Obesity: For More Information About The Authors and Reviewers of This Module

Obesity Partners in Global Health Education
1. How to use this

module
2. Learning
outcomes
3. Definition Welcome to the obesity module.
4. Classification
5.
6.
Section 1 quiz
Global burden of
The rapid rise in the prevalence
obesity of obesity in both rich and poor
7. Section 2 quiz countries in recent years has
8. Pathogenesis been described as an epidemic.
9.
10.
Section 3 quiz
Effects of obesity
At the global level, excess body
11. Section 4 quiz weight is the sixth most important
12. Childhood obesity risk factor for ill health. Many
13. Section 5 quiz adverse health outcomes are
14. Management of
obesity
strongly associated with obesity.
15. Section 6 quiz
16. Summary
17. Information
sources For more information about the authors and reviewers of this module, click here
How should I study this module? Introduction 2
Partners in Global Health Education
1. How to use this

module
2. Learning 1. We suggest that start with the learning 5. Repeat the module until you have
outcomes objectives and try to keep these in mind achieved a mark of >80%.
3. Definition as you go through the module slide by
4. Classification slide, in order. 6. Finish with the formative multiple
5. Section 1 quiz choice questionnaire to assess how
6. Global burden of well you have covered the material as
obesity 2. Print-out the mark sheet. a whole.
7. Section 2 quiz
8. Pathogenesis
3. As you go along, write your answers to 7. You should research any issues that
9. Section 3 quiz
the questions on the mark sheet as best you are unsure about. Look in your
10. Effects of obesity textbooks, access the on-line
you can before looking at the answers.
11. Section 4 quiz resources indicated at the end of the
12. Childhood obesity module and discuss with your peers
13. Section 5 quiz 4. Award yourself marks as detailed on the and teachers.
14. Management of mark sheet: one mark for each keyword
obesity (shown in red text) in the short answer 8. Finally, enjoy your learning! We hope
15. Section 6 quiz questions and for every correct answer that this module will be enjoyable to
16. Summary in the True/False questions. study and complement your learning
17. Information about obesity from other sources.
sources
Learning Outcomes Partners in Global Health Education
1. How to use this

module
2. Learning By the end of the module, you should be able to:
outcomes
3. Definition
4. Classification 1. Define obesity in terms of body mass index (BMI)
5. Section 1 quiz
6. Global burden of 2. Classify obesity in terms of body fat distribution and BMI values
obesity
7. Section 2 quiz 3. Describe the burden of obesity on the world population
8. Pathogenesis
9. Section 3 quiz 4. Discuss the role of lifestyle, genetic predisposition and other causal
10. Effects of obesity
11. Section 4 quiz
factors in the pathogenesis of obesity
12. Childhood obesity
5. Describe the association between obesity and type II diabetes,
13. Section 5 quiz
14. Management of hypertension, cancer and reproductive disorders
obesity
15. Section 6 quiz 6. Define childhood obesity and understand how it relates to adult obesity
16. Summary
17. Information 7. Identify the treatment options available for people with obesity
sources
How is obesity measured? Introduction 1
1. How to use this

module
2. Learning
Obesity is defined as the excessive accumulation of body fat.
outcomes
3. Definition There are a number of ways to measure body fat:
4. Classification
5. Section 1 quiz 1. Measurements that are simple, cheap and appropriate for routine
6. Global burden of use include:
obesity • waist circumference
7. Section 2 quiz • hip circumference
8. Pathogenesis • waist-to-hip circumference ratio
9. Section 3 quiz • Indices derived from weight and height, e.g. body mass
10. Effects of obesity index
11. Section 4 quiz • skin fold thickness using callipers (e.g. triceps, scapular)
13. Section 5 quiz 2. Measurements of body fat that are expensive and require special
14. Management of equipment and highly trained personnel include:
obesity
15. Section 6 quiz • underwater weighing
16. Summary • bioelectrical impedance
17. Information • computerized topography
sources
Classification of obesity (1) –
‘apples’ and ‘pears’ Partners in Global Health Education
1. How to use this

module
Obesity can be classified into two groups on the basis of body fat distribution and the waist-to-hip
2. Learning
outcomes
circumference ratio. This simple classification is easily understood by the public and also
3. Definition predicts the risk of obesity-related health problems.
4. Classification
5. Section 1 quiz The pear shape:
The apple shape:
6. Global burden of
obesity
 also called “android”,  also called “gynaeoid” or
7. Section 2 quiz
8. Pathogenesis “abdominal” or “central” “peripheral” obesity
9. Section 3 quiz obesity
 people with lower waist to hip ratios
11. Section 4 quiz  people with high waist-to-hip ratios are are "pears“ - their body fat is distributed
12. Childhood obesity "apples", their body fat is distributed mainly on the lower trunk, the hips and
13. Section 5 quiz mainly on the upper trunk, the chest and thighs giving the typical ‘pear shape’.
14. Management of abdomen giving the typical ‘apple shape’
obesity  individuals are mostly female.
15. Section 6 quiz  individuals are mostly male
16. Summary  associated health risks are minimal if
17. Information  A waist-to-hip ratio >1.0 for men and any
sources
>0.8 for women indicates an increased
risk of cardio-vascular disease and
diabetes mellitus
Classification of obesity (2) –
body mass index (BMI) Partners in Global Health Education
1. How to use this

