This document discusses obesity, including its definition, measurements, physiological regulation, etiology, complications, workup, and treatment options. It defines obesity as an unhealthy excess of body fat that enhances health risks. Body mass index (BMI) and waist circumference are common measures of obesity. Factors that can contribute to obesity include increased calorie intake, more sedentary lifestyles, medical conditions, and genetic factors. Treatment involves prevention, diet, exercise, medication, and sometimes surgery for severe obesity.

1. -Dr. AISHWARYA RAI
BPT, FELLOW IN REGENERA
REHABILITATION, CKTP.

2. Obesity is defined as an unhealthy excess of body fat which
enhances the risk of morbidity and untimely mortality.
It is accompanied by ;
Burden of chronic diseases,
Metabolic complications,
Worsening of quality of life.
It also,
Obesity exacerbates the age related decline in physical function,
and
Frailty & Disability.
INTRODUCTION

3. BMI (Body Mass Index):
weight(kg)/height Squared (m)
BMI <18.5 underweight
BMI 18.5- 24.9 Normal
BMI 25-29.9 Overweight (I)
BMI 30-39.9 Obesity (II)
BMI >40 Extreme obesity (III)
Waist circumference:
Men > 40 in; Women > 35 in
MEASUREMENT

4. Other approaches to quantify obesity
Anthropometry (skinfold thickness)
Densitometry (underwater weighing)
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Electrical impedance
Other indices
Lean mass index
Fat percentage

5. Body weight is
regulated by both
endocrine and
neural components.
Alterations in
stable weight by
forced overfeeding
or food deprivation
induce physiologic
changes that resist
these perturbations.
PHYSIOLOGICAL REGULATION
OF ENERGY BALANCE

7. AETIOLOGY

8. Increased caloric intake
▪Availability, price
▪ Extra 50 cal/day
(1 tsp sugar) = 2.25 kg/year = 25 kg over 10 years
More sedentary
▪ Television/Computer
▪ Emphasis on academics
ENVIRONMENTAL
FACTORS

9. Cushing’s syndrome
Hypothyroidism
Insulinoma
Craniopharyngioma and other disorders involving the
hypothalamus
Drug induced
MEDICAL FACTORS

10. COMPLICATIONS

13. Physical exam – Focus on possible complications.
Investigations:
Blood sugar, lipid profile, liver function tests
Other tests based on clinical features
TSH, Sleep studies
Dexamethasone suppression test for Cushing’s
syndrome*
WORK UP

14. Prevention
Diet
Increased physical activity
Behavior modification
Medicines
TREATMENT

15. The primary focus of diet therapy is to reduce overall calorie consumption
Very low energy diets (e.g., 400 to 600 kcal/d)
Low-calorie diets, >800 kcal/d
very low fat diets
very low carbohydrate “Atkins” style diets
Guidelines recommend initiating treatment with a calorie deficit of 500– 1000
kcal/d compared with the patient's habitual diet.
Low-carbohydrate, high-protein diets appear to be more effective in lowering
BMI;
improving coronary heart disease risk factors, including an increase in HDL
cholesterol and a decrease in triglyceride levels;
controlling satiety in the short term compared with low-fat diets
DIET

16. Increased energy expenditure is the most obvious
mechanism for an
effect of exercise
Exercise appears to be a valuable means to
sustain diet therapy
Valuable in the obese individual for its effects on
cardiovascular tone and blood pressure.
EXERCISE

17. Recommended if BMI >/= 27 with comorbidities or BMI >/= 30
Medications for obesity have traditionally fallen into two major
categories:
1. Appetite suppressants (anorexiants)
2. Gastrointestinal fat blockers
PHARMACOTHERAPY

18. Indications:
BMI > 35 with an associated comorbidity or a BMI > 40 (irrespective)
Repeated failures of other therapeutic approaches
Capability of tolerating surgery
Weight loss surgeries have traditionally been classified into 3 categories on the basis of
anatomic changes:
Restrictive
Restrictive-malabsorptive
Malabsorptive
SURGERY