ThiQar college of Medicine

.Family & Community medicine dept

Nutrition L7, 3rd stage/online
by: Dr. Muslim N. Saeed
June 15th ,2020
 Obesity
Overview
Assessment
Demographics
Determinants of Obesity
Medical Complications
 Assessment
The primary parameter used to categorize weight is BMI:
BMI= body Wt.(Kg) / squared Ht. in meters
-18.5 and 24.9 is normal in adults
-25 to 29.9 is overweight
-30 to 34.9 is class I obesity, 35 to 39.9 is class II
obesity.
Class III, “severe,” or “extreme” obesity is 40 and
higher. Calculated from height and weight and expressed
in kg/m2.
BMI is a recommended parameter to assess
obesity, but an imperfect tool to measure
adiposity (example greater lean body mass
.rather than adiposity in muscular individuals)
Demographics
 :Gender Differences -1
Men are more likely than women to be overweight,
.whereas women are more likely to be obese
Men, however, are more likely to have central
.obesity, associated with greater health risks
Race and Ethnic Origin -2
Socioeconomic Status: The prevalence ranges from -3
approximately 2% in the least developed countries to
.over 30% in the most developed countries
:Education Level -4
Education level is inversely related to the risk of
.obesity
:Rural and Urban Differences -5
the prevalence of obesity is greater in rural
than urban areas. Factors that reduce physical
.activity may play a role
:Age -6
The incidence of overweight increases steadily
.after age 20 until the seventh decade of life
Determinants of Obesity
Genetic Factors .1
Most of the genetic influence on obesity is poly-
genic. Single-gene mutations related to obesity
.often involve leptin and melano-cortin
Modulation of Appetite .2
Many hormonal factors are involved in appetite,
as well as in the absorption, storage, and use of
.calories
Factors providing input to the brain include
leptin levels, vagal activity, and fluctuation in
.plasma glucose levels
:Lifestyle Influences .3
obesity develops when caloric intake exceeds
caloric expenditure against a background of
.genetic influences
The chief determinants of energy imbalance are
.lifestyle factors
Individual total energy requirements depend on
the basal metabolic rate (BMR), thermic effect
of food, and energy needed for the day’s
.physical activities
:Caloric Intake .4
.tendency to consume more calories needed-
Some of this increase is related to increased-
.portion size
The frequency of meals may play a small role.-
Eating smaller meals more frequently is
.associated with less overweight
Large meals are associated with more insulin-
.release
Activity Changes .5
Decreased energy expenditure may play a
greater role in the development of obesity than
.increased caloric intake
Medications .6
A number of medications are associated with
weight gain, including antidepressants,
antipsychotics, anticonvulsants, and
.hypoglycemic agents
Tricyclic antidepressants, systemic steroid use
.can cause a cushinoid type of obesity
Insulin, as well as oral hypo-glycemics that-
increase production or release of insulin,
.promote weight gain
Metformin, is associated with modest weight-
.loss
Endocrine and Metabolic Factors .7

Specific endocrine or metabolic disorders

known to cause obesity account for less than
.1% of the obese population
A.Hypothyroidism
in children, associated with slow statural-
.growth and developmental delay
More common among adults and more often-
seen in women, hypothyroidism is a relatively
.rare cause of obesity
B. Cushing’s Syndrome
This endocrine disorder is associated with
.central obesity
C. Polycystic Ovary Syndrome
More than 50% of women affected by this
.relatively common disorder are obese
Insulin resistance is a consistent finding, even
.in the absence of obesity
D. Growth Hormone Deficiency
Although growth in height is impaired in growth
hormone deficiency, there is also an increase
.in truncal obesity
Medical Complications of obesity
Hypertension .1
The obesity-related to increase in blood
pressure is associated with an increase in
vascular resistance. Weight loss is the most
effective lifestyle change to decrease blood
.pressure
Dyslipidemia .2
Obesity is associated with elevated TG levels,
.reduced HDL , and an increase in LDL
Type 2 Diabetes Mellitus.3
The risk of T2DM is low below a BMI of 22 to 23
kg/m2. For men, the risk of Type 2 DM above a
BMI of 35 kg/m2 increased 60-times. Up to 80%
of cases of T2DM can be attributed to overweight
.and obesity
Weight loss is recommended to lower glucose
levels in overweight and obese persons with
.T2DM
Metabolic Syndrome .4
The metabolic syndrome brings together a number
.of the comorbidities associated with obesity
Heart Disease .5
The presence of obesity lead to cardiomyopathy
and congestive heart failure (CHF) as the workload
.of the heart increases
Cancer .6
Obesity may be associated with Cancers of the
.esophagus, colon, kidney, gallbladder, and pancreas
Also, increased risk of prostate, gastric, ovarian,
.and endometrial cancers
Pulmonary Disease .7
Obesity can have an impact on overall lung function, It
.increases the work of breathing
Obesity increases pressure on the diaphragm, reducing lung
.function
.Asthma is exacerbated with increased weight
.About 70% of Obstructive Sleep Apnea patients are obese
Fatty Liver Disease .8
.fatty liver disease is first described in obese females
Orthopedic Disorders .9
Overweight children have an increased risk genu
.valgus, and scoliosis
In adults, degenerative joint disease, is related in
part to mechanical factors resulting in increased
.compressive forces on the knee
Gallbladder Disease .10
Obesity, is a risk factor for gallbladder disease,
because cholesterol production increases with
.weight gain, and cholesterol is excreted into bile
Psychological Impact .11
Self-awareness of overweight and the
associated psychological impact can be seen in
.children and can result in poor self-esteem
Also, his may result in poor body image,
.especially in young women
In adults, obesity is associated with depression
.in women
End