For women, over 33%
defines obesity, with 31-33% being borderline.
38. Waist circumference
The waist circumference that increases risk of complications due to
obesity varies by ethnic group and sex:
White men: > 93 cm (> 36.6 in), particularly > 101 cm (> 39.8 in)
White women: > 79 cm (> 31.1 in), particularly > 87 cm (> 34.2 in)
Asian Indian men: > 78 cm (> 30.7 in), particularly > 90 cm (> 35.4 in)
Asian Indian women: > 72 cm (> 28.3 in), particularly > 80 cm (> 31.5 in)
39. Body Composition Analysis
Body composition—the percentage of body fat and muscle—is also
considered when obesity is diagnosed. Although probably
unnecessary in routine clinical practice, body composition analysis
can be helpful if clinicians question whether elevated BMI is due to
muscle or excessive fat.
The percentage of body fat can be estimated by measuring skin-fold
thickness (usually over the triceps) or determining mid upper arm
area.
Other indices used to estimate the degree and distribution of
obesity include the 4 standard skin thicknesses
(ie, subscapular, triceps, biceps, suprailiac) and various
anthropometric measures, of which waist and hip circumferences
are the most important.
40. Body Composition Analysis
Android
Central distribution
High intra-peritoneal fat
content
Increased neck
circumference
Waist-hip ratio >0.8
women, >1.0 men
Increased morbidity
(airway, CVS, metabolic, su
rgical)
Gynaecoid
Peripheral sites
(arms, legs, buttocks)
41. Complications of Obesity
Complications of obesity include the following:
Metabolic syndrome
Diabetes mellitus
Cardiovascular disease
Nonalcoholic steatohepatitis (fatty liver)
Gallbladder disease
Gastroesophageal reflux
Obstructive sleep apnea
Reproductive system disorders
Many cancers
Osteoarthritis
Social and psychologic problems
43. Nutrition Management
Nutrition: A normal eating pattern is important. People who miss breakfast tend to
passively consume too many calories later in the day. Patients should eat small meals and
avoid or carefully choose snacks. Low-fat (particularly very low saturated fat), high-
fiber diets with modest calorie restriction (by 600 kcal/day) and substitution of some
protein for carbohydrate appear to have the best long-term outcome. Fresh fruits and
vegetables and salads should be substituted for refined carbohydrates and processed
food, and water for soft drinks or juices. Alcohol consumption should be limited to
moderate levels. Foods with a low glycemic index and marine fish oils or
monounsaturated fats derived from plants (e.g., olive oil) reduce the risk of
cardiovascular disorders and diabetes. Low-fat dairy products are also part of a healthy
diet. Patients need an adequate amount of vitamin D, preferably obtained by exercising
outdoors in the sunshine.
Use of meal replacements has proven efficacy; use can be ongoing or intermittent.
Diets that require unusual eating habits should be avoided. They are unlikely to be
maintained, and weight increases when patients resume previous poor eating habits.
Diets of < 1200 kcal/day cannot be sustained, but such diets are sometimes needed to
achieve rapid short-term weight loss (eg, to prepare for surgery, to lessen obstructive
sleep apnea). Diets of < 800 kcal/day do not produce greater weight loss and are less
well tolerated.
44. Physical activity
Exercise increases energy expenditure, BMR, and diet-induced
thermogenesis. Exercise also seems to regulate appetite to more closely
match caloric needs. Other benefits include
Increased insulin sensitivity
Improved lipid profile
Lower BP
Better aerobic fitness
Improved psychologic well-being
Strengthening (resistance) exercises increase muscle mass. Because muscle
tissue burns more calories at rest than does fat tissue, increasing muscle
mass produces lasting increases in BMR. Exercise that is interesting and
enjoyable is more likely to be sustained. A combination of aerobic and
resistance exercise is better than either alone.
45. Behavioral Therapy
Behavioral therapy aims to improve eating habits and physical activity
level. Rigid dieting is discouraged in favor of healthy eating. Common-
sense measures include the following:
Avoiding high-calorie snacks
Choosing healthful foods when dining out
Eating slowly
Substituting a physically active hobby for a passive one
Social support, cognitive therapy, and stress management may
help, particularly during the lapses usually experienced during
any long-term weight loss program. Self-monitoring is
useful, and maintenance of a diet diary is particularly effective.
