Obesity,it's type, diagnosis, treatment

2. Department of Community
Medicine
Guided By-
Dr.R.A.Yadav
(Professor)
Dr.O.P. Patel
(Asstt.Professor)
Dr.Pranesh Kumar Singh
(Asstt.Professor)
Submitted By-
Subhash Dwivedi
Roll no-
2008587581036
Batch-2019
Dr.Subodh Kumar Tripathi (Principal)

3. 
CERTIFICATE
This is to certify that Subhash Dwivedi has
successfully completed the project titled
'Obesity' of Department of Community
Medicine under the supervision of
Dr.R.A.Yadav (Professor), Dr. Pranesh
Kumar (Assistant Professor) & Dr.O.P.Patel
(Assistant Professor) at State Ghazipur
Homoeopathic Medical College &
Hospital,Ghazipur.
Signature.........................

4. 
 Introduction
 Types of obesity
 Etiology
 Classification of obesity
 Assessment
 BMI
 Skin fold thickness
 Waist circumference
 Waist:Hip Ratio
 Hazards
 Prevention & control
 Summary
CONTENTS

5. 
 Overweight & obesity terms are used interchangeably
but has different meaning.
 Overweight is defined as body weight that exceeds
the normal or standard weight for a particular person
based on height & frame size.
 An overweight person might have lower than normal
body fat content.
 Obesity refers to the condition of having excessive
amount of body fat. (men with >20% & female with
>35% of body fat).
INTRODUCTION

6. ● Obesity is an abnormal growth of the adipose tissue
due to an enlargement of fat cell size ( hypertrophic
obesity ) or an increase in fat cell number ( hyperplastic
obesity ) or a combination of both, which generally
occur due to various behavioural & lifestyle factors
leading to many lifestyle diseases ( killer or non -
communicable diseases ) such as hypertension,
cardiac diseases, type - 2 diabetes, osteoarthritis,
stroke, cancer, hormonal abnormalities, PCOS, foetal
defects, etc.
● It is often expressed in terms of body mass index (
B.M.I. > 30 ).
● 'Obesity' term is derived from Latin word 'obesus'
meaning fat.

7. ● Over 340 million children & adolscents
aged 5-19 were overweight or obese in
2016 .
● The prevalence of overweight &
obesity among children & adolscents
aged 5-19 has risen dramatically from
just 4% in 1975 to just over 18% in 2016 .
● 39% of adults aged 18 years and
over were overweight in 2018, and
13% were obese .

8. 
Intake & output
The total amount of energy expended
each day is sum of 3 components –
Resting metabolic rate (60 – 75%)
Thermic effect of a meal (10%)
Thermic effect of activity (15 – 30%)
All 3 components increase with
overeating
CONTROL OF BODY
WEIGHT

9. 
 In physical fitness, body composition is used to
describe the percentages of fat, bone, water and
muscle in human bodies. Because muscular tissue
takes up less space in our body than fat tissue,
our body composition, as well as our weight,
determines leanness.
 Muscle mass includes the weight of the muscles in
your body in kilograms or pounds. While the body
fat percentage measures the amount of fat your body
holds.
Body composition

10. COM PONENTS MALE FEMALE
MUSCLE 45% 36%
ESSENTIAL FAT 3% 12%
NON ESSENTIAL FAT 12% 15%
BONE 15% 12%
OTHER 25% 25%

11. 
ETIOLOGY
INACTIVITY
PREGNANCY
LACK OF SLEEP
DRUGS
DIET

12. 
 Medical conditions (cushing syndrome,
hypothyroidism, osteoarthritis, etc)
 Hormonal imbalance
 Glandular malfunction
 Genetic / heredity
 Physiological or psychological trauma
 Altered basic homeostatic mechanism
 Family lifestyle
 Age
 Environmental factors (cultural habits, lack of physical
activity, improper diet)
Etiology

13. 
CLASSIFICATION OF
OBESITY (SHAPE)

14. 
 Upper-body obesity
 Associated with more heart disease, HTN, Type II
Diabetes
 Abdominal fat is released right into the liver
 Encouraged by testosterone and excessive alcohol
intake
 Defined as waist measurement of > 40” for men
and >35” for women.
 It is clinically more important as disease are more
correlated with this abdominal fat.
APPLES- ANDROID

15. 
 It is characterized by accumulation of fat around
hip and buttocks.
 Lower-body obesity--Pear shape
 Encouraged by estrogen and progesterone.
 Less health risk than upper-body obesity.
 After menopause, upper-body obesity appears.
PEARS- GYNECOID

16. 
BODY FAT
DISTRIBUTION

17. 
 Inactivity Obesity
 Food Obesity
 Anxiety Obesity
 Venous Obesity
 Gluten Obesity
 Atherogenic Obesity
Types of Obesity

18. 
HEALTH CONSEQUENCES
OF OBESITY
 Type 2 diabetes
 High blood pressure
 Stroke
 Heart disease
 High cholesterol and
triglycerides
 Gallbladder disease
 Osteoarthritis
 Poor wound healing
 Retinal disease
 Sleep apnea
 Metabolic syndrom.
 Cancer
 Renal diseases
 Depression
 Sexual problems
 Social isolation
 Physical disability
 Discomfort
 Surgical risk

19. 
 Changes in normal body function –
 Respiratory problems
 Lethargy
 Polycythemia
 Abnormal blood clotting
 Enlargement of heart
 CHF
 Low exercise tolerance
Continued....

