This document discusses obesity, including its definition, causes, health risks, and management. Obesity is defined using body mass index (BMI), skin fold thickness, and waist circumference. It can be caused by physical inactivity, eating habits, genetic factors, or secondary issues like hypothyroidism. Managing obesity involves lifestyle changes like diet, exercise and behavior modification, as well as potential pharmacological or surgical options. The goals are to reduce weight by about 10% and maintain weight loss long term.

1. Obesity
PRESENTED BY:
DR.JAYNIKA GARASIA
Asst. Professor
Department of Kayachikitsa
Shri. O. H. Nazar Ayurveda college, Surat

2.  Obesity defined as abnormal or excess fat accumulation that
present a risk to health.
 it's a medical problem that increases the risk of other diseases
and health problems, such as heart disease, diabetes, high blood
pressure and certain cancers.

3.  The term obesity implies excess of adipose tissue measured by following;
 WHO has recommended following standards for definitions of obesity
Body mass index(BMI)
It is defined as person’s weight (kg) divided by the square of person height
(meters).
WHO classification of obesity
Classification BMI (kg/m2) Associated health risk
Underweight <18.5 Low (but risk of other clinical problems higher)
Normal 18.5–24.9 ----
Over weight
Pre-obese 25–29.9 Increased
Obese class I 30–34.9 Moderately increased
Obese class II 35–39.9 Severely increased
Obese class III ≥40 Very severely increased

4. Skin fold thickness
 Estimated by using special callipers.
 Skin fold thickness measured over triceps, biceps,
subscapular and supra-iliac regions.
 Normal triceps skin fold thickness in males-12.5 mm.
 Normal triceps skin fold thickness in females-16.5 mm.

5. Waist circumference
 Waist measurement at the narrowest
segment between ribcage and iliac crests.
 Waist circumference >80 cm in females
 >90 cm in males indicate abdominal obesity.

6. Causes
Simple obesity
 Physical inactivity
 Eating habits
 Psychological factors
 (overeating may be a symptom of depression,
anxiety and frustration)
 Genetic factors

7. Secondary obesity
 Hypothyroidism
 Cushing's syndrome
 Hypothalamic disorders
 Diabetes mellitus
 Medications
 valproic acid, carbamazepine, antidepressants, corticosteroids,
antipsychotics.

8. Risks Associated with Obesity
 Coronary artery disease
 Type 2 diabetes mellitus and insulin
resistance
 Hypertension
 Stroke
 Breast, endometrial and colon cancers
 Varicose veins
 Depression
 Dyslipidaemia
 Cholelithiasis
 Sleep apnoea syndrome
 Osteoarthritis
 Increase in all-cause
mortality
 Deep vein thrombosis

9. Lipoprotein Lipase
 Synthesised by adipocytes.
 Induces obesity by causing deposition of fat in adipose tissue.

10. leptin
 leptin signals to the hypothalamus
in the brain to alert food intake
and conrol energy expenditure.
 leptin produce in fat cell.
 when we eat ,it signals to the
brain that we are full.it works
with hormone gherlin, which tells
our brain that we are hungery.
 leptin’s level increases as stomuch
empties and decreases as stomuch
fills.
 Gherlin acts to stimulates appetite.
 before eating plenty of gherlin
produced by stomuch , making us
hungry.

11. Role of Leptin
 Leptin is a hormone produced by cells of adipose tissue. It
controls food intake and energy expenditure.
 It acts on leptin receptors (expressed in specific regions of the
hypothalamus) to activate and regulate hypothalamic
neuropeptides.
 A defect in leptin gene or its receptor may produce obesity.
 Of obese persons, some have a low level of leptin in the blood
while majority have high leptin levels indicating peripheral
resistance to its actions.
 Defective leptin gene or leptin receptor may be responsible for
only a minority of patients with obesity.

12. MANAGEMENT OF OBESITY
Goals
 Attempt initially to reduce weight by approximately 10% from
baseline. Further weight reduction is attempted after initial success.
 Reduce weight at a rate of about 1/2-l kg per week for 6 months.
 5–10% Weight loss or weight maintenance.
 Lifestyle modification with diet and increased physical activity.
 Pharmacological weight loss therapy.
 Bariatric surgery.

13. Dietary Therapy
Low-Fat Diet
 Encourage low-calorie diets with low
fat. The reduction is usually to the tune
of about 500 calories per day.
 Reducing fat alone without reducing
total calories is not sufficient.
 Low-fat diets also have higher fibre
content and this may also enhance
satiety.
 Unfortunately, many patients cannot
maintain low-fat diet for long time.

14. Very Low Carbohydrate Diet
 Use of very low carbohydrate diet
 These diets work by reducing caloric intake by removing a wide
range of carbohydrate-rich foods.

15. OMEGA 3 FATTY ACIDS FOODS
Omega-3 fatty acids can
significantly reduce blood
triglyceride levels.

16. High-Protein Diet
 It makes use of the increased satiating effect of protein with
reduction in carbohydrate. Fat is kept low at 30%.
 These high protein-low carbohydrate diets induce fat burning which
results in suppression of hunger and promotion of satiety.
 High dietary protein intake increases urinary calcium excretion with
potential risk for bone loss and calcium stone formation.
 Increased risk of colorectal cancer, if increased amount of red meat
is consumed.