46. Biological Therapy
Drugs may be used if BMI is > 30 or if BMI is > 27 and patients have
complications (eg, hypertension, insulin resistance). Most weight loss
due to drug treatment is modest (5 to 10%) at best and occurs during
the first 6 mo; not all patients benefit. Drugs are more useful for
maintaining weight loss but must be continued indefinitely for
weight loss to be maintained. Premenopausal women taking
systemically acting drugs for weight control should use contraception.
Sibutramine – is a centrally acting appetite suppressant that produces
dose-related weight loss. The usual starting dose is 10 mg po once/day;
the dose can be decreased to 5 mg or increased to 15 mg. Common
adverse effects are headache, dry mouth, insomnia, and constipation; the
most common serious one is hypertension. Cardiovascular
disorders, particularly poorly controlled hypertension, are
contraindications.
47. Biological Therapy
Orlistat – inhibits intestinal lipase, decreasing fat absorption and improving
blood glucose and lipids. Because orlistat is not absorbed, systemic effects
are rare. Flatus, oily stools, and diarrhea are common but tend to resolve
during the 2nd yr of treatment. A dose of 120 mg po tid should be taken
with meals that include fat. A vitamin supplement should be taken at least 2
h before or after taking orlistat. Malabsorption and cholestasis are
contraindications; irritable bowel syndrome and other GI disorders may
make orlistat difficult to tolerate. Orlistat is available Over-the-
counter, OTC.
Other OTC weight-loss drugs are not recommended. Some
(eg, caffeine, ephedrine, guarana, phenylpropanolamine) may be marginally
effective, but their adverse effects outweigh their advantages. Others
(eg, brindleberry, l-carnitine, chitosan, pectin, grapeseed extract, horse
chestnut, chromium picolinate, fucus vesiculosus, ginkgo biloba) have not
been shown to be effective and may have adverse effects.
48. Bariatric surgery
Bariatric surgery is the surgical alteration of the
stomach, intestine, or both to cause weight loss.
This is the most definitive and effective treatment for the
morbidly obese patient.
49. Prevention
Regular physical activity and healthy eating improve general
fitness, can control weight, and help prevent obesity and
diabetes mellitus. Even without weight loss, exercise decreases
the risk of cardiovascular disorders. Dietary fiber decreases the
risk of colon cancer and cardiovascular disorders. Sufficient
and good-quality sleep, management of stress, and moderation
of alcohol intake are also important.
50. Prognosis
Untreated, obesity tends to progress. The probability and
severity of complications are proportional to the absolute
amount of fat, the distribution of the fat, and absolute muscle
mass. After weight loss, most people return to their
pretreatment weight within 5 yr, and accordingly, obesity
requires a lifelong management program similar to that for any
other chronic disorder.
53. Introduction
When considering psychological aspects of obesity, it is
currently believed that most psychological disturbances are
more likely to be consequences rather than causes of obesity.
It is clear that there are some well-defined psychiatric
conditions that can be considered causal, e.g. binge-eating
disorder. However, the traditional view that obesity is a
psychopathology manifested as overeating has now been
largely replaced with the idea that genetic predisposition is to
a large extent driving the overconsumption.
54. Relationship
With Spouse?
Childhood?
Mood?
Job?
Education?
Interpersonal
Relationship
Relationship?
with Mother?
Friends?
55. Psychological issues
Studies have shown that, on the average, an obese individual will
have issues concerning the following:
Poor childhood interaction
Education
Job
Interpersonal relationship
Mood swings
Friends
Relationship with mother
Relationship with spouse
56. Psychological issues
One of the most compelling illustrations of the psychological
implications of obesity (14), was based on interviews of morbidly
obese subjects after they had lost weight by surgical means. Their
results were dramatic. Most patients reported that they would
prefer to be normal weight with a major handicap
(deaf, dyslexic, diabetic, legally blind) than to be obese again. In
contrast, research on other handicaps has indicated a strong
tendency for people to evaluate their own handicap as less
disabling than other handicaps, e.g. blind individuals would often
prefer to be blind, etc. Thus obesity, as perceived by obese
individuals themselves, is an extremely serious handicap, although
it is not generally recognized as such.