module
2. Learning
outcomes
3. Definition
The internationally accepted classification for obesity is the
4. Classification Quetelet's Index, also called the Body Mass Index (BMI)
5. Section 1 quiz
6. Global burden of
obesity The BMI is a measure of a person’s weight in relation to
7. Section 2 quiz
8. Pathogenesis
height and it is calculated as:
9. Section 3 quiz
11. Section 4 quiz weight divided by height squared (kg/m2)
13. Section 5 quiz
14. Management of
obesity
15.
16.
Section 6 quiz
Summary
BMI = weight in kilograms = kg/m2
17. Information square of height in meters
sources
WHO classification of obesity
tion 1
1. How to use this

module
2. Learning
outcomes
3. Definition
Classification BMI (kg/m2) Risk of co-morbidity
4. Classification
5. Section 1 quiz
Normal 18.5 - 24.9 Not increased
6. Global burden of
obesity Overweight or pre-obese 25.0 - 29.9 Increased
7. Section 2 quiz
8. Pathogenesis Obesity, further classified as: 30.0 Increased as follows:
9. Section 3 quiz
10. Effects of obesity – Class I 30.0 - 34.9 – Moderate
11. Section 4 quiz
12. Childhood obesity – Class II 35.0 - 39.9 – Severe
13. Section 5 quiz
14. Management of – Class III 40.0 – Very severe
obesity
15. Section 6 quiz Source: Adapted from WHO 1997
16. Summary
17. Information Note: Although overweight is identified by a BMI of ≥ 25.0 kg/m2, the risks of
sources
obesity-associated diseases, such as diabetes, hypertension and dyslipidaemia,
increase from a BMI of about 21.0 kg/m2.
A weight and height chart is a useful clinical tool to
determine a person’s BMI
oduction 1
1. How to use this

module
2. Learning
outcomes
3. Definition
4. Classification
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
obesity
15. Section 6 quiz
16. Summary
17. Information
sources Source: Weight Control Information Network , NIH
Advantages of BMI
1. How to use this
2.
module
Learning
Advantages of using BMI to classify obesity:
outcomes – it is low-cost and easy to use for health professionals for
3. Definition
4. Classification assessing individuals
5. Section 1 quiz
– it is commonly used to determine desirable body weights
6. Global burden of
obesity and allows people to compare their own weight status to
7. Section 2 quiz
8. Pathogenesis
that of the general population
9. Section 3 quiz – it correlates well with the amount of body fat as measured
11. Section 4 quiz
by more complex techniques
12. Childhood obesity – it predicts dangers associated with obesity; as BMI
13. Section 5 quiz
14. Management of
increases the risk for diseases increases
obesity
15. Section 6 quiz
– it is a useful screening tool to use at the population level
16. Summary and, because it is universally accepted, BMI reference data
17. Information
sources
is available for many different populations
Disadvantages of BMI
1. How to use this

module
2. Learning
outcomes 1.72 Ht 1.72
3. Definition
metre metre These men have the same
4. Classification height, weight and BMI, but have
84 Wt 84
5. Section 1 quiz Kg Kg different percent body fat
6. Global burden of
obesity BMI calculated as follows:
28.4 BMI 28.4
7. Section 2 quiz
8. Pathogenesis BMI = 84 = 84 = 28.4 kg/ m2
9. Section 3 quiz (1.72)2 2.96
11. Section 4 quiz (a) (b) Click to reveal answer
13. Section 5 quiz
Although BMI is equally high in both men, in (a)
14. Management of
obesity it is due to lean body mass whereas in (b) it is
15. Section 6 quiz due to body fat. This shows that, used alone, a
16. Summary Which of these men high BMI is not diagnostic of obesity. BMI also
17. Information is at risk of ill varies with age and sex in those <18 years.
sources health and why? These are some of the disadvantages of using
BMI to assess health risks.
End of Section 1 Partners in Global Health Education
1. How to use this

module
2. Learning
outcomes Well done!
3. Definition
4. Classification You have come to the end of the first section.
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of We suggest that you answer Questions 1 to 3 to assess your learning
obesity so far. Please remember to write your answers on the mark sheet
15. Section 6 quiz
before looking at the correct answers!
16. Summary
17. Information
sources
Question 1: Write “T” or “F” on the answer sheet. When you have completed all 5
questions, click on each box and mark your answer.
1. How to use this

Click for the
module
correct answer
2. Learning
outcomes
3. Definition a) Obesity is the excessive accumulation of body a
4. Classification
5. Section 1 quiz fat
6. Global burden of
obesity
7. Section 2 quiz
b) Body mass index (BMI) is the most universally b
8. Pathogenesis
accepted index of obesity
9. Section 3 quiz
c) A woman with a BMI of 46.0 is overweight c
11. Section 4 quiz
13. Section 5 quiz d) To calculate the BMI of an individual, we need
14. Management of
d
obesity the weight, height and body fat distribution
15. Section 6 quiz
16. Summary e) A man with weight 76 kg and height 1.55 m is e
17. Information
sources obese
Question 2: Complete the missing information on your mark sheet regarding
the classification of obesity and the associated health risk
Award yourself 1 mark for each right answer Partners in Global Health Education
1. How to use this

