What is Obesity?. Some important notes and concepts.

1. Obesity
Its Impact on
The Modern
Life
By :
Dalia Alrousan

2. What is Obesity ?
How it impacts our
daily life ?
Is the world obese
?
Specifically is
Jordan obese ?

3. Contents :
-Introduction
-What Is Obesity?
-Is the world obese?
Obesity in Jordan
-What are the risk factors?
The consequences of obesity
-How can obesity affect your life quality?
Obesity and body weight control mechanism
Obesity and physical activity
-Diseases associated with obesity
-What is the successful long-term weight loss maintenance?
-Anroexia Nervosa VS. Bulimia nervosa

4. Part (A):
Introduction
Definitions

5. Introduction :
The world we live in today is constantly exploring ways to make life easier,
faster, and more efficient for the modern individual, but often times such
improvements and short cuts in life can lead to bigger issues. The fast
paced lifestyle we enjoy during this technologically advanced age provides
countless options for easy living, or more notably, quicker food options
which usually means they have had most of their nutrient content
compromised. Over the year’s people have had greater amount of access to
junk foods and tempting sugary sweets that bring along with them
numerous health concerns. As a result, diseases such as obesity, along with
many others, run rampant in our societies worldwide at present day more
than they have during any period in previous history.

6. The increasing urbanization and mechanization of the world has reduced our levels of physical
activity, The World Health Organization believes that more than 60% of the global population is
not sufficiently active , which is lead to many diseases such as obesity.
Today obesity is localized and affect each part of the population, the rate of obese people is
increasing each day, and as we know that obesity is associated with many diseases like diabetes
and high blood pressure, as many different risk factors interplay with each other's the risk of being
obese is increase too, also of around 40% of obese children will end up being obese for the rest of
their life.
Many Health organization are working in reducing the rate of obese people worldwide, as they
also consider obesity as the 5th killer worldwide, also each individual and health worker should
have a role in reducing the rate of obesity and educate people about the risk factors of obesity and
its consequences.

7. Obesity :
chronic low- grade
subclinical inflammatory
state

8. Obesity was issued by the American Medical Association as a deadly food related disease recognized
worldwide. This disease is classified by an individual having excess amounts of body fat and can be
measured by the Body Mass Index (BMI) scale. Having a body mass index of over 30 can contribute to the
diagnoses of Obesity, it’s also the starting point of other diseases to begin taking a toll on your life. People
with a BMI of over 40 are considered severely obese, or morbidly obese, and have the greatest risk for
accumulating other diseases. Although it is a treatable disease, it can be hard to overcome for most people
dealing with it as obesity is caused by a mixture of genetic and environmental factors. It is not caused
simply by over indulging in food, it’s a chronic illness and a complicated one to treat.
Obesity is not a lifestyle choice, rather it’s a chronic disease, its
complex, heterogeneous, polygenic, multifaceted state of
chronic low- grade, subclinical local and systemic sterile
inflammation

9. WHO.org

10. Part (B) :
Statistics

11. Is the world obese ?
Overweight and Obesity are now dramatically on the rise

12. Some recent WHO global estimates
follow:

13. In 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these
over 650 million adults were obese.
In 2016, 39% of adults aged 18 years and over (39% of men and 40% of women) were
overweight.
Overall, about 13% of the world’s adult population (11% of men and 15% of women)
were obese in 2016.
The worldwide prevalence of obesity nearly tripled between 1975 and 2016.
r obese in 2016 lived in Asia. In 2016, an estimated 41 million children under the age of 5
years were overweight or obese. Once considered a high-income country problem,
overweight and obesity are now on the rise in low- and middle-income countries,
particularly in urban settings. In Africa, the number of overweight children under 5 has
increased by nearly 50 per cent since 2000. Nearly half of the children under 5 who were
overweight o
Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.