20. 
 Increased morbidity
 Increased mortality
 Obesity lowers life expectancy
Hazards of Obesity

21. 
ASSESSMENT
OF
OBESITY

22. ASSESSMENT
METHODS
LABORATORY
METHODS
#Hydrostatic
weighing
#Dual energy x-ray
absorptiometry
# Air
displacementplethy
smography
FIELD
METHODS
# Skin fold
measurement
# Bioelectrical
impedance
# Near
infraredinteractance
# Ultrasound
# CT / MRI
ANTHROPOMETRIC
METHODS
# BMI
# Waist : Hip
# Waist : Height

23. 
 Scientifically validated densitometric method to
measure human body composition.
 ADP is based on the same principles as the gold
standard method of hydrostatic weighing, but
through a densitometric technique that uses air
displacement rather than water immersion.
 Air-displacement plethysmography offers several
advantages over established reference methods,
including a quick, comfortable, automated,
noninvasive, and safe measurement process, and
accommodates various subject types (e.g., children,
obese, elderly, and disabled persons).
Air Displacement
Plethysmography

24. 

25. 
They can differentiate
subcutaneous from visceral
fat and so are important in
research purposes.
CT / MRI

26. 
ANTHROPOMETRIC
METHODS

27. 
Refers to measurement of the size &
proportion of human body.
Uses circumference, skeletal breadths,
skinfold thickness & segment lengths.
These methods are relatively simple,
inexpensive & do not require high degree of
technical skills & training.

28. 
 Waist circumference (WC) is an indicator of health
risk associated with excess fat around the waist.
 Start at the top of your hip bone, then bring the
tape measure all the way around your body, level
with your belly button. Make sure it's not too tight
and that it's straight, even at the back. Don't hold
your breath while measuring. Check the number on
the tape measure right after you exhale.
Waist Circumference
HIGH RISK
MEN - >102cm (>40in)
WOMEN - >88cm (>35in)

29.  A high waist circumference is associated with an
increased risk for type 2 diabetes, dyslipidemia,
hypertension, and CVD in patients with a BMI in a
range between 25 and 34.9 kg/m2.
 Monitoring changes in waist circumference over time
may be helpful, in addition to measuring BMI, since it
can provide an estimate of increased abdominal fat even
in the absence of a change in BMI.
 Furthermore, in obese patients with metabolic
complications, changes in waist circumference are
useful predictors of changes in CVD risk factors.
 In some populations, waist circumference is a better
indicator of relative disease risk than is BMI.
 Waist circumference also assumes greater value for
estimating risk for obesity-related disease at older ages.

30. 
Calculated as Weight(kg)/Height(m^2)
BMI measures individual’s total weight
relative to its height.
BMI may be high in a vey muscular person.
For similar BMIs women have greater fat
mass than their male counterparts.
So BMI may be misleading in certain cases.
BMI

31. 
CATEGORY WHO criteria for
BMI
ASIAN criteria
for BMI
DISEASE RISK
UNERWEIGHT < 18.5 < 18.5 -
NORMAL 18.5 – 24.99 18.5 – 22.9 -
OVERWEIGHT 25 – 29.99 23.0 – 24.9 Increased
OBESE I 30 – 34.99 25.0 – 29.9 High
OBESE II 35 – 39.99 30.0 – 34.9 Very High
OBESE III (MORBID
OBESITY)
> 40 > 35 Extremely high

33. 
 It is the dimensionless ratio of the circumference of
the waist to that of the hips.
 It determines how much fat is stored on your waist,
hips, and buttocks.
Waist : Hip Ratio
Health risk Female Male
Low <0.80 < 0.95
Moderate 0.81 – 0.85 0.96 – 1.0
High >0.85 > 1.0

34. 
 Measurement procedure:
 Stand up straight and breathe out. Use a tape
measure to check the distance around the smallest
part of your waist, just above your belly button.
This is your waist circumference.
 Then measure the distance around the largest part
of your hips — the widest part of your buttocks.
This is your hip circumference.
 Calculate your WHR by dividing your waist
circumference by your hip circumference.