module
2. Learning
outcomes
3. Definition
4. Classification Classification BMI Health risk
5. Section 1 quiz
6. Global burden of
40.0
obesity
7. Section 2 quiz a? b?
8. Pathogenesis
9. Section 3 quiz
10.
11.
Effects of obesity
Section 4 quiz
Overweight c? Increased
13. Section 5 quiz
14. Management of d? <25.0 e?
obesity
15. Section 6 quiz
16. Summary
17. Information
Click to Reveal Answers
sources
Question 3: A 25 year old male athlete weighs 87.3kg and has a height
of 1.75m
Write your answers on the mark sheet. When you have completed all 3 questions, click on the box and mark your answers. Partners in Global Health Education
1. How to use this

module
2. Learning
outcomes
3. Definition
4. Classification a)Calculate his BMI
5. Section 1 quiz
6. Global burden of
obesity
b)How would you classify his BMI ?
7. Section 2 quiz
8.
9.
Pathogenesis
Section 3 quiz
c) Is the classification of obesity based
11. Section 4 quiz on BMI reliable for his man and, if not,
13.
14.
Section 5 quiz
Management of
why?
obesity
15. Section 6 quiz
16. Summary
17. Information
sources Click to Reveal Answers
The global burden of obesity Partners in Global Health Education
1. How to use this

module
The obesity epidemic that began in the United States during the late
2. Learning
1970s is now occurring the rest of the world. Public health officials
outcomes
are concerned that obesity is reaching epidemic proportions in both
3. Definition
adults and children. A high prevalence of obesity now occurs in the
4. Classification more affluent populations of countries that have food security
5. Section 1 quiz problems and significant rates of under-nutrition. Current data
6. Global burden of indicate that in the world today:
obesity
7. Section 2 quiz
 there are > 1.1 billion overweight adults, and at least 312
8. Pathogenesis million of them are clinically obese
9. Section 3 quiz  10% of all children are either overweight or obese, while 17.6
10. Effects of obesity million children under the age of five are estimated to be
11. Section 4 quiz overweight
12. Childhood obesity • The prevalence of obesity has increased by about 10-40% in the
13. Section 5 quiz majority of European countries in the past 10 years. Britain now
has the highest obesity rate in Western Europe: 50% of the UK The USA has the highest
14. Management of
obesity
population are overweight (BMI  25.0 kg/m2) and about 20% are obesity rate in the world. IN
obese (BMI  30.0 kg/m2). American adults, 50m are
15. Section 6 quiz
obese (BMI >30.0) and 6m have
16. Summary • Obesity levels range from 5% in China, Japan, and certain African class III obesity (BMI >40.0).
17. Information nations to over 75% in urban Samoa. Even in low prevalence Obesity in adolescents has
sources countries like China, rates are almost 20% in some cities. increased from 5% in 1966
-1970 to 14% in 1999.
Recent increase in the prevalence of obesity in the USA (1)
1. How to use this
module
2. Learning
outcomes
3. Definition
4. Classification
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
obesity
15. Section 6 quiz
16. Summary
17. Information
sources
Source: U.S. Center for Disease Control

Obesity in adults on the increase - worldwide
1. How to use this

module
Dramatic increases in obesity in recent years is not confined to the USA. These graphs
2. Learning
outcomes illustrate the rise in obesity in adults in both rich and poorer countries.
3. Definition
Prevalence of obesity (%)

4. Classification Former E. W. Samoa (urban) - 80
USA
5. Section 1 quiz Men Germany 25-69 yrs.
- 70
England 20-74 yrs. 25-65 yrs. - 60
6. Global burden of Brazil 16-64 yrs.
- 50
obesity Japan
- 40
25-64 yrs. - 30
7. Section 2 quiz 20+ yrs. - 20
8. Pathogenesis - 10
- 0
1973 1978 1991 1978 1991
9. Section 3 quiz 1982 1987 1993 1975 1989 1980 1966 1991 1995 1985 1989 1992
- 80
Prevalence of obesity (%)

- 70
11. Section 4 quiz - 60

Women - 50
- 40
13. Section 5 quiz - 30
- 20
14. Management of - 10
obesity - 0
1982 1987 1993 1975 1989 1980 1966 1991 1995 1973 1978 1991 1985 1989 1992 1978 1991
15. Section 6 quiz
16. Summary
17. Information
sources
The growing epidemic of obesity - Source: IOTF

Obesity in children living in poorer countries
1. How to use this

module
Africa & Middle East: 4 year olds Latin America and Caribbean: 4-10 year olds
2. Learning
outcomes
3. Definition
4. Classification Morocco Haiti & Dominican
Republic
5. Section 1 quiz Egypt
6. Global burden of Mexico
obesity
Niger Guatemala
7. Section 2 quiz Senegal
Yemen
8. Pathogenesis Nigeria
Columbia
9. Section 3 quiz Burkina Uganda
10. Effects of obesity Faso Peru Brazil
Kenya
11. Section 4 quiz
Cameroon Rwanda
Tanzania
13. Section 5 quiz Zambia <5% Paraguay
14. Management of <5% 5-9.9% Chile
obesity 5-9.9% Namibia Madagascar 10-14.9%
15. Section 6 quiz 10-14.9% 15-19.9%
16. Summary 15-19.9% >25%
>25% Zimbabwe
17. Information
sources
Source: adapted from IOTF unpublished data

