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![• Height-weight chart:
▫ Weight 10% to 20% above ideal body weight is
overweight;
▫ 20% or more above ideal body weight is obesity.
▫ Ideal weight calculation
1. Broca’s index = Height (cms) – 100
2. Corpulence index =
This should not exceed 1.2
3. Ponderal index = Height (cm)
3
weight (kg)
4. Lorentz’s formula
= [Height (cm) – 100] – Height (cm) – 150
2(women) or 4(men)
Actual weight
Desirable weight](https://image.slidesharecdn.com/obesity-230410053934-85962ec7/85/OBESITY-pptx-17-320.jpg)
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OBESITY.pptx
- 1. DR B.RAJASEKHAR CONSULTANT NEPHROLOGIST ADITYAMULTISPECIALITY HOSPITAL
- 2.
- 5. Definition • Obesity isan abnormal growth of the adipose tissue due to an enlargement of fat cell size (hypertrophic obesity) or an increase in fat cell number (hyperplasic obesity)or a combination of both. • Obesity is an abnormal increase in the proportion of fat cells characterized predominantly by adipocyte hypertrophy.
- 6. Table 2.0: Estimatedglobal prevalence and numbers of people with obesity and severe obesity in 2010, 2020, 2025 and 2030 Obesity prevalence defined by BMI 2010 2020 2025 2030 % n % n % n % n Women Obesity (Class I, II and III) ≥30kg/m2 14 304m 17 445m 18 512m 20 586m Severe obesity (Class II and III) ≥35kg/m2 4 100m 6 159m 7 188m 7 219m Severe obesity (Class III) ≥40kg/m2 1 32m 2 54m 2 65m 3 77m Men Obesity (Class I, II and III) ≥30kg/m2 9 207m 13 324m 14 380m 15 439m Severe obesity (Class II and III) ≥35kg/m2 2 44m 3 79m 3 96m 4 114m Severe obesity (Class III) ≥40kg/m2 0.5 11m 1 22m 1 28m 1 34m All adults Obesity (Class I, II and III) ≥30kg/m2 11 511m 15 764m 16 892m 18 1,025m Severe obesity (Class II and III) ≥35kg/m2 3 143m 5 238m 5 284m 6 333m Severe obesity (Class III) ≥40kg/m2 1 42m 2 77m 2 93m 2 111m
- 7. Table 3.0: Estimatedglobal DALYs and deaths in 2019 attributed to high BMI, and as a proportion of all preventable NCDs Global DALYs Global deaths Attributed to high BMI N = 160m, equivalent to 2,070 per 100,000 N = 5m equivalent to 64 per 100,000 Proportion of all preventable NCDs 21.5% 18.0%
- 8. Table 3.6: NCDDALYs per 100,000 that result from BMI in the South East Asian region Country DALYs per 100,000 population Indonesia 2,701 Sri Lanka 2,443 Thailand 2,311 Myanmar 2,038 India 1,511 Bhutan 1,409 Nepal 1,079 Bangladesh 1,031 Maldives 964 Timor-Leste 680
- 9. Table 5.0: Obesityprevalence and numbers amongst children aged 5-9 years and 10-19 years in 2020 and 2030, by WHO region Children 5-9y 2020 2020 2030 2030 % No. % No. AFR 5% 7m 9% 16m AMR 19% 14mm 23% 17m EMR 12% 10m 15% 13m EUR 13% 7m 16% 9m SEA 6% 10m 12% 20m WPR 18% 22m 27% 29m World 11% 71m 15% 103m Children 10- 19y 2020 2020 2030 2030 % No. % No. AFR 3% 8m 6% 20m AMR 15% 22m 19% 27m EMR 8% 12m 13% 22m EUR 8% 9m 11% 13m SEA 3% 12m 8% 25m WPR 10% 24m 18% 43m World 7% 86m 11% 150m
- 10. Table 5.7: 2030projections for child obesity (5-19 years) in South East Asia Country Prevalence 2030 Thailand 22% Maldives 18% Indonesia 14% Sri Lanka 13% Timor-Leste 12% Myanmar 11% Bhutan 10% Bangladesh 8% India 8% Nepal 6%
- 11. Etiology • Age ▫ Canoccur at any age. • Sex ▫ Women are more likely to gain weight than men with the same calorie intake. ▫ Menopause contribute in weight gain. ▫ Pregnancy also contribute to the development of obesity in women
- 12. • Genetic ▫ Familyhistory • Biologic Basis ▫ Change in regulation of eating behavior, energy metabolism, body fat metabolism by hypothalamus. ▫ Increased circulating plasma levels of leptin, insulin, and ghrelin, and decreased levels of peptide YY. ▫ Interaction of these hormones and peptides at the level of the hypothalamus. ▫ Alterations of adipokines (hormones secreted by adipocytes and cytokines) Decreased level of Adiponectin Increased level of Resistin
- 13. • Environmental Factors ▫Greater access to pre-packed food, fast food and soft drinks. ▫ Increased portion size of meals ▫ Eating outside home ▫ Lack of physical exercise ▫ Low Socioeconomic status ▫ Lack of sleep • Psychosocial Factors ▫ Tendency to overeat ▫ Social gatherings or parties • Eating Habits ▫ Excessive calorie intake • Alcoholism • Smoking
- 14. • Drugs ▫ Corticosteroids ▫Contraceptives ▫ Insulin ▫ Beta-adrenergic blockers ▫ Antidepressants ▫ Anti-seizure drugs ▫ Antipsychotic drugs • Disorders ▫ Endocrine disorders ▫ Congenital anomalies ▫ Metabolic problems ▫ Chromosomal anomalies ▫ CNS disorders.