35. 
 Indirectly measures the thickness of subcutaneous adipose tissue.
 To use SKF method to calculate total body density, in order to
calculate relative body fat (BF%), certain basic relationships are
assumed –
 SKF is a good measure of subcutaneous fat.
 The distribution of fat subcutaneously & internally is same for all
individuals within each gender.
 Due to relation of subcutaneous fat & total body fat, sum of several
skinfolds can be used to estimate total body fat.
 Age is an independent predictor of Db for both men & women
Skin Fold Measurement

36. 
 Abdomen
 Thigh
Various
sites

37. 
Total of all four sites is considered -
15-45 mm – 8-22 % of total body fat
46-75 mm – 23-30 % of total body fat
76-150 mm – 31-40 % of total body fat
151-170 mm – 41-45 % of total body fat
Up to 22% it is normal (males)
Up to 30% it is normal (females)

38. 
BODY FAT
ANALYZER

39. 
PREVENTION
&
MANAGEMENT

40. ● It is a chronic medical condition.
● Definition of successful treatment:
◆ Attainment of normal weight
◆ No treatment induced
morbidity
● This is rarely achieved in clinical
practice.

41. 
OBESITY
Assessment of existing
condition
LIFESTYLE CONSIDERATION
# Diet
# Increased physical activity
# Behavioral modification
PHARMACOLOGICAL CONSIDERATION
# Appetitesupressants
# Fat absorption inhibitors
Prevention and control of obesity :
A) Primary Prevention -
1. Lifestyle Assessment Related to obesity Risk -
• Assess BMI atleast annually , monitor for
increasing BMI .
• Review dietary & physical activity habits
in addition to sleep duration.
• Review other risk factors -
- medical comorbidities
- familial obesity
- medication use
- lack of nutrition knowledge, skills for food
preparation.

42. 2. Counseling and Approaches -
• Discuss weight control interventions for overweight
patients.
• Encourage a self - management approach - setting goals
for healthy lifestyle habits.
3. Physical Activity & Exercise-
• Encourage adults & children to :
-decrease sedentary activity
-engage in regular physical activity

43. 4. Diet & Eating -
• Promote consumption of a variety of nutritious
foods .
• Recommend avoidance of high calorie foods and
sugar sweetened beverages.
• Encourge & support breastfeeding during
infancy.
• Promote family meals and limited eating out
and fast food.
• Limit children's screen time and exposure to food
& beverage marketing.

44. 5) Sleep-
• Promote age-appropriate sleep durations .
• Children:
-Preschoolers (3-5 years) : 11-13 hours
-School-aged (5 12 years) : 10-11 hours
• Adolscents : (12-18yrs) : 9-10 hours
• Adults : 7-8hours.

45. ◆ NUTRITION:
• NUTRITION COUNTS!
• Nutrition is everything!
-Healthy foods, fruits, vegetables, legumes.
• Low sugar, low fat.
• Play an hour a day.

46. ◆ FRUITS & VEGETABLES:
WHO states:
• Fruits and vegetables need to be part of
the daily diet to prevent disease such as
obesity and non communicable diseases.
• The statistics are startling.
• Lack of enough fruits and vegetables
cause-
~19% of GI deaths
~ 31% of Ischemic heart diseasd
~ 11% of stroke

47. ◆ WEIGHT CONTROL:
• Weight control is widely defined as
approach to marinating weight with in
the healthy range of BMI 18.5 to 24.9 kg
/m2.
• Prevention of weight control should
begin in early childhood
• Obesity is harder to tear in adults .
• Control can by dietary change, increase
physical activity, and combination of
both.

48. ◆ DIETARY CHANGES:
• Proportion of energy dense food should be
reduce.
• Increase fiber diet
• Intake is not great then demand
• Modification of human behavior
• Increase physical activity.
• Appetite suppression drug.
• Health education

49. Surgical Treatment:
• Gastric bypass
• Gastroplasty
• Jaw-wiring
◆ Health education has an important role to
play in teaching the people how to reduce
overweight and prevent obesity .

50. 
LIFESTYLE MODIFICATION

51. 
The abnormal growth of the adipose tissue (hypertrophic or
hyperplastic) results due to errors in lifestyle habits & various
behavioural factors which lead to many lifestyle disorders (Killer
diseases). These diseases increase morbidity, mortality & lower the life
expectancy. There are various ways to measure obesity, such as- BMI,
waist circumference, skin fold thickness, waist:hip ratio,etc. Obesity is
preventable. Awareness about overweight, obesity & there health
consequences should me made among the community. Proper balanced
diet & eating, age appropriate-sleep duration, avoidance of high calorie
food, increase regular physical activities & decrease in sedentary
activities- are to be promoted in the community. In this way,we can
prevent obesity & can live a healthy & long life.
Summary

52. 