Prevalence of overweight in 10-year old children in selected
countries
1. How to use this

module
2. Learning
outcomes Malta
3. Definition Italy
4. Classification USA
5. Section 1 quiz Chile
6. Global burden of Australia
obesity Germany
7. Section 2 quiz Venezuela
8. Pathogenesis Japan
9. Section 3 quiz Singapore
10. Effects of obesity France
11. Section 4 quiz UK
12. Childhood obesity Hungary
13. Section 5 quiz
Slovakia
China
14. Management of
obesity Hong Kong
15. Section 6 quiz Sweden Overweight girls
Brazil Overweight boys
16. Summary
Netherlands
17. Information
sources 40 30 20 10 0 10 20 30 40
%
Source: adapted from IOTF unpublished data
Projected prevalence of obesity in adults by 2025
1. How to use this

module
2. Learning
outcomes
3. Definition
4. Classification
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
obesity
15. Section 6 quiz
16. Summary
17. Information
sources
Source: IOTF data

The burden of obesity – costly, deadly…
1. How to use this

module The morbidity and mortality burden of
2. Learning The financial burden of obesity:
outcomes obesity:
3. Definition • Overall, about 2.5 millions deaths are
4. Classification
• WHO data show that obesity
attributed to overweight/obesity worldwide
5. Section 1 quiz accounts for 5-10% of the total
health
6. Global burden of
obesity care budget in several developed • In the UK, about 30,000 deaths are
7. Section 2 quiz countries attributable to obesity. Ten times this
8. Pathogenesis
figure occurs in the US where obesity is
9. Section 3 quiz
• This is probably a low estimate as the second greatest preventable cause of
10. Effects of obesity not all of the cost of management
11. Section 4 quiz of obesity and its related problems death following smoking
12. Childhood obesity can be calculated
13. Section 5 quiz • Nearly 70% of cases of cardiovascular
14. Management of • In 2000, the U.S. spent $117 billion
obesity
disease are associated with obesity
on obesity (9% of the national total
15. Section 6 quiz
health budget)
16. Summary • Obesity predisposes to an overall
17. Information reduction of quality of life and premature
sources
death from diet related, chronic non-
communicable diseases
1. How to use this
2.
module
Learning
Well done!
outcomes This is the end of the second section.
3. Definition
4. Classification
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
We suggest that you proceed to answer question 4 to assess your
obesity learning further. Do remember to write your answers on the mark
15. Section 6 quiz sheet before looking at the right answer!
16. Summary
17. Information
sources
Question 4: Write “T” or “F” on the answer sheet. When you have completed all 5
questions, click on each box and mark your answer.
1. How to use this Click for the

module correct answer
2. Learning
outcomes
a) obesity is a worldwide public health
3.
4.
Definition
Classification
problem a
5. Section 1 quiz
6. Global burden of
obesity b) obesity is not a major public health problem
7. Section 2 quiz in developing nations b
8. Pathogenesis
9. Section 3 quiz
10. Effects of obesity c) the highest rate of obesity is found in the
11. Section 4 quiz
U.S.A c
13. Section 5 quiz
14. Management of
obesity d) obesity related problems account for less
15. Section 6 quiz than 5% of healthcare budget in developed d
16. Summary
countries
17. Information
sources e) obesity leads to premature death from diet
related chronic communicable diseases
e
Calories in and calories out – the imbalance
1. How to use this

module
2. Learning The energy value of food can be expressed in
outcomes calories. Obesity occurs when a person consumes
3. Definition more calories than his/her body needs.
4. Classification
5. Section 1 quiz
Excess calories are stored as fat and lead to
6. Global burden of weight increase. For example, consuming 3,500
obesity
calories more than the body needs results in a gain
7. Section 2 quiz
of 0.45kg of fat.
8. Pathogenesis
9. Section 3 quiz
The factors which affect the balance between
11. Section 4 quiz
calories in and calories out differ from one person
to another. Obesity is believed to result from a
complex interplay of the following factors (click each
13. Section 5 quiz
factor for details):
14. Management of
obesity
15. Section 6 quiz Genetic factors
16. Summary Socio-economic (lifestyle and diet)
17. Information Cultural factors
sources
Psychological and medical factors
1. How to use this

module
2. Learning
outcomes
Well done!
3. Definition
4. Classification This is the end of the third section.
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
We suggest that you proceed to answer questions 5 and 6 to assess
obesity your learning further. Do remember to write your answers on the
15. Section 6 quiz mark sheet before looking at the right answer!
16. Summary
17. Information
sources
Question 5: Which of the following factors will increase the
risk of obesity in an individual?
Write “T” or “F” on the answer sheet, then click on each box to mark your answer. Partners in Global Health Education

