This document discusses obesity, including its definition, classification, epidemiology, morbidity and mortality, assessment and measurements, prevention and management, and addressing barriers. Obesity is defined as abnormal or excessive fat accumulation that may impair health. It is classified based on body mass index (BMI) and other criteria. Globally, obesity rates have significantly increased over recent decades and are associated with increased risk of diseases such as heart disease, diabetes and some cancers. Assessment methods include BMI, waist circumference, skin fold thickness and other measurements. Prevention and management involves diet, exercise, weight loss medications and sometimes surgery. Addressing obesity requires efforts across multiple levels including individual lifestyle changes, community programs, and national policies.

1. OBESITY
DR C.VANKHUMA
Associate Professor of
Community Medicine

2. PRESENTATION OVERVIEW
• Definition
• Criteria for classification.
• Epidemiology and diseases associated with obesity
• Morbidity/mortality associated with it.
• Assessment & measurements of obesity
• Prevention & Management
• Addressing barriers and efforts by stakeholders

3. SESSION LEARNING OBJECTIVES
▪ To enable the learner to define , describe and discuss the
epidemiological features of Obesity.
▪ To enable the learner to enumerate and prescribe the various
assessment methods and measurements and laboratory test
of obesity and its management at a primary care level.
▪ To enable the learner to understand and discuss the
preventive and epidemiological control measures.

4. DEFINING OBESITY
“Overweight and obesity are defined as abnormal or
excessive fat accumulation that may impair health.” -
World Health Organization

5. DEFINING OBESITY
AMA debate: Is obesity a disease or a condition/risk factor?
“…recognize obesity as a disease state with multiple
pathophysiological aspects requiring a range of interventions
to advance obesity treatment and prevention.”
– American Medical Association

6. CLASSIFICATION BASED ON WORLD HEALTH
ORGANIZATION

7. CLASSIFICATION OF OBESITY IN CHILDREN
Children/Adolescents CDC
Growth Charts (2-19 yrs)
• Sex/age-specific BMI
• BMI ≥ 95th percentile is obese
• 85th to less than 95th
percentile is overweight
Children under 5 years of age (WHO) :
•Overweight is weight-for-height greater than 2
standard deviations aboveWHO Child Growth
Standards median;
•Obesity is weight-for-height greater than 3
standard deviations above theWHO Child Growth
Standards median.
Children aged between 5–19 years(WHO) :
•Overweight is BMI-for-age greater than 1
standard deviation above the WHO Growth
Reference median;
•Obesity is greater than 2 standard deviations
above theWHO Growth Reference median.

8. AETIOLOGY

9. GLOBAL BURDEN
• 4 million people dying each year as a result of being overweight or
obese in 2017 according to the global burden of disease.
• From 1975 to 2016( 40 yrs), the prevalence of overweight or obese
children and adolescents aged 5–19 years increased more than four-fold
from 4% to 18%
• 39% of adults aged 18 years and over were overweight in 2016, and
13% were obese.
• 39 million children under the age of 5 were overweight or obese in
2020
• INDIA : In NFHS-5, the percentage of overweight or obese women is
24%, up from 20.6 % and 19% to 23% among men in NFHS-4 (2015-
16)

12. RAISED BMI AND NON-COMMUNICABLE
DISEASES
Raised BMI is a major risk for
• Heart Disease
• Stroke
• Diabetes
• Musculoskeletal disorders (especially osteoarthritis – a highly
disabling degenerative disease of the joints)
• Some cancers (including endometrial, breast, ovarian, prostate,
liver, gallbladder, kidney, and colon)

13. MORBIDITY ASSOCIATED WITH OBESITY
• Type 2 Diabetes
• Cardiovascular Disease
• Stroke
• Hypertension
• Nonalcoholic fatty liver
disease
• Osteoarthritis
• Some cancers

15. MORBIDITY FROM CHILDHOOD OBESITY
• Preschoolers who are overweight or obese are 5 times
as likely to be overweight or obese as adults
• Obesity in children associated with high cholesterol and
blood sugar, asthma, mental health problems,
cardiovascular disease risk factors
• ~50% ofType 2 diabetes incidence in adolescence versus
3% a few decades ago
• Effective obesity treatments can decrease risks of developing
such diseases.

16. ASSESSMENT &
MEASUREMENTS OF OBESITY

17. MEASUREMENTS OF OBESITY
• BODY MASS INDEX- BMI was first used in 1835 as a way to
estimate the proportion of body fat based on height and weight
• BMI has low sensitivity, especially below 30
• Cannot discern fat vs. muscle content or metabolic risk factors
• Validity?