14. The prevalence of overweight and obesity among children and adolescents aged 5-19 has
risen dramatically from just 4% in 1975 to just over 18% in 2016. The rise has occurred
similarly among both boys and girls: in 2016 18% of girls and 19% of boys were
overweight.
While just under 1% of children and adolescents aged 5-19 were obese in 1975, more 124
million children and adolescents (6% of girls and 8% of boys) were obese in 2016.
Overweight and obesity are linked to more deaths worldwide than underweight. Globally
there are more people who are obese than underweight – this occurs in every region
except parts of sub-Saharan Africa and Asia.

15. Age–standardized prevalence of
overweight and obesity (BMI>=25)
and obesity (BMI>=30), ages 20+
years, by sex, 1980–2013
Age–standardized prevalence of
overweight and obesity, and
obesity alone (based on IOTF
cutoffs), ages 2–19 years, by sex,
1980–2013
Ng et al 2014; Estimated; 2013 [6]

16. Prevalence of overweight and
obesity (BMI>=25) and
obesity (BMI>=30), by age
and sex, 2013
Prevalence of obesity
(BMI>=30) by age across birth
cohorts for males and females
in developed and developing
countries
Ng et al 2014; Estimated; 2013 [6]

17. Is Jordan Obese ?
Jordan is obese and
hungry too.
A study in Jordan that
aimed to explore the
social determinants
associated with obesity
among Jordanian women
using the national data
from the Jordan
Population and Family
Health Survey 2009.

18. Results :
*The overall prevalence of overweight was 30% and obesity was 38.8%
among Jordanian women aged 15–49 years.
*Results of multivariate analysis showed that age; residing in the south region
of Jordan, marriage at an early age, parity, wealth status and smoking were
statistically significant predictors of overweight and obesity among women in
Jordan.
*Results show that there is an urgent need to implement health programs to
prevent and control overweight and obesity at the national level. Social
determinants should be taking into consideration in designing and
implementing these programs.

19. Table 1 shows the characteristics
of the JPFHS respondents; one-
third of the respondents were
overweight, and 38.8% of
respondents were obese. About
two-thirds of the respondents
were living in the central region
of Jordan; about 84% resided in
urban areas. Approximately half
of respondents were aged 25–34
years. About two-thirds of
respondents had finished
secondary education. Of
respondents 86% were reported
as not working. Approximately
57% of respondents were
married at age ≥ 20 years.
Almost 10% of respondents were
smokers. Less than half of the
respondents had 3–5 ever-born
children, and 49% of
respondents were classified as
having a high wealth index
(Table 1).
Variable No. %
Body–mass index
Normal weight 1136 27.6
Overweight 1380 33.6
Obese
Region
1594 38.8
Central 2553 62.1
North 1188 28.9
South Residence 368 9.0
Urban 3456 84.1
Rural Age (years) 653 15.9
15–24 474 13.4
25–34 1526 43.2
35+ Education 1532 43.4
Primary or less 434 10.6
Secondary 2432 59.2
Higher than secondary
Working status
1243 30.3
Not working 3522 86.0
Working
Age at marriage (years)
575 14.0
10–15 324 7.9
16–19 1448 35.2
20+
Cigarette smoking
2337 56.9
Non-smoker 3685 89.7
Smoker
Number of children ever born
412 10.3
1–2 1000 26.5
3–5 1770 46.8
6+ Wealth index 1012 26.7
Low 726 17.7
Middle 1367 33.3