2. Learning
outcomes
3. Definition
4. Classification a) physical inactivity a
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz b) consumption of fast foods b
8. Pathogenesis
9. Section 3 quiz
10.
11.
Effects of obesity
Section 4 quiz
c) psychological depression c
13. Section 5 quiz
14. Management of
obesity
d) normal sized parents d
15. Section 6 quiz
16. Summary
17. Information
sources
e) hyperthyroidism e
Question 6: Several factors play a role in the pathogenesis of
obesity. What risk factors match the following pictures?
1. How to use this

module
2. Learning
outcomes
3. Definition
4. Classification
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
b)?
11. Section 4 quiz
a)? Click to Reveal Answers
13. Section 5 quiz
14. Management of
obesity
15. Section 6 quiz
16. Summary
17. Information
sources
c)? d)?
Effects of obesity
1. How to use this

module Obesity is a disease. Associations with obesity are protean.
2. Learning Click on each medical association for details
outcomes
3. Definition
4. Classification Medical associations of obesity Other effects of obesity
5. Section 1 quiz
6. Global burden of
obesity  increase burden of disease world wide
7. Section 2 quiz
8. Pathogenesis
 Hypertension and type II diabetes  increase financial burden on national
9. Section 3 quiz health budgets
 coronary artery disease, and
11. Section 4 quiz stroke, cancers  decrease in overall life expectancy
and reproductive abnormalities  social effects including poor quality of
13. Section 5 quiz
14. Management of  psychological complications includin life
obesity
15. Section 6 quiz
g eating disorders, respiratory and o
16. Summary ther complications
17. Information
sources
1. How to use this

module
2. Learning
outcomes
Well done!
3. Definition
4. Classification This is the end of the fourth section.
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
Please answer questions 7. Do remember to write your answers on
obesity the mark sheet before looking at the right answer!
15. Section 6 quiz
16. Summary
17. Information
sources
Question 7: Which of the following are recognised associations of obesity.
Write “T” or “F” on the answer sheet, then click on each box to mark your answer.

2. Learning
outcomes a) Hypertension
3. Definition
a
4. Classification
5. Section 1 quiz
6. Global burden of b) Type 1 diabetes b
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz c) Osteoarthritis c
11. Section 4 quiz
12.
13.
Childhood obesity
Section 5 quiz d) Ovarian cancers d
14. Management of
obesity
15. Section 6 quiz
e
16. Summary e) Coronary heart disease
17. Information
sources
What is childhood obesity ? Partners in Global Health Education
1. How to use this

module
2. Learning
outcomes
3. Definition
4. Classification
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
obesity
15. Section 6 quiz
16. Summary
17. Information
sources
Source: 1998-2005 Self Realization Publications

Defining childhood obesity (1)
1. How to use this

module Obesity in childhood has reached epidemic levels. In the US, it is the most common nutritional
2. Learning disorder in children. Developing countries are also affected as the prevalence rises
outcomes among children of urban dwellers who emulate the ‘affluent western lifestyle’
3. Definition
4. Classification
5. Section 1 quiz
As in adults, the WHO uses the body mass
6. Global burden of
obesity index (BMI) as the standard definition of
7. Section 2 quiz obesity in children.
8. Pathogenesis
9. Section 3 quiz BMI is calculated with the same formula for
10. Effects of obesity children and adults, but the results are
11. Section 4 quiz interpreted differently:
13. Section 5 quiz • BMI for children, also referred to as BMI-
for-age, is gender and age specific
14. Management of
obesity
15. Section 6 quiz • BMI changes dramatically with age in
children as body fat changes with growth,
16. Summary
and between girls and boys with maturity
17. Information
sources
BMI-for-age, gender specific growth charts
used for children and teens 2 – 20 years of age.
Defining childhood obesity (2)
1. How to use this

module
2. Learning
In children, obesity is defined as a BMI greater than the 95 th percentile for age while overweight is
outcomes a BMI greater than the 85th percentile for age
3. Definition
4. Classification Classification BMI-for-age
5. Section 1 quiz BMI-for-Age is used for children and teens
6. Global burden of because of their rate of growth and Underweight < 5th percentile
obesity
development. It is a useful tool because:
7. Section 2 quiz
8. Pathogenesis
 BMI-for-age in children and
9. Section 3 quiz Normal 5th percentile
10. Effects of obesity adolescents compares well to to < 85th percentile
11. Section 4 quiz laboratory measures of body fat
13. Section 5 quiz  BMI-for-age can be used to track body Overweight 85th percentile
to < 95th percentile
14. Management of size throughout life
obesity
15. Section 6 quiz
16. Summary obesity > 95th percentile
17. Information
sources
Risk factors for childhood obesity
1. How to use this

module
2. Learning • obesity in one or both parents
outcomes
3. Definition • infants of diabetic mothers
4. Classification
5. Section 1 quiz • children from single parent families and families with fewer children
6. Global burden of
obesity
• higher birth weight and rapid growth during infancy are associated with an increased
7. Section 2 quiz
8. Pathogenesis
prevalence of obesity
9. Section 3 quiz
• formula feeding during infancy (breast feeding in women who did not smoke during
11. Section 4 quiz
pregnancy [but not in women who smoked during pregnancy] was significantly
12. Childhood obesity associated with a reduced risk of obesity)
13. Section 5 quiz
14. Management of
• sedentary lifestyle – increase TV viewing, computer games, car rides, including a
obesity reduction in number of mandatory physical education classes in schools especially
15. Section 6 quiz in the US
16. Summary
17. Information • increase consumption of sugar sweetened drinks, soda, snacks, energy dense fast
sources food in large portions
The relationship between childhood and adult obesity
1. How to use this

