Obesity is a medical condition caused by several factors like genetics, lifestyle, and diseases. It increases the risk of many health issues like diabetes, cardiovascular diseases, respiratory problems, and some cancers. The presentation outlines the definition of obesity, its causes and health impacts, recommendations for prevention on individual and population levels. Barriers to prevention are also discussed.

1. Obesity: The Culprit
Presented by-
Dr. Jheelam Biswas
Department of NCD, BUHS

2. Outlines
• What is obesity
• Causes of Obesity
• Health consequences of obesity
• Obesity and Diabetes
• Obesity and cardiovascular diseases
• Obesity and chronic respiratory diseases

3. Outlines
• Obesity and cancer
• Obesity and Mental illness
• Barriers to prevention
• Recommendations
• Conclusion

4. What is obesity
• Obesity is a medical condition in which excess
body fat accumulates to the extent that it may
have a negative effect on health, leading to
reduced life expectancy and/or increased
health problems

5. Measuring obesity
• For adult-
 BMI ≥ 30 kg/m2
 WC >90cm in male, >80cm in female
 Waist-hip ratio >0.90 (male), >0.85 (female)
 Waist-height ratio (overweight: men, 0.53 to
0.57 and women, 0.49 to 0.53)

6. Measuring obesity (cont..)
• For children <5 years -
Weight to height more than 3 SD than WHO child
growth standard median
• For children of 5 to 19 years-
BMI for age more than 2 SD than WHO growth
reference chart

7. Types of obesity

8. Prevalence of obesity
• According to 2016, WHO updated data 1.9 billion
people are considered as obese who are aged
18 years or above
• According to WHO STEPS survey 2010 in
Bangladesh, the prevalence of overweight and
obesity together constituted 17.6% of the
population, the prevalence was much higher in
women (21.6%) than in men (13%)

9. Causes of obesity
• Several factors are responsible for
obesity-
Behavioral and lifestyle factors
Diseases
Drugs
Genetics

10. Behavioral factors
Unhealthy dietary patterns
Less physical inactivity
Medication use
Easy availability of fast food
Unfavorable physical activity environment
Less education and skills
 Food marketing and promotion

11. Drugs and diseases
• Many diseases like-
 Cushing’s disease
 Polycystic ovary syndrome
 Thyroid and other endocrine disorders
• Many drugs like-
 Steroids
 Antidepressants

12. Mental illness and genetics
• Many mental illnesses like-
Depression
Eating disorders
• Genetics and environmental influences also
play major role (Multifactorial obesity)

13. Health consequences of obesity
• According to CDC obesity affects almost all
organ systems and creates adverse health
effects.
Hypertension
Dyslipidemia
Type 2 diabetes
Coronary heart disease
Stroke

14. Health consequences (cont…)
Gallbladder disease
Osteoarthritis
Sleep apnea, obesity related asthma
Endometrial,breast,colon, liver cancers
Low quality of life
Mental illness
Chronic pain

15. Obesity and Diabetes
• Diabetes mellitus (DM) and obesity have a
complex relationship
• Obesity stands out as a risk factor for Type 2
DM
• Obesity causes insulin resistance and thus it
becomes a precursor for Type 2 DM

16. Type 2 Diabetes
Beta cell failure
Impaired glucose tolerance
Obesity
Genetic predisposition+ Environmental
factors+ sedentary lifestyle

17. Obesity and Diabetes (cont.)
• In the Harvard Alumni Health Study, it was found
that, body weight and high blood sugar level are
directly related and weight gain is a significant
risk factor for development of diabetes mellitus
• Persons with central obesity are more at risk of
developing DM and CVD.