17.  Physical Exercise
 It reduces abdominal fat and increases cardiorespiratory fitness.
 Moderate exercise should be done for 30-45 minutes/day and 3-5
days a week.

18. Physical Activity
 60-90 min of daily activity (at least 30 min). Gradual
increases in physical activity should be encouraged to
enhance adherence and avoid injury.
 Advises multiple short (10 to 15 minutes) bouts of activity
(walking breaks at work, gardening, or household work).
 Using simple exercise equipment (e.g., treadmills),
jogging, swimming, biking, golfing, team sports, and
engaging in resistance training.
 Regular exercise is supposed to play a role in decreasing
abdominal fat, preventing regain of weight and thus
maintenance of weight, for those who have once
successfully reached up to desired level of weight by
exercise.
 Avoiding common sedentary activities in a leisure time
(television watching and computer games).

19.  Behaviour Modification
 It is a useful adjunct to diet and physical exercise.
 Patients often require motivation to lose weight.

20. Behaviour Therapy:
 Behavioral therapy should be designed to provide
the patients with a set of principles and techniques
to modify their eating and activity habits.
 Behavioral change should include the benefit of
social support, stress management, the value of a
regular exercise regimen and an improvement in
eating habits (e.g., setting goals, planning meals,
reading labels, eating regular meals, reducing
portion sizes, self-monitoring, and avoiding eating
binges).
 Originally, the treatment was exclusively based on
the learning theory (behaviorism).

21. Pharmacotherapy
 Dietary therapy, physical exercise and behaviour modification should be
considered before using drugs.
 Drugs may be used if BMI > 30 kg/m2 .
 Drugs may also be used, if BMI is 27-30 kg/m2 and the patient has an increased
risk:
 Asian ethnicity.
 Overweight/obesity-related disease likely to improve with weight loss, such as
type 2 diabetes, obstructive sleep apnea and dyslipidaemia of obesity.
 The patient should be monitored for safety throughout.
 If patient has not lost at least 5% of their body weight by week 12 of using drugs,
consider for discontinuation.

22. Drugs
 Sibutramine
 Suppress appetite
 inhibits reuptake of noradrenaline and serotonin, promoting and
prolonging satiety.
 Dose – 10 mg starting, may be increased to 15 mg dailyif inadequate
wt. loss on 10 mg.
 Give along with life style modification.
 Side-effects – Dry mouth, constipation, insomnia, noradrenergic effects
of the drug can cause tachycardia and increased blood pressure.
Sibutramine should be avoided in patients with arrhythmia or
uncontrolled hypertension.

23.  Orlistat
 It is an intestinal lipase inhibitor. It generates malabsorption of 30%
dietary fat.
 Binds intestine and Pancreatic lipase and helps in Lipid metabolism
 and thus it Reduces absorption of dietary TG, Chol., and fat soluable
vitamins.
 Dose – 120 mg with each of the main meals, to be taken immediately
after a meal or one hour later.
 Side effects – are related to effect of fat malabsorption such as loose
stools, faecal urgency and flatus. The drug should be used only in patients
who can adhere to a low-fat diet.

24.  Statins. e.g.-Atrovastin, Rosuvastin
 It lowers LDL level and LDL-C lowering is the primary treatment goal of dyslipidemia.
 Fibrates--e.g.-Clofibrate, Fenofibrate.
 Fibrates are a type of cholesterol-lowering medication. They work by decreasing your
triglycerides and increasing your HDL cholesterol.
 In people with high triglycerides, fibrates can significantly reduce the risk of heart
disease, heart attack and stroke.
 Niacin-e.g.- Niacor, Niaspan.
 Niacin is used with diet changes (restriction of cholesterol and fat intake) to reduce the
amount of cholesterol (a fat-like substance) and other fatty substances in your blood and
to increase the amount of high density lipoprotein

25. Surgery
 Known as bariatric surgery.
 Useful in patients with BMI > 40 kg/m2 when other methods have
failed, and patients with BMI > 35 kg/m2 who have identifiable
medical, physical or psychosocial problems associated with their
obesity.

26. Various options include
 Jaw wiring-
 There was a period in the 1970s and 1980s when doctors wired
shut the jaws of people for up to a year to help them lose
weight. People did lose weight initially when their jaws were
wired shut.
 Jejunoileal shunt.
 A procedure consisting of the surgical anastomosis of the
proximal portion of the jejunum connected to the distal
portion of the ileum, bypassing the nutrient-absorptive
segment of the small intestine.

27.  Gastroplasty or sleeve gastrectomy.
 gastroplasty can reduce the size of the stomach .
 Laparoscopic adjustable gastric banding.
 The band allows food to be retained in your upper pouch
for a longer period of time, causing you feel fuller more
quickly. Then, the food passes to your lower stomach and
digestion happens normally. There is no change in the way
food is absorbed.
 Liposuction.
Liposuction is a cosmetic
surgery used to remove
excessive fat deposited
between the muscle and
the skin.