This document provides an overview of obesity including its classification, causes, signs and symptoms, health risks, and treatment options. Some key points: - Obesity is classified based on BMI and is a metabolic disease that impairs health when excess body weight accumulates. - Risks of obesity include high blood pressure, diabetes, heart disease, and certain cancers. - Treatment involves lifestyle changes focused on diet and exercise as well as potential use of weight loss medications or bariatric surgery. - Post-surgery care involves following dietary guidelines and exercise recommendations to aid in continued weight management.

1. Prepared by: Roxanne Mae E. Birador S.N.

3. OVERVIEW
(American Society for Metabolic & Bariatric Surgery [ASMBS], 2012)
OBESITY is not merely a
condition; rather it is a
metabolic disease that
accumulates to the extent
that health is impaired.

4. According to the
World Health
Organization (WHO),
at least 2.8 million
adults die each year
as a result of being
overweight or obese.
overweight and
obese rank 5th
among the leading
risks for global
deaths

5. According to the former president of the Philippine Association for the
Study of Overweight and Obesity Inc.(PASOO)., October 2014.

6. OBESITY
"growing epidemic"
Dr. Rosa Allyn Sy
Endocrinologist
Philippine based on the study of the Food and Nutrition
Research Institute (FNRI) of the Department of Science and
Technology (DOST) in 2013.

7. CLASSIFICATION BMI RANGE HEALTH RISK
Overweight 25-30 Mild
Class I 30-35 Moderate
Class II 35-40 Severe
Class III >40 Very severe/ Morbid

9. Simple (Alimentary obesity)
Secondary obesity
Childhood obesity

11. Cushing Syndrome
Prader-Willi
Syndrome

13. Visceral Fat (abdominal obesity;
surrounding internal organs)
Subcutaneous Fat (limb obesity;
beneath the skin - about 80% of all
body fat)

14. Genetics
Lifestyle
Inactivity
Medical problems such as: Prader-Willi
syndrome, Cushing's syndrome
Certain medications such as:
antidepressants, anti-seizure medications,
antipsychotic medications
Quitting smoking
Lack of sleep

17. Signs of obesity include:
Clothes feeling tight and needing a larger size.
The scale showing that the person gained
weight.
Having extra fat around the waist.
A higher than normal body mass index and
waist circumference.

18. High blood pressure (hypertension)
High blood glucose (sugar) or diabetes
High blood cholesterol and triglycerides
(dyslipidemia or high blood fats).
Heart attacks due to coronary heart
disease, heart failure, and stroke.

19. Bone and joint problems - more weight
puts pressure on the bones and joints.
This can lead to osteoarthritis, a
disease that causes joint pain and
stiffness.
Stopping breathing during sleep (sleep
apnea). This can cause daytime fatigue
or sleepiness, poor attention, and
problems at work.

20. P = Pressure [ increased blood pressure]
H = HDL [ decreased good cholesterol]
A = Abdominal obesity
T = Triglycerides [elevated]
S = Sugars [insulin resistance]

21. Calculating BMI and measuring
waist circumference
Calculating Body Fat Percentage
using caliper
Blood tests

22. CALIPER

24. Bioelectric Impedance (BIA)

25. Underwater Weighing (DENSITOMETRY)

26. Air-Displacement Plethysmography

27. ACUPUNCTURE in combination with DIET RESTRICTIONS

28. Weight loss drugs (anti-obesity
drug)
ORLISTAT (Xenical)
reduces caloric intake by binding to
gastric and pancreatic lipase to
prevent digestion of fats.

29. • If a meal is missed or contains no fat, the dose of
orlistat should be omitted. Avoid high fat meals to
minimize adverse GI effects. Distribute fat calories
over three main meals daily.
• Take a daily multivitamin containing fat-soluble
vitamins at least 2 h before/after orlistat. It should
be taken at least two hours after an orlistat dose or
at bedtime.
• Orlistat should be used in conjunction with other
measures to manage obesity.

30. • Treatment should be continued beyond six months
only if at least 10% of body weight has been lost
since the start of treatment.
• Some of the weight loss in those taking orlistat
probably results from individuals reducing their fat
intake to avoid severe gastrointestinal effects.
• Vitamin supplementation (especially of vitamin D)
may be considered if there is concern about
deficiency of fat-soluble vitamins.

31. • On stopping orlistat there may be a gradual
reversal of weight loss.
• Severe obesity should be managed in an
appropriate setting by staff who have been
trained in the management of obesity.
• Monitoring should take place on a regular
basis.
• Continue treatment beyond 12 weeks only if
weight loss since start of treatment exceeds
5%.