- 15. Pathophysiology Long-term sedentary lifestyleand/or excessive calorie intake Imbalance between energy expenditure & energy intake Adipocyte hypertrophy Increases adipocyte volume & increases lipid storage Visceral and subcutaneous fat accumulation Alterations of adipokines Overweight or Obesity Increases risk for diseases
- 16. Measurements of obesity •Height-weight chart • Body mass index (BMI) • Waist circumference • Waist-to-hip ratio • Skinfold Thickness
- 17. • Height-weight chart: ▫Weight 10% to 20% above ideal body weight is overweight; ▫ 20% or more above ideal body weight is obesity. ▫ Ideal weight calculation 1. Broca’s index = Height (cms) – 100 2. Corpulence index = This should not exceed 1.2 3. Ponderal index = Height (cm) 3 weight (kg) 4. Lorentz’s formula = [Height (cm) – 100] – Height (cm) – 150 2(women) or 4(men) Actual weight Desirable weight
- 18. • Body massindex (BMI): ▫ Best methods for defining obesity. ▫ BMI = Weight (kg)/Height (m2) • Below 18.5 • 18.5–24.9 • 25.0–29.9 • 30.0-34.9 • 35.0-39.9 • ≥ 40.0 Underweight Normal Overweight Obese class I Obese Class II Obese Class III or Morbid obesity
- 19. • Waist circumference: ▫≥102 cm in men and ≥88cm in females is associated with an increased risk of metabolic complications. • Waist-to-hip ratio ▫ Preferred tool to measure for overweight and obesity when the patient is predominantly muscular. ▫ The waist measurement is divided by the hip measurement to calculate the ratio. ▫ WHR of <0.80 is optimal. ▫ WHR greater than 0.8 indicates greater risk for health complications. ▫ A high WHR (> 1.0 in men and > 0.85 in women) indicates abdominal fat accumulation.
- 20. • Skinfold Thickness ▫For assessing body fat. ▫ Several varieties of callipers are used. (E.G., Harpenden skin callipers) ▫ Normal finding is mid triceps + mid biceps + sub scapular + supra iliac = 50mm in women or 40 mm in men.
- 21. Classification of obesity 1.Primary obesity and secondary obesity 2. According to BMI 3. According to body shape or fat distribution
- 22. • Primary obesity ▫Due to excess calorie intake for the body's metabolic demands. • Secondary obesity ▫ Due to various congenital anomalies, metabolic problems, chromosomal anomalies, or CNS disorders.
- 23. • According toBMI ▫ Individuals with a BMI • 25.0–29.9 • 30.0-34.9 • 35.0-39.9 • ≥ 40.0 Overweight Obese class I Obese Class II Obese Class III or Morbid obesity • In the view of genetic susceptibility, Union Ministry of Health and Family Welfare of India has scaled down the BMI to >23 kg/m2 to be classified as overweight.