module Thirty percent of childhood obesity leads to adult obesity and 70% obese adolescents become
2. Learning
obese adults. The longer a child remains obese beyond age 3 years, the more likely that the obesity
outcomes will persist into adulthood. This true life story illustrates this – reproduced with the kind permission of
3. Definition Mrs. S.
4. Classification
Born in the 60’s with a birth weight of 2.7kg (normal weight), she
5. Section 1 quiz
quickly became plump in infancy. Neither parent was overweight
6. Global burden of
obesity (father 82.6kg and1.52m; mother 50.8kg and 1.52m)
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz Aged 13 –
10. Effects of obesity From the age of 7, she was significantly bridesmaid
11. Section 4 quiz heavier than her peers. In her early teens, at wedding
12. Childhood obesity she “weighed 88.9kg” and was advised by
13. Section 5 quiz her paediatrician to join a slimming club.
14. Management of The weight gain persisted till adulthood.
obesity
15. Section 6 quiz Married at age 40
She is currently on nine different weight - 178 kg,
16. Summary
17. Information
medications for obesity related problems Height - 1.65m
sources BMI = 66 kg/m2
The relationship between childhood and adult obesity
1. How to use this

module
2. Learning
outcomes Now that you have read this story, list 5 obesity-associated problems
3. Definition
that may occur in this woman.
4. Classification
5. Section 1 quiz Mrs S. actually developed
6. Global burden of 1. hypertension
obesity
7. Section 2 quiz
2. type II diabetes
8. Pathogenesis 3. hypothyroidism
9. Section 3 quiz 4. menorrhagia
5. recurrent cellulitis
11. Section 4 quiz
13. Section 5 quiz Other possible problems include:
14. Management of • osteoarthritis
obesity • stroke
15. Section 6 quiz
• metabolic syndrome
16. Summary
• coronary heart disease
17. Information
sources • menstrual disorders
• psychological disorders
• cancers – ovarian, endometrial, breast, cervical, prostate
1. How to use this

module
2. Learning
outcomes
You have come a long way!
3. Definition
4. Classification This is the end of the fifth section.
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
Please answer question 8. Do remember to write your answers on the
obesity mark sheet before looking at the right answer!
15. Section 6 quiz
16. Summary
17. Information
sources
Question 8: The following are statements about childhood obesity.
Write “T” or “F” on the answer sheet, then click on each box to mark your answer.
1. How to use this

module Click for the
correct answer
2. Learning
outcomes
3. Definition a) obesity is not a problem in children a
4. Classification
5. Section 1 quiz
6. Global burden of
b) BMI-for-age is used for children and
obesity teens because of their rate of growth and b
7. Section 2 quiz development
8. Pathogenesis
9. Section 3 quiz c) the use of BMI to define obesity does
10. Effects of obesity not depend on gender c
11. Section 4 quiz
13. Section 5 quiz d) BMI-for-age in children and adolescents
14. Management of compares well to laboratory measures of d
obesity body fat
15. Section 6 quiz
16. Summary
e) the longer a child remains obese beyond
17. Information
sources
age 3 years, the more likely that the e
obesity will persist into adulthood
Management of obesity
1. How to use this

module
Effective management of obesity requires long-term strategies and an integrated, multi-
2. Learning
outcomes disciplinary approach that includes community-based support for behavioural modification
3. Definition including diet and exercise. Research over the last decade indicates that a 5-10%
4. Classification reduction in body weight is sufficient to significantly improve medical conditions associated
5. Section 1 quiz with obesity, such as hypertension, diabetes mellitus, and elevated cholesterol levels.
6. Global burden of
obesity
Currently there is lack of evidence of effective programmes for integrated management of
7. Section 2 quiz
8. Pathogenesis
obesity. But the following management options for the management of obesity exist:
9. Section 3 quiz  dietary modification
 behavioural modifications
11. Section 4 quiz
12. Childhood obesity  physical activity
13. Section 5 quiz
 pharmacotherapy
14. Management of
obesity  bariatric surgery
15. Section 6 quiz
16. Summary
17. Information
As always, “prevention is better than cure”. Recently the UK government has set a target
sources to halt the rise in obesity in children aged ≤11 by 2010. Strategies for the prevention of
childhood and adult obesity may need to address factors during or before infancy that are
related to infant growth.
Management options (1)
1. How to use this

module
2. Learning
outcomes Dietary modification
3. Definition  the most common and conservative treatment for obesity utilizes a
4. Classification nutritionally balanced, low calorie diet
5. Section 1 quiz
6. Global burden of
 diet must include more fruit and vegetables, nuts, whole grains and
obesity exclude fatty and sugary foods
7. Section 2 quiz
8. Pathogenesis  weight-loss programs recommend diets consisting of 1,200 to 1,500
9. Section 3 quiz calories per day, usually in the following proportions: 60 percent
10. Effects of obesity carbohydrate, 30 percent fat, and 10 percent protein
11. Section 4 quiz
 individuals must be carefully screened and medically supervised while on
13. Section 5 quiz
the diet (the degree of weight loss being dependent on individuals ability
14. Management of
obesity
to adhere to dietary recommendations)
15. Section 6 quiz
16. Summary  studies have shown that meal replacements are often more effective than
17. Information very low calories diets, resulting in an increase in the amount of initial
sources weight loss and enabling dieters to maintain their weight loss
1. How to use this