20. Table 2 shows that region significantly
correlated to BMI (P value < 0.005);
two-thirds of respondents who lived in
central areas were reported as either
overweight or obese. Less than half of
women living in rural areas were
obese, whereas about one-third of
those who lived in urban areas were
obese (P value < 0.000). Half of
women aged 35+ years were obese
whereas about one-third of women
aged 25–34 were reported overweight
but only one-quarter of women in the
same age group were obese (P value
< 0.000).Working women were less
likely to be obese comparing with not
working women (P value <
0.000).Moreover, age at marriage,
number of children ever born and
smoking status were significantly
related to the status of BMI with P
value less than 0.05 (Table 2).
Variable Normal weight Overweight Obese P- value
No. % No. % No. %
Region < 0.0001
Central 774 30.3 867 34.0 912 35.7
North 272 22.9 403 33.9 513 43.2
South 89 24.2 110 29.9 169 45.9
Residence 0.024
Urban 977 28.3 1168 33.8 1311 37.9
Rural 159 24.3 212 32.4 283 43.3
Age (years) < 0.0001
15–24 251 53.0 135 28.5 88 18.6
25–34 537 35.2 599 39.3 389 25.5
35+ 258 16.9 507 33.1 766 50.0
Education < 0.0001
Primary or less 93 21.4 117 27.0 224 51.6
Secondary 650 26.7 796 23.7 987 40.6
Higher than secondary 393 31.6 467 37.6 383 30.8
Working status 0.002
Not working 989 28.1 1147 32.6 1386 39.4
Working 144 25.0 231 40.2 200 34.8
Age at marriage (years) < 0.0001
10–15 60 18.5 90 27.8 174 53.7
16–19 381 26.3 455 31.4 613 42.3
20+ 695 29.7 835 35.7 807 34.5
Cigarette smoking 0.023
Non-smoker 966 27.0 1237 33.6 1452 39.4
Smoker 137 32.5 143 34.0 141 33.5
Number of children ever born < 0.0001
1–2 447 44.7 354 35.4 200 20.0
3–5 428 24.2 640 36.2 702 39.7
6+ 138 13.6 273 27.0 600 59.3
Wealth index 0.040
Low 219 30.2 216 29.8 726 40.1
Middle 370 27.1 449 32.8 1367 40.1
High 546 27.1 715 35.5 2015 37.4

21. Table 3 shows the results of
multivariate analysis. We found that
women who resided in the southern
part of the country were 1.6 times
more likely to be overweight or obese
compared to the middle region (OR =
1.6; 95% CI 1.2–2.09). Women aged
35+ years were three times more
likely to be obese compared to
women aged 15–24 (OR = 3.1; 95%
CI 2.14–4.28). Marriage at early ages,
having more children ever born and
being a non-smoker were statistically
positive significant predictors of
overweight and obesity among
women in Jordan. Women who were
classified as having low wealth index
and women who were classified as
having middle wealth index were
slightly more likely to be obese
compared with women classified as
having high wealth index (OR = 1.3;
95% CI 1.02–1.6; OR = 1.2; 95% CI
(1.02–1.46) respectively (Table 3).
Variable OR (95% CI) P-value
Region
Central 1
North 1.2 (0.99–1.43) 0.065
South Residence 1.6 (1.20–2.09) 0.001
Urban 1
Rural Age (years) 0.95 (0.76–1.19) 0.66
15–24 1
25–34 1.3 (0.92–1.73) 0.157
35+
Education
3.1 (2.14–4.28) < 0.0001
Primary or less 1
Secondary 1.2 (0.90–1.58) 0.217
Higher than secondary
Working status
0.98 (0.71–1.35) 0.871
Not working 1
Working
Age at marriage (years)
1.1 (0.82–1.35) 0.675
10–15 2.2 (1.57–2.88) < 0.0001
16–19 1.3 (1.11–1.60) 0.002
20+
Cigarette smoking
1
Non-smoker 1.5 (1.12–1.92) 0.005
Smoker
Number of children ever born
1
1–2 1
3–5 1.8 (1.44–2.24) < 0.0001
6+
Wealth index
2.5 (1.85–3.28) < 0.0001
Low 1.3 (1.02–1.61) 0.032
Middle 1.2 (1.02–1.46) 0.027
High 1

22. Part (C) :
*Risks Factors
*Consequences

23. Risk factor definition according to WHO :
Is any attribute , characteristics ,or exposure of an individual that increases
the likelihood of developing a disease or injury.
Some examples :
1-Underweight.
2- Over weight.
3-High blood pressure.
5-Tobacco and alcohol consumption.
6-Unsafe water , sanitation and hygiene.