18. Obesity and Diabetes (cont.)
• National health survey, 1995 in US showed that
in white people around 65–75 % of incident
cases of diabetes could be avoided if the whole
population would not exceed a BMI of 25 kg/m2
• Also weight loss of 16% resulted dramatic
reduction in the incidence of type 2 diabetes

19. Obesity and Diabetes (cot.)
• In 2001, NIH Clinical Research Unit, Arizona,
conducted an experimental study to find out
that adults with waist to hip ratio >35.5 in (male)
and >38.5in (female), had impaired glucose
tolerance and hyperinsulenimia
• But having weight reducing diet and physical
excises for 6 months, it became normal

20. Obesity and Diabetes (cont.)
• According to Health Technology Assessment
systematic reviews 2008, for each kilogram of
weight gained annually over a period of
10 years, there is an associated 49% increase
in the risk of developing T2DM in the
subsequent 10 years
• According to WHO reports, 2013, 86% of adults
with T2DM are overweight or obese

21. Obesity and Diabetes (cont.)
• A comparative study conducted by BADAS in
January 2011 to December , found a significant
association between DM and obesity indices
• There women are found more obese than men,
and more prone to developing DM, also younger
people are more at risk than older people

22. Obesity and cardiovascular diseases
• Obesity increases the risk of the development of
cardiovascular events
• Three mechanisms are responsible for obesity
related hypertension and as the consequence
cardiovascular diseases

23. Obesity and cardiovascular diseases
(cont..)
• Activation of the
sympathetic nervous
system
• Activation of the
renin-angiotensin
system
• Sodium retention

24. Obesity and cardiovascular diseases
(cont..)
• The consequence of both obesity and obesity
related hypertension leads are cardiovascular
diseases like Stroke and Myocardial Infraction
• Obesity is related with raised blood lipids, which
in turn causes atherosclerosis, followed by
development of cardiovascular diseases

25. Obesity and cardiovascular diseases
(cont..)
• In Framingham Heart Study, it was found that, a
5% weight gain was associated with a 20–30%
increase in hypertension and ischemic heart
diseases incidence
• Harvard Male Alumni study found a weight gain
of 25 pounds was associated with a 60%
increase in hypertension and cerebrovascular
incidences

26. Obesity and cardiovascular diseases
(cont..)
• DACODA Study 2008 across different ethnic
groups like Chinese, Japanes, Malawi, it was
found that, obese women were at 2 fold risk of
developing CVD in the BMI group of 24.0 - 24.9
kg/m2
• WHO recommends the use of lower BMI cut
points for Asian population

27. Obesity and cardiovascular diseases
(cont..)
• According to WHO STEPS survey,
Bangladesh, 2010, the prevalence of
hypertension is 17.9% in general, 18.5% in men
and 17.3% in women
• A health survey at the year 2015 on 665
students of Rajshahi University aged 22-25 yrs,
reported that a major portion of obese

28. Obesity and cardiovascular diseases
(cont..)
students (52.46%) were pre-hypertensive and
34.43% obese students were stage I
hypertensive patient.
• A meta analysis on CVD risk factors among
Bangladeshi population has found a strong
relationship with increased waist hip ratio and
CVD incidence

29. Obesity and chronic respiratory
diseases
• Obesity is associated with chronic inflammatory
state, and adipose tissue also releases some
inflammatory mediators and causes many
respiratory diseases like-
• Obstructive sleep apnea
• Obesity Hyperventilation Syndrome,
• COPD
• Obesity related asthma

30. Obesity and chronic respiratory
diseases (cont..)

31. Obesity and chronic respiratory
diseases (cont..)
• One of the first reports identifying an association
between symptoms of asthma and overweight
was published in 1984
• In this retrospective study held among British
population the relationship between overweight
and seven respiratory symptoms was found

32. Obesity and chronic respiratory
diseases (cont..)
• A longitudinal study conducted in Tucson
Epidemiologic Study of Airways Obstructive
Diseases in 1999, reported that obesity in
chronic bronchitis is probably because of
sedentary lifestyle and vice versa
• Burden of Obstructive Lung Disease (BOLD)
Initiative, 2008, reported that 54% of the
patients with COPD had a BMI >30 kg/m2