18. BMI + WAIST CIRCUMFERENCE
MEASUREMENTS OF OBESITY

19. MEASUREMENTS OF OBESITY
• PONDERAL INDEX:
• (<40 Overweight)
• BROCA INDEX:
• LORENTZ FORMULA:
• CORPULENCE INDEX
• (normal < 1.10)
• ,>1.10 Overweight ,
• >1.2 Obese)

20. MEASUREMENTS OF OBESITY
SKIN FOLD THICKNESS (SFT):
• Rapid & non-invasive method of fat assessment
• –‘Herpenden skin calipers' are good for estimation of SFT
• –Main drawback: Poor repeatability (Poor precision)
• –Measurement at 4 sites: Mid-triceps, biceps, sub-scapular, supra-iliac
regions.
• Sum > 50 mm in girls indicate obesity
• Sum > 40 mm in boys indicate obesity
• Single best measurement site of skin fold thickness: Mid triceps
• - 18 mm in boys indicate obesity
• - 32 mm in girls indicate obesity

21. ASSESSMENT & MEASUREMENTS OF OBESITY
Herpenden skin calipers

22. ASSESSMENT & MEASUREMENTS OF OBESITY

23. ASSESSMENT & MEASUREMENTS OF OBESITY
• WAIST CIRCUMFERENCE (WC) :
• Good predictor of risk of
cardiovascular diseases
• WAIST: HIP RATIO (WHR):
• High WHR indicates abdominal fat
accumulation
• -WHR > 1.0 in men indicate
obesity
• WHR > 0.85 in women indicate
obesity
Cut-offs for waist circumference in India:

24. ASSESSMENT & MEASUREMENTS OF OBESITY
• How to Measure Your Waist to Hip Ratio
• Measure at the smallest point. Wrap a tape measure around your waist
at the smallest point, usually around your belly button. This is your waist
circumference. Record the number.
• Measure your hips. Next, wrap the tape measure around your hips at the
widest part. This is your hip circumference. Record the number.
• Divide. Use a calculator to divide your waist size by your hip size. This is
your waist-to-hip ratio.

25. ASSESSMENT & MEASUREMENTS OF OBESITY
WEIGHT: HEIGHT RATIO (WHTR) :
• WHO has declared WHt Ratio as ‘best indicator of cardiovascular risk’
• WHtR is ‘age and sex independent’
• Cut-off for WHtR: 0.5
• CVD risk increase if WHtR >0.5
[NEW INDICATOR OF CV RISK by WHO]
OTHER INDICATORS:
• Total body water
• Total body potassium
• Body density
• Measurement of fat cells in the
body.

26. PREVENTION & MANAGEMENT

27. PREVENTION & MANAGMENT
• Weight Reduction - 5 - 10 % of body weight over 6 months.
• Reduce Intake of Calories - Proposed limits are :
• 1000 - 1200 calories for a woman and
• 1200 - 1600 calories for a man per day.
• Eating small frequent meals, and reducing portion sizes are other
ways to reduce calories.
• Eating healthy - high in fiber and low in saturated and trans fat,
cholesterol, sodium and added sugar especially high fructose
syrup.

28. PREVENTION & MANAGMENT
• Moderate but regular aerobic exercises such as stretching
,walking, swimming, gardening and dancing provided it
does not exceed their cardiovascular capacity as well as
bone and muscle strength.
• Promotion of exercise &
physical activity

29. PREVENTION & MANAGMENT
• Counseling & behavior therapy
• Weight-loss medicines are used if it is not possible
to lose 1 pound per week after 6 months of lifestyle
changes.
• They have to be taken along with other methods like
diet and exercise.
• Doctors have to monitor the person continuously while
taking weight-loss medications.

30. PREVENTION & MANAGMENT

31. PREVENTION & MANAGMENT
Weight-loss surgeries may be an option, usually as a last resort, and are only
recommended in case of morbid or gross obesity for adults with a BMI of 35
or above. or for those who have a life-threatening condition.

32. ADDRESSING THE BARRIERS TO HEALTHY DIET
• Access to healthy food
• Food advertising
• Avoid large portion sizes
• Affordability of healthy food
• Time constraints
• Established behaviors

33. ADDRESSING BARRIERS TO PHYSICAL ACTIVITY
• Safety issues
• Areas non-conducive to
physical activity or exercise
• Time constraints
• Established behaviors
• Sedentary lifestyle

34. COMMUNITY LEVEL INTERVENTION
• STATE AND LOCAL PROGRAMS
• Resources are available to help disseminate consistent
public health recommendations and evidence-based
practices for state, District and local public health
organizations and practitioners.
• “ Fit India Movement’
• COMMUNITY EFFORTS
• To reverse the obesity epidemic, community efforts should
focus on supporting healthy eating and active living in a
variety of settings. Learn about different efforts that can be
used in early childhood care, hospitals, schools,
and food service venues.

35. NATIONAL LEVEL INTERVENTION
• India’s flagship nutrition
programme – Poshan Abhiyaan,
which was launched in 2018
• The program has also
identified obesity as a
concerning factor in India.
• The third annual report of
Poshan Abhiyan said that “the
nation needs to mobilize solid
efforts to address the emerging
and cross-cutting challenges of
urbanization and Overweight-
Obesity ”.

36. • Health promotion, awareness generation and
promotion of healthy lifestyle
• Screening and early detection
• Timely, affordable and accurate diagnosis
• Access to affordable treatment,
• Rehabilitation

37. CHECK YOUR PROGRESS
• What do you understand by Obesity, its causes , classification and
mention the preventive and control measures.
• What are the complications arising out of obesity or Morbidity and
Mortality associated with Obesity.
• How will you assess an obese patient/ What are the various tools for
measurements for obesity.
• Write Short notes on Epidemic of Childhood Obesity.

38. REFERENCES
1. Park'sTextbook of Preventive And Social Medicine
2. IAPSM’sTextbook of Community Medicine
3. Obesity - WHO | World Health Organization
4. Health service delivery framework for prevention and
management of obesity -WHO