The document discusses obesity as a complex global epidemic affecting 1.9 billion overweight individuals, with 600 million classified as obese. It examines contributing factors such as dietary patterns, genetics, and physical inactivity, along with the serious comorbidities linked to obesity like cardiovascular disease and diabetes. The document also outlines assessment techniques, medical and surgical management options, and the importance of education, dietary changes, and exercise in obesity treatment.

1. OBESITY
Presented by: Rutvi Raualji (MPT)

2. Contents
• Introduction
• Obesity: a global pandemic
• Causes of obesity
• Co-morbidities due to obesity
• Complications

3. Introduction
• Obesity refers to the condition of
having an excessive amount of body
fat.
• Over-weight refers to body weight
that exceeds some average for
stature perhaps age.
• Prevalence: 1.9 billion people were
overweight; 600 million people
were obese.

4. Obesity- A Global Epidemic
• Complex condition with serious and psychological dimensions that impact
all age and socio-economic groups both developed and developing
countries.
• Obesity results from imbalance between daily energy intake and energy
expenditure resulting in excessive weight gain.
• An excessive fat gain results from complex interactions of:
1. Genetic
2. Cultural
3. Insomnia
4. Social
5. Environmental
6. Physiological
7. Energy metabolism
8. Behavioural
9. Food habits

5. Causes of obesity
1. Dietary pattern
2. Fast food and obesity link in
adults
3. Genetics/ Hereditary
4. Physical inactivity

6. DIETARY PATTERN
• Changes in diet and reduced energy expenditure
via patterns of work often referred as nutrition
transition- leading to obesity worldwide.
• Adverse changes in diet- which is composed of
greater saturated fat and added sugars; reduction
in complex carbs, dietary fruits and vegetables.
FAST FOOD AND OBESITY LINK IN
ADULTS
• Fast food consumption is one/ more times per
week.
• Characteristics of fast food: excessive amount of
refined starch, added sugar, high fat content, low
dietary fibre.
• Research suggests fast food directly increased
energy intake and is inversely proportional to the
quality of food.
GENETICS
• Researches have provided dear evidences of a
biological mechanism susceptible to gain weight
and is dominated by high calorie food and
sedentary lifestyle.
• Protein encoded gene F70 is affected and makes
person susceptible of becoming obese.
PHYSICAL INACTIVITY
• Regular physical activity, through either
recreation or occupation can help to minimize
weight gain and fat gain.
• Increases tendency to regain lost weight and
counters a common genetic variation that makes
people more likely to gain excess weight.
• Variation in physical activity accounts for >75%
of weight gain.

7. Co-morbidities due to obesity
1. Cardiovascular disease
2. Hypertension
3. Type 2 DM
4. Dyslipidaemia
5. Ischemic stroke
6. Sleep apnoea
7. Degenerative joint disease
8. Cancer
9. Fertility problem
10. Peripheral vascular disease

8. Criteria for Excessive Body Test
• 3 approaches
1. Percentage of body mass
composed of fat
2. Distribution/ patterning of fat
at different anatomic regions
3. Size and number of individual
fat cells

9. Patterning of adipose tissue
• 2 types:
1. Abdominal area (central/ android
type);
2. Peripheral gynoid type
• Increased in central fat: causes
heart disease
• Male: Percentage of visceral fat
increases progressively with age
• Female: Increases at onset of
menopause
Subtypes
of
Abdominal
Obesity
Subcutaneous abdominal obesity:
Accumulation of fat around belly
which is obviously visible.
Retroperitoneal fat: Fat gets
accumulated around the kidney
region generally visible.
Visceral fat: Fat gets accumulated
around intestine, liver. (Not visible
fat)

11. Investigations
1. Thyroid function test
2. Blood sugar
3. Abdominal USG
4. MRI to see visceral fat
5. ECG
6. Lipid profile

12. Assessment in Physiotherapy
1. BMI
2. Waist-to-Hip ratio
3. Skin fold measurements

13. Assessment
➢BMI:
• To access normalcy of
one’s body mass.
• Related to stature and
body mass
• BMI= body mass (kg)/
(height)2 (m2)
• Classification of
overweight and obesity
Category BMI
Underweight <18.5
Normal 18.5-24.9
Overweight 25.0-29.9
Obesity Class 1 30.0-34.9
Obesity Class 2 35.0-39.9
Obesity Class 3 ≥ 40.0

14. ➢Waist-to-Hip ratio:
• An indicator of pattern of distribution of subcutaneous
adipose tissue.
• Distribution of fat: important indicator of congestive heart
failure
• More fat is abdominal area- increases risk of CHD
• Men generally have a higher ratio than women
• Women: 0.85-1.7 (high risk); <0.85 (low risk)
• Men: 0.95-1.9 (high risk); <0.95 (low risk)
• Waist measurement: locate narrowest point between ribs
and iliac crest
• Hip measurement: locate greater trochanter and measure
widest lateral extension of hips

15. ➢Skin fold measurement:
• Predicts body fatness
• Pincer calliper mainly used.
• Site:
1. Biceps: Vertical fold at anterior midline of upper arm
2. Triceps: Vertical fold at posterior midline of upper arm,
hallway between tip of shoulder and elbow
3. Subscapularis: oblique fold just below bottom tip of
scapula
4. Abdomen: vertical fold 1 inch to the right of the umbilicus
5. Supra iliac: Oblique fold just above hip bone
6. Thigh: vertical fold at midline of thigh, 2/3rd distance from
middle of the patella to hip.
• Average man has 15%-17% of body fat; and average woman
has 18%-22% of body fat.