24. Genetics risk factors
Environmental
Risk Factors
Epigenetics
factors
Mechanism
EE GE
EG
EGE
Many factors interplay to cause the diseases as discussed here by the chart :

25. The consequences of obesity:
The fundamental cause of obesity and overweight is
an energy imbalance between calories consumed and
calories expended.
Energy
In
Energy
Out

26. Obesity related
cardiometabolic
complications –DM2 , CVD ,
CANCER.

27. - 6 types of cancer are
induced and caused by
obesity:
1-Colon cancer.
2-Pancreatic cancer.
3-Bladder Cancer.
4-Kidney Cancer.
5-Bone marrow cancer.
6-Endometrium Cancer.

28. Part (D):
How can obesity affect your life
quality?
Obesity and body weight control
mechanism
Obesity and physical activity

29. Bad Nutrition
Habits and
Physically
Inactive.
Due to complex
synergistic interplay
between both: genetic,
epigenetics and
environmental risk
factors, mainly diet and
physical activity, which
act by means of
mediators of energy
intake and energy
expenditure.
Once u become obese ,
your whole life will
change , its already
start to changing when
you were at the risk of
becoming obese when
you started doing bad
nutrition habits and
physically inactive.

30. Obesity and PA:
Modest but attainable
increases in the level of
physical activity,
especially for those who
are currently inactive or
sedentary, could have
important positive
health effects.

32. Physical inactivity, which has progressively increased over the past several decades,
significantly increases the risk of numerous diseases/disorders, including several forms
of cancer, diabetes, hypertension, coronary and cerebrovascular diseases,
overweight/obesity, and all-cause mortality, among others. Unless there is a reversal
of this sedentary lifestyle, the incidence of these diseases/disorders will increase, life
expectancy will decrease, and medical costs will continue to rise .For instance, one
estimate predicts that these diseases would be reduced by almost one third if the most
inactive portions of the population increased their activity levels.

33. So what are
the benefits of
physical
activity in
weight
management?

34. - Helps n regulating appetite
- increases BMR (Basel Metabolic Rate)
-Reduces genetic fat deposit set-point level.
-Reduces body fat and increases lean body
content
There is a myth that exercise will increase
appetite, which counteracts the effects of
exercise.
-Bone disease: increases bone
mineralization
Strong muscles put tension on bones,
thereby increasing bone density.
-Mental health: stimulates production of
brain opiates.
-Stress Management:
Produces feelings of self-worth.
Provide socialization
Assessment of personal health and
exercise needs

35. Part (E) :
Diseases associated with
obesity

36. Metabolic syndrome : 30% of
middle‐aged people in developed countries
have features of metabolic syndrome.
Type 2 diabetes: 90% of type 2
diabetics have a body mass index (BMI) of
>23 kg m−2
Hypertension : 5× risk in obesity. 66%
of hypertension is linked to excess weight ,
85% of hypertension is associated with a
BMI >25 kg m−2
Coronary artery disease (CAD) and
stroke :3.6× risk of CAD for each unit
change in BMI , Dyslipidaemia
progressively develops as BMI increases
from 21 kg m−2 with rise in small
particle low‐density lipoprotein , 70% of
obese women with hypertension have left
ventricular hypertrophy , Obesity is a
contributing factor to cardiac failure in
>10% of patients , Overweight/obesity
plus hypertension is associated with
increased risk of ischemic stroke
Respiratory effects : Neck circumference of
>43 cm in men and >40.5 cm in women is
associated with obstructive sleep apnoea,
daytime somnolence and development of
pulmonary hypertension.
Cancers : 10% of all cancer deaths among
non‐smokers are related to obesity (30% of
endometrial cancers).
Reproductive function : 6% of primary
infertility in women is attributable to obesity.
Impotency and infertility are frequently
associated with obesity in men.
Osteoarthritis (OA): Frequent association in
the elderly with increasing body weight – risk
of disability attributable to OA equal to heart
disease and greater to any other medical
disorder of the elderly.
Liver and gall bladder disease: Overweight
and obesity associated with non‐alcoholic fatty
liver disease and non‐alcoholic steatohepatitis
(NASH). 40% of NASH patients are obese;
20% have dyslipidaemia