33. Obesity and chronic respiratory
diseases (cont..)
• A cross sectional study in Santos University
Hospital, Brazil, it was reported adolescents
with BMI >30kg/m2, have significant decrease
in lung volume and total lung capacity
• The prevalence of lung disease in obese
people found to be high in the different other
studies, obstructive lung diseases having
predominated

34. Obesity and cancer
• Obese people often have chronic low-
level inflammation, which can, over time, cause
DNA damage that leads to cancer
• A study in 2013, Australia, among post
menopausal women, obese and overweight
women were found to be in two to about four
times risk than normal-weight women to develop
endometrial cancer

35. Obesity and cancer (cont..)
• World cancer research foundation report 2015
reported that, obese people are slightly (about
30%) more likely to develop colorectal cancer
than normal-weight people
• This study also reported that postmenopausal
women, with higher BMI are in modest increase
in risk of breast cancer

36. Obesity and Mental illness
• Obesity and mental illness are interlinked
• Due to psychiatric illness, depression, there is
lack of physical work , poor body image, binge
eating, and anti psychotic medications causes
obesity, again the social situations created by
obesity may also lead to mental illness

37. Obesity and Mental illness (cont.)
• In a longitudinal study in 1997, among US
adolescents, increased BMI was positively
found to be related to depression
• In US healthy survey 2011, it was found that,
15% of the obese men were taking
antidepressants, about the same amount had
some type of sleeping problem

38. Obesity and Mental illness (cont.)
• In 2014, four different national studies across
Europe and Australia, shows that 46%- 79% of
seriously mentally ill individuals have BMI ≥ 30
kg/m2
• In 2013, researchers from Monash University
reported that obese children show signs of
emotional disturbance (23.4%) than non obese
children (14.3%)

39. Barriers to prevention
• For adults-
 Some people may not choose to change their
lifestyle or agree to treatment
 Lack of knowledge about buying and cooking
food, and how diet and exercise affect health
 The cost and availability of healthy foods and
opportunities for exercise

40. Barriers to prevention (Cont.)
 Safety concerns, for example about cycling
 Lack of time
 Personal tastes
 The views of family and community members
 Low levels of fitness, or disabilities
 Low self-esteem and lack of assertiveness.

41. Barriers to prevention (Cont.)
• For children and young adults
• Availability of junk foods near school
• Lack of time
• Lack of confidence and low self esteem
• Scarcity of playground in school and residential
areas

42. Prevention strategies
• Two types of prevention approach can be taken
to prevent and control obesity-
 Population based approach
 Individual based approach

43. population-based prevention

44. Individual-based approach
• Providing information and lifestyle modification
• This part includes providing information about
healthy diet and physical activities
• Aware the person about the consequences of
excessive weight gain

45. Dietary advice
 Adjust portion sizes to age, gender, weight, and
activity level
 Encourage children to eat regular meals
including breakfast
 Encourage intake of low salt foods and limit the
intake of energy-dense foods and fast foods .
 Encourage intake of daily 5 rations of fruits

46. Physical activity
• Children:
 Encourage children gradually to perform at least
60 minutes of moderate to vigorous exercise
daily
 Discourage sedentary behavior of more than
2 hour for children particularly of screen time
 Encourage family approach to physical exercise

47. Physical activity (cont..)
• Encourage adults to do at least 30 minutes of
moderate-intensity physical activity on 5 or more
days a week
• This should be built up over time; start by
walking 10 minutes a day on a few days during
the first couple of weeks then add more time
and days gradually

48. Managing obesity
• This part is appropriate for those who are
already suffering from obesity.
• It includes-
 Taking history and identifying risk factors
 Taking appropriate measurements
 Giving proper dietary advice
 Advising proper physical activities
 Psychological assessments

49. Conclusion
• In conclusion, obesity epidemic a new challenge
to public health professionals as it is one of the
main risk factor for most of the non-
communicable disease
• National and community level as well as
individual level approaches are needed to take
to face this challenge