module Behavioural modifications
2. Learning
outcomes
 many eating and exercise habits combine to promote weight gain.
3. Definition
keeping a food diary that records times, places, activities, and emotions may be linked
4. Classification
to periods of overeating or inactivity will reveal areas needing modification
5. Section 1 quiz
6. Global burden of
 lifestyle modification is best achieved when the affected individual is motivated,
obesity
enthusiastic and supported to achieve set goals
7. Section 2 quiz
8. Pathogenesis
 patients are helped to avoid eating while on their feet, watching TV or
9. Section 3 quiz
playing games. Eat home cooked meals rather than fast foods
11. Section 4 quiz
 motivated to walk rather than use cars, escalators, lifts. Reduce TV, computer game
hours, and use of energy saving devices
13. Section 5 quiz
14. Management of
obesity Physical activity
15. Section 6 quiz
16. Summary  research clearly indicates that regular exercise is the single best predictor for
17. Information achieving long-term weight control
sources
 regular exercise leading to weight loss has been shown to improve blood pressure
control, blood sugar levels in diabetics and other obesity-related complications
1. How to use this

module Pharmacotherapy
2. Learning  It is recommended that anti-obesity drugs be used only :
outcomes  in individuals aged 18-75yrs with a BMI of 30kg/m 2 or more
3. Definition  in individuals with a BMI of ≥27kg/m 2 with existing risk factors such as
4. Classification diabetes, cardiac disease, obstructive sleep apnoea or hypertension
5. Section 1 quiz  in individuals with a BMI of >30kg/m 2, in whom at least 3 months of managed
6. Global burden of care (supervised diet, exercise, and behaviour modification) fails to lead to
obesity
significant reduction in weight
7. Section 2 quiz
8. Pathogenesis  Two drugs have been licensed for use in the treatment of obesity:
9. Section 3 quiz • Orlistat - prevents fat digestion and absorption by binding to gastrointestinal
10. Effects of obesity lipases; useful for those with a high intake of fat
11. Section 4 quiz
• Sibutramine - reduces appetite and increases thermogenesis; recommended for
12. Childhood obesity those who cannot control their appetite
13. Section 5 quiz
14. Management of
obesity  These drugs should not be used as sole therapy for obesity. Their use requires strict
15. Section 6 quiz regular monitoring and must be discontinued if weight loss is <5% after 12 weeks of
16. Summary
use or weight gain recurs while on the drugs
17. Information
sources  Anti-obesity drug treatment should not be used beyond a year and never beyond two
years as few studies have examined the consequences of their long-term use
 Gradual reversal of weight loss is known to occur on stopping pharmacotherapy

1. How to use this

module
2. Learning
Bariatric surgery
outcomes
3. Definition  Surgery may be a weight-loss option for patients who are severely
4. Classification obese (with a BMI of  40 kg/m2 or those with BMI  35kg/m2 who suffer
5. Section 1 quiz
from serious medical complications).
6. Global burden of
obesity
7. Section 2 quiz  There are two accepted surgical procedures for reducing body weight:
8. Pathogenesis
gastroplasty and gastric bypass; both reduce the stomach to a small pouch
9. Section 3 quiz
that markedly limits the amount of food that can be consumed at any one
11. Section 4 quiz time.
13. Section 5 quiz
 Studies show that there is weight loss of 25 to 30% over the first year post
14. Management of
obesity operatively with rapid normalization of blood pressure and glucose in
15. Section 6 quiz patients with hypertension and diabetes. This is maintained for about five
16. Summary years after surgery. However, longterm monitoring is needed and surgery
17. Information is not without attendant operative risks.
sources
End of Section 6
1. How to use this

module
2. Learning
3.
outcomes
Definition
Well done!
4. Classification This is the last of the sections.
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
11. Section 4 quiz
13. Section 5 quiz
14. Management of
Please answer questions 9 and 10. Do remember to write your
obesity answers on the mark sheet before looking at the right answer!
15. Section 6 quiz
16. Summary
17. Information
sources
Question 9: Answer the following questions on the
management of obesity Partners in Global Health Education
1. How to use this

module
2. Learning
outcomes
3.
4.
Definition
Classification
a) List the current management options
5. Section 1 quiz for obesity
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis b) Surgery is sometimes considered in
9.
10.
Section 3 quiz
Effects of obesity
the management of obesity,
11. Section 4 quiz
12. Childhood obesity i. list the criteria for surgery
13. Section 5 quiz
14. Management of
obesity ii. what surgical options exist?
15. Section 6 quiz
16. Summary
17. Information Click to Reveal Answers
sources
Question 10: Mark the following statements as either True or
False
1. How to use this

Click for the
2. Learning
outcomes
3. Definition a) obesity management requires an
4. Classification integrated multi-disciplinary approach a
5. Section 1 quiz
b) regular exercise is the single best
6. Global burden of
obesity predictor for achieving long-term weight
7. Section 2 quiz control b
8. Pathogenesis
c) diet must exclude more fruit and
9. Section 3 quiz
vegetables, nuts, whole grains and include
fatty and sugary foods c
11. Section 4 quiz
12. Childhood obesity d) the criteria for use of pharmacotherapy is
13. Section 5 quiz a BMI > 20 kg/m2 with persistent co- d
14. Management of morbidity
obesity
15. Section 6 quiz e) a 5-10% reduction in body weight is
16. Summary sufficient to significantly improve medical e
17. Information conditions associated with obesity
sources
What Have I Learnt about Obesity? (1)
1. How to use this