57. Present cultural disposition of the body
Lean, thin body
Self-discipline, achievement of
cultural ideal
Fat, chubby body
Ultimate failure publicly displayed
for all to see and judge
58. Social Discrimination
Though might seems unremarkable, comparing the obese general population
with the prevalence of discrimination, but when compared with other forms of
discrimination, such as race and age, it becomes thoughtful.
Reported experiences of weight discrimination among adults = 12%
(Andreyeva, Puhl, & Brownell, 2008)
It is the 4th most prevalent form of discrimination
Rates similar to race (11%) & age (14%) discrimination
Rates are higher among obese women as compared to men
Weight discrimination in the workplace is often largely ignored, but it’s a serious
issue and one that’s been in the news recently after a Texas hospital said it would
require new employees to have a body mass index of less than 35. (That’s about
245 lb. for a man of 5 ft. 10 in., and 195 lb. for a 5-ft. 2-in. woman.)
Read more: http://moneyland.time.com/2012/05/02/why-being-
overweight-could-earn-you-a-lower-salary/#ixzz21vhbi6HU
59. Weight Bias
Negative attitudes affecting
interactions
Stereotypes leading to:
Stigma
Rejection
Prejudice
Discrimination
Verbal, physical and relational
forms
Subtle and overt expressions
60. Dieting relationship trap
Because of social as well as medical pressures to be thin, obese patients turn to
health professionals for support and advice about losing weight. However, they may
encounter what has been termed "dieting relationship trap" with negative
undercurrents.This situation has been described by Garrow as follows:
"The patient is initially pleased to find a doctor or dietician who is willing and able
to help with sensible dietary advice.. Both parties may underestimate the time it
will take to achieve adequate weight loss, and the difficulty of sustaining dietary
compliance over a period of many months … Inevitably the time comes when the
patient returns having not lost weight …Obese patients usually suffer from low
self-esteem ... When they perceive that they have failed, they are precipitated into
an agony of self-reproach ... and virtually invite the health carer to discharge them
… The correct response is to identify factors which precipitated the problem, to
provide encouragement, not criticism. The wrong response is to fix the blame for
failure on the patient ... On the other hand..there is little to be gained from
monthly meetings at which ... the difficulty of dieting is agreed ... but nothing is
done to increase the chance of success next time."
61. Social Realities of Weight Bias
Overweight people are one of the last socially acceptable
targets for bias and discrimination (Puhl & Brownell, 2001)
WHY?
Body as controllable, malleable
Attributions
Perceived social consensus
62. Body as Controllable and Malleable
Weight loss strengthens weight control
beliefs among participants (Blaine, DiBlasi, &
Connor, 2002)
63. Attributions
Internal and Controllable
Lack willpower
Lack motivation
Lazy
Don’t care
―Ideology of blame‖ (Crandall, 1994)
Deserve psychological, social, and
physical consequences
The perception of obesity as a condition
that one brings on oneself creates little
sympathy towards the obese.
64. Perceived Social Consensus
Perceptions of other people’s
stereotypical beliefs
(Puhl, Schwartz, &
Brownell, 2005), leading to:
Stigma
Rejection
Discrimination
Prejudice
65. Psychoanalytic Thought of the obese
Oral-stage fixation
Survey found psychoanalysts commonly linked weight gain in
obese patients to:
Disappointment in love relationships
Fear of competition
Fear of heterosexuality
Inability to deal with negative affect
Feelings of being unloved/un-loveable
67. Introduction
Researchers have used more traditional psychometric instruments for
assessment of mental health and psychological functioning in obese
individuals and compared them with healthy reference populations (17).
In this way, it was observed that severely obese Swedish men and
(particularly) women, scored markedly worse on a mental well-being
measure and had more anxiety and depressive symptoms.
Furthermore, the general mental state of obese subjects was poorer than
that of patients with rheumatoid arthritis, intermittent
claudication, cancer survivors with no recurrence and spinal cord-
injured persons several years after injury. Anxiety and depressive
symptoms showed similar patterns in comparisons with chronically
diseased and injured patients.