32. Weight loss drugs (anti-obesity drug)
Sibutramine hydrochloride
(Meridia)
prevents the reuptake of serotonin
and norepinephrine

33. • Monitor weight changes carefully to
determine therapeutic effect.
• Lab tests: Periodic liver function, bilirubin,
alkaline phosphatases, lipid profile.
• Monitor BR and HR regularly; report
sustained increases in BP or HR
immediately.

34. • Monitor for and immediately report S&S of
serotonin syndrome.
• Monitor persons with narrow-angle glaucoma
closely for worsening intraocular pressure.
• Notify physician if any of the following
develop: Rash, hives, or other S&S of an
allergic reaction; signs of hyperstimulation
such as restlessness, shivering, profuse
sweating, irritability, and tremor.

35. • Take in the morning; causes less
interference with sleep.
• Check with physician before taking any
OTC cough, cold, allergy, or weight-loss
drugs.
• Maintain strict adherence to prescribed
antihypertensives.

36. • Inform physician of all drugs being taken.
Serious adverse effects may be
experienced with concomitant use of some
drugs used to treat depression.
• Do not breast feed while taking this drug
without consulting physician.

37. Weight-loss surgery, also called
Bariatric Surgery

38. VAGAL NERVE BLOCKADE

41. Building motivation and confidence to
the patient
Guide the patient in:
Dietary changes
Exercise and activity
Behaviour change
Prescription weight-loss medications

42. PATIENT EDUCATION AFTER SURGERY
Eat smaller but more frequent meals that
contain protein, do not exceed in 1 cup of
each meal.
Eat only high foods in nutrients.

43. Ensure low carbohydrate intake.
Eat slowly and chew thoroughly.
Assume low fowler’s position during
mealtime and then remain in that
position for 20-30 minutes.

44. Do not drink fluid with meals,
consume fluids up to 30 minutes
before a meal and 30-60 mins. After
mealtime.
Take dietary supplements of vitamins.

45. Follow up with healthcare provider for
monthly injections of vitamin B12 and
iron as prescribed.
Walk for at least 30 minutes daily.

46. Imbalanced Nutrition: More than
Body Requirements related to food
intake that exceeds body needs
Disturbed Body Image related to
biophysical/psychosocial factors such
as patient’s view of self

47. Impaired Social Interaction related to
verbalized or observed discomfort in
social situations (Self-concept
disturbance)
Deficient Knowledge related to lack
of/misinterpretation of information

48. References:
New Club: OBESITY 101., American Journal of Clinical Nutrition.
Retrieved (July 17, 2015) from: http://www.newyou.com.ph/facts-
about-obesity
Trisha Macas, GMA news., overweight-obesity., October 21, 2014., 3
out of 10 Filipino adults are overweight, obese – report. Retrieved (July
17, 2015) from:
report#sthash.bKzG4shG.dpufhttp://www.gmanetwork.com/news/stor
y/384493/lifestyle/healthandwellness/3-out-of-10-filipino-adults-are-
overweight-obese-report
Orlistat: VOL: 102, ISSUE: 18, PAGE NO: 27., GENERIC AND
PROPRIETARY NAMES., May 04, 2013., Nursing Times. Retrieved (July
17, 2015) from: http://www.nursingtimes.net/nursing-
practice/specialisms/nutrition/orlistat/203242.article

49. Cummings DE, Frayo RS, Marmonier C, Aubert R, Chapelot D (Aug
2009). "Plasma ghrelin levels and hunger scores in humans initiating
meals voluntarily without time- and food-related cues". American
Journal of Physiology. Endocrinology and Metabolism 287(2): E297–
304.
Sakata I, Sakai T (2010). "Ghrelin cells in the gastrointestinal
tract". International Journal of Peptides 2010. Retrieved (July 17, 2018)
from: http://www.bodybuilding.com/fun/are-your-hunger-hormones-
sabotaging-your-fat-loss.html
Public Health England., April 01, 2013., Measurement of Obesity.
Retrieved (July 17, 2015) from:
http://www.noo.org.uk/NOO_about_obesity/measurement

50. SIBUTRAMINE HYDROCHLORIDE MONOHYDRATE., Retrieved
(july 17, 2015) from:
http://www.robholland.com/Nursing/Drug_Guide/data/mono
graphframes/S013.html
Janice L. Hinkle., Kerry H. Cheever., Brunner & Suddarth’s.,
Textbook of Medical-Surgical Nursing 13th Edition., Volume 2.,
Wolters Kluwer I Lippincott Williams & Wilkins.Obesity., pp.
1272.
Marilynn E. Doenges., Mary Frances Moorhouse., Alice C.
Murr., Nurse’s Pocket Guide., Edition 13th., Diagnoses.