- 24. Health risks associatedwith obesity • Increased mortality ▫ Especially associated with visceral fat • Type 2 Diabetes • Hypertension • Coronary heart disease & stroke • Metabolic syndrome • Cancer- Colon cancer, breast cancer in postmenopausal women, endometrial cancer • Gallstones • GERD • Asthma
- 25. • Osteoarthritis • Lowback pain • Reduced fertility • Sleep apnoea (interrupted breathing during sleep) • Liver disease • Kidney disease • Pregnancy complications ▫ Gestational diabetes ▫ Pre-eclampsia ▫ Foetal defects • Obesity reduces life expectancy by an average of 3 to 10 years according to its severity.
- 27. Diagnostic measures • Historycollection • Physical examination ▫ Full medical assessment • Measurements of obesity • Laboratory examination ▫ Fasting lipid profile ▫ Liver function tests ▫ Thyroid function tests ▫ Fasting glucose and haemoglobin A1c(HBA1c)
- 28.
- 29. Life style modifications NutritionalTherapy Physical activity Behavior modification
- 30. Nutritional Therapy • Calorie-RestrictedWeight-Reduction Diet ▫ Low calorie diet 800-1200 calories per day ▫ Very Low calorie diet Less than 800 calories per day
- 31. Healthy eating habits •Limit total fat intake and shift fat consumption away from saturated fats to unsaturated fats and elimination of trans fats. ▫ Eat fat-free and low-fat dairy products, such as low-fat yogurt, cheese, and milk. ▫ Avoid whole milk, whole-milk cheese, cream, butter, and ice cream ▫ Avoid foods containing solid fats(vanaspati ghee, coconut, and palm oils) such as deep fried fast foods ▫ Limit foods prepared with partially hydrogenated oils (doughnuts, cookies, crackers, muffins and cakes). ▫ Limit use of ground beef, sausage, and processed meats.
- 32. • Increase consumptionof fruits, vegetables, pulses, whole grains, legumes and nuts • Limit intake of sugar and salt. • Eat regularly. Do not skip meals. • Reduce fat intake by baking, or steaming foods. Portion size • Measure foods to determine the correct portion size. • Avoid oversized portions. • Use a smaller plate, bowl, and glass.
- 33. Food weight • Eatfoods that are lower in calories and fat for a given amount of food. ▫ For eg: replacing a full-fat food product that weighs two ounces with a low-fat product that weighs the same. • Eat foods that contain a lot of water, such as vegetables, fruits, and soups. Fad diet • Weight-loss plan that promises dramatic results. • Typically, these diets are not healthy and don't result in long-term weight loss.
- 34. Physical activity • Regularphysical exercise. • To increase energy expenditure. • Daily 30 minutes to 1 hour per day.
- 35. Behavior modification • Changingbehaviors or habits related to food and physical activity is important for losing weight. • Change the habits promoting weight gain such as watching television for long hours. • Self monitoring ▫ Keep a record of weight loss. • Stimulus control • Reward the success for meeting weight-loss goals.
- 36. Pharmacotherapy • Only asadjuncts to a nutritional therapy and exercise program. • Prescribed only when BMI is 28 kg/m 2 or more with other weight related conditions or BMI 30 kg/m 2 or more. • Two categories of drugs: 1) Appetite-suppressing drugs 2) Nutrient absorption blocking drugs
- 37. Appetite-suppressing drugs Noradrenergic drugs Serotonergicdrugs Mixed noradrenergic-serotonergic drugs Noradrenergic drugs • Reduce food intake by noradrenergic mechanism in the CNS. • Recommended only for short term use- less than 12 wks. • Eg: phentemine, diethyipropol, phendimetrazine, Benzpbetamine
- 38. Serotonergic drugs • Actby either increase the release of serotonin or decrease its uptake, thus reducing the metabolism. • Not currently used because of its adverse effects. Mixed noradrenergic-serotonergic drugs • Inhibits both serotonin and norepinephrine uptake, thus decreases appetite. • Eg: Sibutramine
- 39. Nutrient absorption blockingdrugs • Eg: Orlistat • Inhibits the action of intestinal lipases, thus block breakdown and absorption of fat in the intestine.
- 40. Surgical management • Thefield of obesity surgery is called bariatric surgery • Indications ▫ Morbid obesity. ▫ Gross obesity for 5 years ▫ Failure to reduce weight with other forms of therapy ▫ Body weight 100% above ideal weight ▫ Presence of a high-risk condition that weight loss would relieve.