38. Part (F) :
What is the successful
long-term weight loss
maintenance?

39. Obesity is a serious problem and must be
treated accordingly with big lifestyle changes.
One important aspect is maintaining weight by
introducing many factors including diet and
exercise. A healthy nutrient balanced diet and
moderation is key as the diet contributes to
around 70% of weight loss, the other 40%
goes to the equally important physical activity.
Energy in and energy out is a crucial aspect in
losing weight or maintaining it, so becoming
active is extremely beneficial to one’s overall
health and can even reduce stress. Sleeping
the recommended 7 to 8 hours a night is also
very important, as those who neglect sleep are
shown to gain more weight due to hormonal
imbalances. Weight gain can also be
contributed to genetics and even prescription
medication, so consulting with a physician is
important for people dealing with obesity,
because even the smallest weight loss can
improve your health.

40. Part (G):
Anorexia Nervosa VS. Bulimia
nervosa

41. Anorexia nervosa
-Many people with anorexia nervosa see themselves as overweight, even when
they are clearly underweight. Eating, food, and weight control become
obsessions. People with anorexia nervosa typically weigh themselves repeatedly,
portion food carefully, and eat very small quantities of only certain foods. Some
people with anorexia nervosa may also engage in binge-eating followed by
extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of
laxatives, diuretics, or enemas.
Bulimia nervosa
Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is
considered a healthy or normal weight, while some are slightly overweight. But like
people with anorexia nervosa, they often fear gaining weight, want desperately to lose
weight, and are intensely unhappy with their body size and shape. Usually, bulimic
behavior is done secretly because it is often accompanied by feelings of disgust or
shame. The binge-eating and purging cycle happens anywhere from several times a
week to many times a day.

42. Anorexia nervosa is
characterized by:
Extreme thinness (emaciation)
A relentless pursuit of thinness
and unwillingness to maintain a
normal or healthy weight
Intense fear of gaining weight
Distorted body image, a self-
esteem that is heavily influenced
by perceptions of body weight
and shape, or a denial of the
seriousness of low body weight
Lack of menstruation among girls
and women
Extremely restricted eating.

43. Bulimia nervosa is characterized by recurrent and frequent episodes of eating
unusually large amounts of food and feeling a lack of control over these
episodes. This binge-eating is followed by behavior that compensates for the
overeating such as forced vomiting, excessive use of laxatives or diuretics,
fasting, excessive exercise, or a combination of these behaviors.

45. Any
Questions ?

46. HELP yourself
H : Healthy
E : Eating
L : Lifestyle
P : Plane

47. References :
1. Al-Domi 2019. PHD.Hydar al-domi , Department of Nutrition , University Of
Jordan
2. World Health Organization , https://www.who.int/en/news-room/fact-
sheets/detail/obesity-and-overweight
3. Overweight and obesity among Jordanian women and their social determinants ,
http://www.emro.who.int/emhj-vol-19-2013/12/overweight-and-obesity-among-
jordanian-women-and-their-social-determinants.html
4. http://www.annclinlabsci.org/content/42/3/320.full
5. https://www.ajpmonline.org/
6. Global, regional, and national prevalence of overweight and obesity in children
and adults during 1980-2013: a systematic analysis for the Global Burden of
Disease Study 2013.
7. https://www.ncbi.nlm.nih.gov/pubmed/24880830

48. 1. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-789X.2007.00311.x
2. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-
biology/adipogenesis
3. https://www.obesityaction.org/get-educated/understanding-your-weight-and-
health/what-is-obesity/
4. https://www.medicalnewstoday.com/articles/262226.php
5. https://www.medicalnewstoday.com/articles/323551.php
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516224/