68. Introduction
Neuropsychiatric co-morbidities associated with obesity include:
Macular degeneration
Alzheimer's disease
Depression or Depressive illness.
Depression, Alzheimer’s disease and Macular Degeneration are
found in obese people. Several studies have shown that there is an
increased risk of depression, psychological and emotional
distress, poor coping abilities and low self-esteem. Women are
particularly affected. Obese adolescents who binge-eat are more
likely to have high levels of psychological distress.
69. Obesity and Depression
Depression
Depression is a mental condition characterized by loss of pleasure in enjoyable
activities, and states of pessimism and intense sadness. Depression is commonly
measured through an individual's response to surveys. Depressive symptoms are not
measured over a period of time but reflect the individual's feelings at that point in
time, leading to an inefficiency in this method of measurement. Studies that use
suicide to reflect depression are subject to bias due to the variety of conditions that
may lead to suicide, such as obesity, gender or circumstance.
Obesity
Obesity can be defined as an excess of body fat. It is commonly measured through the
Body Mass Index (BMI), which compares a person's weight and height. A BMI greater
than 30kg/m2 indicates obesity, while a BMI between 25-30kg/m2 signals
overweight. World obesity is increasing at an alarming rate, so much so that the
phrase ’obesity epidemic’ has become common. In Australia, the 1999-2000
Australian Diabetes Obesity and Lifestyle Study found that 60% of Australians over 25
years were overweight, and 21% of those were obese. Obesity leads to conditions
such as heart disease, stroke and diabetes, resulting in a lower life expectancy.
70. Obesity and Depression
By looking at both obesity and depression through an evolutionary
perspective both could be viewed as adverse effects of an evolutionary
response.
In the case of obesity as human beings are bodies evolved to survive in an
environment in which we led a very active lifestyle. Because of this the
human body functions best when it gets regular exercise. In today’s world
there is no longer a need to hunt or run from predators. This causes
humans to be far more sedentary which can lead to weight gain and in
many cases obesity (Eaton, B. S. 2002).
In the case of depression one theory is that depression helps human beings
un attach themselves from unreachable achievements. This could lead
humans to not take risks that could potentially harm them in some way
(Nesse, M. R. 2000).
There is a positive correlation between obesity and depression!
71. Obesity and Depression
Depression has been associated with obesity, but it has not yet been
proven that one causes the other. In fact, it is incredibly difficult to do so
because the relationship is complicated by other factors, such as
socioeconomic class and genetic make up.
To determine if depression leads to obesity or vice versa, large population
studies need to be carried out over a period of time.
Northern Finland recently published results of a study that followed a
1966 birth cohort to assess the chance of obesity and depression in young
adults (up to the age of 31 years). Results indicated that teenage obesity
increases the chance of suffering depression as a young adult.
Similarly, depression and obesity can occur at the same time in females in
adulthood and adolescence.
Abdominal obesity was found to be a strong predictor of depression.
72. Depression resulting in obesity?
Depression can result in dietary behaviors which may lead to
obesity. Binge eating or comfort eating may result from
depression, which is also associated with increased alcohol
unhealthy food consumption.
73. Obesity resulting in depression?
Poor diets, particularly ones low in folic acid, are associated
with depression. Social stigma associated with obesity may
lead to depression later in life, especially in young women.
This may be emphasized in social groups in which there are
lower rates of obesity.
74. Obesity, Depression and Race
African American women appear, on average, to be more
satisfied with their bodies, to have less desire to be thin, and to
have less fear of fat than do White women.
However, other data suggest that the association between
obesity and self-esteem is the same between these races.
75. References
http://www.clinicaladvances.com/article_pdfs/gh-article-200711-redinger.pdf
http://emedicine.medscape.com/article/123702-overview
Psychosocial aspects of obesity: Individual and societal perspectives By Lauren Lissner
The Pathophysiology of Obesity and Its Clinical Manifestations Richard N. Redinger, MD
http://www.usfsm.edu/academics/cas/capstone/2009-
2010/psychology/jaramillo%20-%20obesity%20and%20depression.pdf
http://www.virtualmedicalcentre.com/healthandlifestyle/obesity-and-
depression/111#C2
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.90.2.251
The Merck Manual, Professional Edition.