17. ➢Bioelectrical impedance analysis
• A low level of electric current is
passed through client’s body and
impedance is measured.
• Electrolytes are good conductors of
electric current, therefore when
volume is large, current flows
more easily through body with less
resistance.

18. ➢Air displacement technique:
Individual sits inside small
chamber
Computerized pressure sensors
determine the amount of air
displaced by person
Difference of air volume with person
inside the chamber from volume of
empty chamber – calculates body
volume
Body density and fat percentage is
calculated

19. Medical Management
• Orlistat- Anti-lipase – it
causes coating of
intestine where fat is not
absorbed.

20. Surgical Management
1. Bariatric surgery
2. Lipo-suction
3. Gastric clamping and Bypass
surgery

21. Aims to manage obesity
1. Education of the client
2. Optimal nutrition
3. Behavioural interventions: Increased exercise and physical activity
along with medical supplementations

22. 1.) Education
• To break the myth: Many people are falsely led to
believe that they can lose weight without putting
in effort or changing from sedentary lifestyle.
• Guiding the client utilizing exercise as means of
reducing obesity.
• Encourage them to make list of personal reasons
to adopt active lifestyles.
• Set short-term goals- this focus attention of
participants toward behaviour change.
• Self managements technique like planning and
goal setting.

23. 2.) Dietary Exercise
➢ Low Carbohydrate Ketogenic diets:
• Ketogenic diets emphasize carbohydrate restriction while generally
ignoring total calories and diet cholesterol and saturated fat content.
• Restricting daily carbohydrates intake to less than or equal to 20 grams
mobilizes fat for energy
➢ High Protein diets:
• Low carbs and high protein- may pose health risks
• High quality protein+ Carbohydrates+ Essential Fatty Acids+
Micronutrients= Improves diet safety
• Extreme high protein intake- supresses appetite through fat mobilization
and ketone formation.
➢ Semi- Starvation Diet: Therapeutic Fasts or Very Low Caloric Diet
(VLCD):
• Diet provides between 400-800kcal- high quality protein foods/ liquid
meal replacement
• These breaks established dietary habits and reduces appetite.

24. 3.) Exercises for weight control
• Most desirable solution is to increase energy output.
• Physically active individual usually maintains desirable
body composition
• Increase level of regular physical activity along with
dietary restrains maintains the weight loss more
efficiently.
• Regular exercises produces less accumulation of central
adipose tissue associated with aging.
Increase
calorie
expenditure
Negative
energy
balance
Weight loss
Improves:
physical
fitness, health
risk profile,
alters body
composition
and body fat
distribution

25. Ideal exercise consists of continuous, large muscle
action with moderate to high caloric cost such as
circuit resistant training, walking, running, rope
skipping, stair stepping, cycling and swimming.
Aerobic training
Resistance training

26. Caloric restraint + Exercise = Ideal combination
• Provides more flexibility in reducing weight.
• Advantages:
1. Increases overall size of energy deficit
2. Facilitates lipid mobilization and oxidation from adipose tissues
3. Increase relative body fat loss by preserving fat free body mass.
4. Requires less reliance on caloric restrains
5. Contributes to long term success
6. Provides significant health related benefits
7. Offsets deterioration in immune system function- accompanies weight loss

27. Behaviour Therapy
1. It provides a set of strategies for patients to modify their eating and
physical activity.
2. Record keeping: individual tracks the type and amount of foods and
beverages consumed, along with their caloric content. This helps in
monitoring eating patterns, select targets for reducing calorie intake
and track progress in meeting daily calorie goals.
3. Tracking weight regularly; once a week during weight loss and as
often as daily during weight loss maintenance.

28. Complications
Cardiovascular complications
•Hypertension, Congestive heart failure, Cor Pulmonale, Varicose veins, Pulmonary embolism, Coronary artery disease
Endocrine complications
•Metabolic syndrome, Type-2 DM, Dyslipidaemia, Polycystic ovarian syndrome
Respiratory complications
•Dyspnoea, Obstructive sleep apnoea, Hypo-ventilatory syndrome, Asthma
Gastro-intestinal complications
•Gastro-oesophageal reflex disorder, Non-alcoholic fatty liver, Bladder stone, Hernia, Colon cancer
Genito-urinary complications
•Urinary stress incontinence, Breast and uterine cancer, pregnancy related complications, hypogonadism
CNS complications
•Cerebrovascular stroke, Idiopathic intracranial hypertension, Peripheral neuropathy, Dementia
Miscellaneous
•Depression, Psychological disorder, Cellulitis, Lymphedema, Carbuncles, Acanthosis nigricans

29. References
• Physiology of Sports and Exercise- Jack H. Wilmore, David L. Costill
• Exercise Physiology- William D. McArdle, Frank I. Katch, Victor L.
Katch
• Alamuddin N, Bakizada Z, Wadden TA. Management of obesity.
Journal of Clinical Oncology. 2016 Dec 10;34(35):4295-305.
• Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and
management of obesity. New England Journal of Medicine. 2017 Jan
19;376(3):254-66.

30. That’s all folks.