module
2. Learning • Obesity is the excessive accumulation of body fat, best defined by the Body
outcomes Mass Index (or Quetelet's Index).
3. Definition • BMI is the universal and convenient measure of obesity. It is calculated as
4. Classification weight divided by height squared (kg/m2). The BMI-for-age is used to assess
5. Section 1 quiz obesity in children.
6. Global burden of
obesity
• In adults (age >18years), obesity is defined by a BMI of  30 kg/m2, and
overweight by a BMI between 25 and 29.9 kg/m2. A child with a BMI-for-age
7. Section 2 quiz
>95th percentile is obese while one with a BMI-for-age >85th percentile is
8. Pathogenesis
overweight.
9. Section 3 quiz
• The longer a child remains obese beyond age 3 years, the more likely that the
obesity will persist into adulthood. 30% of obese children are also obese as
11. Section 4 quiz adults. 70% obese adolescents end up as obese adults.
• Obesity is believed to result from a complex interplay of several factors;
13. Section 5 quiz
genetic, environmental (lifestyle and dietary), cultural, socio-economic,
14. Management of psychological and medical conditions.
obesity
15. Section 6 quiz
• Obesity is a known risk factor for several life-threatening, chronic medical and
16. Summary
metabolic conditions: hypertension, coronary artery disease, stroke, type II
diabetes, cancers.
17. Information
sources • A 5 - 10% reduction in body weight has been shown to significantly improve
medical conditions associated with obesity.
What Have I Learnt about Obesity? (2)
1. How to use this

module
2. Learning
outcomes
• Obesity has reached epidemic proportions in several developed
3. Definition countries of the world and is also creeping up in urban cities of the
4. Classification
underdeveloped world.
5. Section 1 quiz
6. Global burden of • Globally, there are more than 1.1 billion overweight adults, and at least
obesity
312 million of them are clinically obese. 10% of all children worldwide
7. Section 2 quiz
are either overweight or obese, while 17.6 million children under the
8. Pathogenesis
age of five are estimated to be overweight.
9. Section 3 quiz
11. Section 4 quiz • Rapid urbanization and economic development have led to changing
12. Childhood obesity lifestyles and diets across the world which promote excessive weight
13. Section 5 quiz gain.
14. Management of
obesity
15. Section 6 quiz • An increasing incidence of obesity is also being seen in the poor,
16. Summary developing countries of the world
17. Information
sources
• Increase body weight is now the sixth most important risk factor
contributing to the overall burden of disease worldwide
Sources of Information/images and References
1. How to use this

module
• Baird J, Fisher D, Lucas P, et al. Being big or growing fast: systematic review of size and growth in
2. Learning infancy and later obesity. BMJ 2005; S1:468-583
outcomes • Bray G A, Popkin B M. Dietary fat intake does affect obesity! Am J Clin Nutr. 1998, 68:1157-73
3. Definition • Calle EE, et al. BMI and mortality in prospective cohort of U.S. adults. New England Journal of
4. Classification Medicine.1999;341:1097–1105.
5. Section 1 quiz • Cole TJ and Rolland-Cachera MF. In: Childhood and Adolescent Obesity. Burniat W, Cole T, Lissau I
and Poskitt (Eds). Cambridge University Press, 2002
6. Global burden of
obesity • Haslam DW, Jones WPT. Obesity. Lancet 2005; 366:1197-1209
7. Section 2 quiz
• Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. International Journal of Obesity.
1985;9:147–153.
8. Pathogenesis • Gallagher D, et al. How useful is BMI for comparison of body fatness across age, sex and ethnic groups?
9. Section 3 quiz American Journal of Epidemiology 1996;143:228–239.
10. Effects of obesity • Rudolf M C J, Hochberg Z, Speiser P. Perspectives on the development of an international consensus
11. Section 4 quiz on childhood obesity. Arch Dis Child 2005; 90:994-996.
• Stamatakis E, Primatesta P, Chinn S et al. Overweight and obesity trends from 1974 to 2003 in English
children: what is the role of socioeconomic factors? Arch Dis Child 2005; 90:999-1004
13. Section 5 quiz • World Health Organization. Physical status: The use and interpretation of anthropometry. Geneva,
14. Management of Switzerland: World Health Organization 1995. WHO Technical Report Series
obesity • WHO Obesity; Preventing and managing the global epidemic. Report of a WHO Consultation on Obesity.
15. Section 6 quiz Geneva, 3-5 June 1997
16. Summary • www.who.int/nutr; www.cdc.gov/growthcharts; www.corbis.com;
17. Information • Cartoon characters from the WeightWise campaign of the British Dietetic Association.
sources • Drent ML, van der Veen EA. Lipase inhibition: A novel concept in the treatment of obesity. Int J Obes
Relat Metab Disord 1993; 17:241-244.

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Obesity Partners in Global Health Education

1. How to use this

Partners in Global Health Education

1. How to use this

1. How to use this

Partners in Global Health Education

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1. How to use this

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Partners in Global Health Education

1. How to use this

Partners in Global Health Education

1. How to use this

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Source: U.S. Center for Disease Control

1. How to use this

Prevalence of obesity (%)

Prevalence of obesity (%)

12. Childhood obesity

The growing epidemic of obesity - Source: IOTF

1. How to use this

Source: adapted from IOTF unpublished data

1. How to use this

1. How to use this

Source: IOTF data

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1. How to use this

Source: 1998-2005 Self Realization Publications

1. How to use this

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 Gradual reversal of weight loss is known to occur on stopping pharmacotherapy

1. How to use this

1. How to use this

1. How to use this

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1. How to use this