- 41. Bariatric surgeries Bariatric surgeries Vertical Banded Gastroplasty Restrictive surgeries AdjustableGastric Banding Malabsorptive surgeries Biliopancreatic Diversion Biliopancreatic Diversion with Duodenal Switch Combination of malabsorptive & restrictive Roux-en-Y gastric bypass
- 42. Restrictive surgeries • Reducesthe size of a stomach to 30 ml or less, which causes the patient to feel full quicker. 1. Vertical Banded Gastroplasty • Involves partitioning the stomach into a small pouch in the upper portion along the lesser curvature of the stomach. • This small pouch drastically limits capacity.
- 43. 2. Adjustable Gastric Banding •Stomach size is limited by an inflatable band placed around the fundus of the stomach. • Referred to as LapBand B. • The band is connected to a subcutaneous port and can be inflated or deflated (by fluid injection in the hospital) to change the stoma size to meet the patient's needs as weight is lost. • Laparoscopic procedure.
- 44. Malabsorptive surgeries • Lengthof the small intestine is decreased, so that less food is absorbed. 1. Biliopancreatic Diversion • Involves removing approximately three fourths of the stomach • The remaining portion of the stomach is connected to the lower portion of the small intestine. • Most of the calories and nutrients are routed into the colon. • Nutrients pass without being digested.
- 45. 2. Biliopancreatic Diversionwith Duodenal Switch • Variation of Biliopancreatic Diversion. • Half of the stomach is removed, leaving a small area. • The entire jejunum is excluded from the rest of the GI tract. • The duodenum is disconnected and sealed off. • The ileum is divided above the ileocecal junction and the distal end of the jejunum is anastomosed to the first portion of the duodenum. • The distal end of the biliopancreatic limb is anastomosed to the ileum.
- 46. Combination of Restrictive& Malabsorptive Surgery 1. Roux-en-Y gastric bypass • Most common bariatric surgery. • In this procedure, the stomach size is decreased with a gastric pouch anastomosis that empties directly into the jejunum.
- 47. Cosmetic surgeries • Toreduce fatty tissue and skin folds. 1. Lipectomy 2. Liposuction
- 48. 1. Lipectomy • Alsocalled adipectomy. • To remove unsightly flabby folds of adipose tissue. • Up to 15% of the total fat cells are removed from the breasts, abdomen, lumbar and femoral areas. 2. Liposuction • Also called suction assisted Lipectomy. • Liposuction is a surgical procedure that uses a suction technique to remove fat from specific areas of the body, such as abdomen, hips, thighs, buttocks, arms or neck. • A long hollow stainless steel cannula is inserted through a small incision over the fatty tissue to be suctioned.
- 49. Nursing diagnosis • Imbalancednutrition: more than body requirements related to excessive intake in relationship to metabolic needs. • Impaired skin integrity related to alterations in nutritional state, immobility, excess moisture and multiple skinfolds • Ineffective breathing pattern related to decreased lung expansion from obesity. • Chronic low self-esteem related to body size, inability to lose weight.
- 50. Postoperative Care • Maintainairway. • Manage pain. • Elevate head end at 35° to 40 angle to reduce abdominal pressure and increase tidal flow. • Wound care. • ROM exercises. • Early ambulation. • Measures to prevent thrombophlebitis. • Change position every 1 every to 2 hours.
- 51. • IV fluidsand NG tube feeding. • Breathing and coughing exercises. • Frequent mouth and nose care. • Frequent observation of wound for the amount and type of drainage, condition of the sutures, and signs of infection. • Maintain hygienic needs, skin care. • Maintain intake output chart.
- 52. Postoperative dietary management •Immediate postoperative period (first 24 hr) ▫ Water and sugar-free clear liquids are given (30 ml every 2 hr while awake). • At 1 day to 2 weeks postoperatively ▫ A high-protein liquid diet every 2 hours while awake. • At 2 to 4 weeks postoperatively ▫ A pureed diet is provided at frequent intervals. • At 4 to 6 weeks ▫ Starts on a transition diet that includes solids, as well as pureed foods.
- 53. Discharge instructions: • Eatthree meals per day (containing protein and fiber). • Include two protein snacks per day. • Restrict total meal size to less than 1 cup. • Eat slowly. • Chew thoroughly. • Eat only foods packed with nutrients (eg, peanut butter, cheese, chicken, fish, beans). • Do not eat and drink at the same time. • Drink plenty of water, from 90 minutes after each meal to 15 minutes before the next meal. • Avoid liquid calories, such as alcoholic beverages, fruit drinks, and regular soda (cola). • Walk for at least 30 minutes per day.
- 56.