About obesity Definition, its assessment, Epidemiology, Pathophysiology, Naturopathic, Management are described.

1. BY : DR. SATYENDRA SINGH
BNYS, MD
Obesity

2. Definition
• Form of malnutrition
• Obesity is the excessive or abnormal accumulation of fat or adipose tissue in the body that impairs
health via its association to the risk of development of diabetes mellitus, cardiovascular disease,
hypertension, and hyperlipidemia.
• Overweight and obesity are defined as abnormal or excessive fat accumulation that
presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and
over 30 is obese.- WHO
• Medical condition in which excess body fat got accumulated to the extent that it may have
or can later manifest negative effect on health. People are generally considered obese
when there BMI is over 30 kg/m sq. With the range 25-30 kg/m sq. Defined as overweight.
• Some countries use lower values.

3. Assessment of
obesity

4. • BMI - BMI comes under
Anthropometric
measurement but we in
clinical setup generally
include waist
circumference, waist to hip
ratio[men- more than 1:1 &
in women- 0:8 significant],
skin fold thickness, may
involve thigh or biceps
circumference too.

5. Classification of obesity based on BMI
•Underweight: less than 18.5 kg/m2
•Normal range: 18.5 kg/m2 to 24.9 kg/m2
•Overweight: 25 kg/m2 to 29.9 kg/m2
•Obese, Class I: 30 kg/m2 to 34.9 kg/m2
•Obese, Class II: 35 kg/m2 to 39.9 kg/m2
•Obese, Class III: more than 40 kg/m2

6. BIA/BEI
• Bioelectrical impedance
(BIA/BEI) -estimates body
composition based on 2
factors- fat (Fat Mass) &
muscle body power (FFM)
• Both of above stated methods
are field methods

7. MRI
• Radiological technique uses magnetism, radio
waves & a computer to produce body image.
• Why for obesity? - how body is made up of fat &
water mainly which is about 63% hydrogen
• As MRI works on the basis of proton/ positive
charged particle

8. Dual energy X-ray absorptiometry (DXA)
• Though primarily used to evaluate
bone mineral density, also used to
scan or to assess adiposity
• Both of above stated methods are
reference measurements

9. Underwater weighing / Densitometry
• Individuals are weighed in
air & while submerged in
tank.
• Uses - body volume, body
density & body fat %
• As fat is more buoyant(less
dense) than water
• Body fat is inversely
proportional to body density

10. Other advanced methods used are
• Air displacement plethysmography
• Dilution method / hydrometry
• Laboratory studies - CBC, RFT, LFT, Lipid profile, HbA1c, TSH,
vit.D, Urine -R/M & so on.

11. • Prevalence[% of population affected with a disease in a particular time]
• Incidence [frequency/occurrence rate]
• Worldwide obesity has tripled since -1975
• In 2016 - >1.9 million adults were overweight & >650 million were obese
• Though is a preventable condition
Epidemiology

12. • Imbalance between daily energy intake vs. expenditure = increasing weight gain
• Though is a multifactorial disease caused by :
1. genetics/ hereditary [FTO gene- adiposity, attracts other contributors]
2. Cultural
3. Societal factors
4. Insulin insensitivity
5. Lack of physical exercises
6. Insomnia
7. Endocrine disorders
8. Medications
9. Dietary habits
Aetio/Etiology

14. • Although it is associated with CVD, dyslipidemia, Insulin resistance in turn resulting in
Diabetes, stroke, gallstones, fatty liver, obesity, sleep apnea & various other health
complications.
• Leptin - adipocyte hormone which reduces food intake & body weight.
• In obesity - cellular leptin hormone resistance is seen.
• Adipose tissue secretes adipokines and free fatty acids which results In systemic
inflammation causing insulin resistance & increased TGs levels & therefore = obesity
• Further obesity cause - fatty acid deposition in the myocardium - causing Lt. Ventricular
dysfunction also alters renin-angiotensin system causing elevated Blood pressure and
salt retention in the body.
• Although, body fat distribution helps us to assess the risk
Pathophysiology

16. Clinical features
Clinical features of obesity can give rise to multiple health issues.
Prognosis must be taken into consideration based on following factors:
• Age of onset of obesity
• Amount of central obesity/ adiposity
• Severity of obesity
• Gender
• Associated co morbidity
• Race

17. Differential Diagnosis
• Acromegaly (Excess GH)
• Adipose Dolorosa (painful folds of fatty/adipose tissue or growth of multiple benign fatty
tutors called as lipomas)
• Ascites
• Cushing syndrome/ hypercortisolism - iatrogenic or due to medication or reason(high
cortisol levels for long duration)
• Hypothyroidism
• Insulinoma (neuroendocrine benign tumor in pancreas causes excess production of insulin)
• PCOD

18. Management
• Due to its multifactorial origin its hard to have a clear cut treatment protocol or management as
here we an individual based approach.
Management includes:
• Dietary modifications
• Behaviour interventions [motivational interviewing, dialectical behaviour therapy, interpersonal
psychotherapy]
• Medications [phentermine, orlistat, lorcaserin[serotogenic- should be avoided], liraglutide,
diethylpropion, phendimetrazine]
• Surgical intervention - Bariatric surgery [gastric banding, Rou-en-Y gastric bypass]

20. Naturopathy management

21. • Walking amidst the nature, cycling and trekking was part of physical
workout.
• Diet included lot of fruits and vegetables, high fiber and low calorie satwik
food. Different types of Juices and salads, whole cereals, proteins to
increase fiber and bulk were planned.
• Weight reduction Therapeutic Massages to improve circulation, reduce
weight and improve flexibility were also planned
• Poultice massage with medicated powder for toning of the skin.
• Steam and Sauna to increase the body’s basal metabolic rate and help to
lose weight.
• Warm water enemas for cleansing colon and alternative periods of fasting
are also beneficial.
• Water immerse bath with Epsom salt, cold hip bath, mud bath packs as
per needs.