Obesity Treatment, Prevention and Management: Ajeet Jaiswal

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Paper No. : 09 Physiology and Sports Anthropology
Module : 17 Obesity treatment, prevention and management
Development Team
Principal Investigator Prof. Anup Kumar Kapoor

Department of Anthropology, University of Delhi
Paper Coordinator Dr Rashmi Sinha

IGNOU, Delhi
Content Writer Dr. Ajeet Jaiswal & Dr. RRM SIngh

Department of Anthropology & Department of Physical Education &
Sports, Pondicherry University
Content Reviewer Prof. Satwanti Kapoor

Department of Anthropology, University of Delhi
Physiology and Sports Anthropology

Anthropology Obesity treatment, prevention and management
Description of Module
Subject Name Anthropology
Paper Name 09 Physiology and Sports Anthropology
Module Name/Title Obesity treatment, prevention and management
Module Id 17

Contents
Introduction
Definition
Symptoms
Complications arising due to Obesity
Obesity and quality of life
Tests and diagnosis
Obesity Causes treatment and prevention
Causes of Obesity according to WHO
Treatments of Obesity
Dietary changes
Exercise and activity
Behavior changes
Prescription weight-loss medication
Weight-loss surgery
Other treatments
Lifestyle and home remedies
Alternative medicine
Prevention of Obesity
Prevention of weight gain after treatment
Measuring Obesity
Child Obesity
Causes
Treatment
Summary
Learning objectives:
• The course provides introductory information about Treatment and prevention and management
of different diseases and disorder
• The study of this module enables the students at postgraduate level to understand Treatment
and prevention and management of obesity.

INTRODUCTION
Preventive healthcare (alternately preventive medicine or prophylaxis) consists of measures taken for
disease prevention, as opposed to disease treatment(Katz and Ather, 2009; Hugh et.al, 1979) Just as
health encompasses a variety of physical and mental states, so do disease and disability, which are
affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices. Health,
disease, and disability are dynamic processes which begin before individuals realize they are affected.
Disease prevention relies on anticipatory actions that can be categorized as primary, secondary, and
tertiary prevention (Hugh et.al, 1979).
Each year, millions of people die preventable deaths. A 2004 study showed that about half of all
deaths in the United States in 2000 were due to preventable behaviors and exposures (Mokdad, et.al,
2004). Leading causes included cardiovascular disease, chronic respiratory disease, unintentional
injuries, diabetes, and certain infectious diseases (Mokdad, et.al, 2004). This same study estimates that
400,000 people die each year in the United States due to poor diet and a sedentary lifestyle (Mokdad,
et.al, 2004).
According to estimates made by the World Health Organization(WHO), about 55 million people died
worldwide in 2011, two thirds of this group from non-communicable diseases,
including cancer, diabetes, and chronic cardiovascular and lung diseases (The Top 10 Causes of Death,
2014). This is an increase from the year 2000, during which 60% of deaths were attributed to these
diseases (The Top 10 Causes of Death, 2014). Preventive healthcare is especially important given the
worldwide rise in prevalence of chronic diseases and deaths from these diseases.
There are many methods for prevention of disease. It is recommended that adults and children aim to
visit their doctor for regular check-ups, even if they feel healthy, to perform disease screening, identify
risk factors for disease, discuss tips for a healthy and balanced lifestyle, stay up to date with
immunizations and boosters, and maintain a good relationship with a healthcare provider (Vorvick,
2013).
Some common disease screenings include checking for hypertension (high blood
pressure), hyperglycemia (high blood sugar, a risk factor for diabetes
mellitus), hypercholesterolemia (high blood cholesterol), screening for colon
cancer, depression, HIV and other common types of sexually transmitted disease such
as chlamydia, syphilis, and gonorrhea, mammography (to screen for breast cancer), colorectal
cancer screening, a pap test (to check for cervical cancer), and screening forosteoporosis. Genetic
testing can also be performed to screen for mutations that cause genetic disorders or predisposition to
certain diseases such as breast or ovarian cancer (Vorvick, 2013). However, these measures are not
affordable for every individual and the cost effectiveness of preventive healthcare is still a topic of
debate (Michael et.al, 2010; Cohen, et.al, 2008).

In this module we will discuss about Treatment and prevention and management of Obesity
Obesity is excessively high amount of body fat or adipose tissue in relation to lean body mass. Everyone needs a certain
amount of body fat for stored energy, heat insulation, shock absorption, and other functions. genreally, women have more
body fat than men.
• Obesity means having too much body fat.

• It is not the same as being overweight, which means weighing too much.
• A person may be overweight from extra muscle, bone, or water, as well as from having too much fat.
Obesity has gained epidemic proportions in our world today and the developed countries seem to be
affected more than the other countries. However, all are catching up fast with this serious disorder. Though the
general awareness on this disorder has increased the problem seems to be growing without any end in sight.
Obesity can lead to many serious health conditions like type II diabetes, cardio vascular diseases, osteoarthritis,
gallstones and also some kind of cancers. Obesity can also contribute to the metabolic diseases. Further, it also
negatively impacts the quality of life and self esteem.
Definition
Obesity is a complex disorder involving an excessive amount of body fat. Obesity isn't just a cosmetic
concern. It increases your risk of diseases and health problems, such as heart disease, diabetes and high
blood pressure.
Being extremely obese means you are especially likely to have health problems related to your weight.
The good news is that even modest weight loss can improve or prevent the health problems associated
with obesity. Dietary changes, increased physical activity and behavior changes can help you lose
weight. Prescription medications and weight-loss surgery are additional options for treating obesity.
Overweight vs. Obese
Traditional Definitions
 Obese: Body fatness above population norm

 Overweight: Body weight above population norm
Symptoms
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Obesity is diagnosed when your body mass index (BMI) is 30 or higher. Your body mass index is
calculated by dividing your weight in kilograms (kg) by your height in meters (m) squared.
What is Body Mass Index (BMI)?
The BMI is a statistical measurement derived from your height and weight. Although it is considered
to be a useful way to estimate healthy body weight, it does not measure the percentage of body fat. The
BMI measurement can sometimes be misleading - a muscleman may have a high BMI but have much
less fat than an unfit person whose BMI is lower. However, in general, the BMI measurement can be a
useful indicator for the 'average person'.
Fig:1

Fig:2
BMI Weight status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0-34.9 Obese (Class I)
35.0-39.9 Obese (Class II)
40.0 and higher Extreme obesity (Class III)
For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly
measure body fat, so some people, such as muscular athletes, may have a BMI in the obese category
even though they don't have excess body fat. Ask your doctor if your BMI is a problem. Fig: 3
Symptoms and Complications of Obesity
The health risks associated with obesity include:
 breathing disorders (e.g., sleep apnea, chronic obstructive pulmonary disease)

 certain types of cancers (e.g., prostate and bowel cancer in men, breast and uterine cancer in
women)
 coronary artery (heart) disease
 depression
 diabetes
 gallbladder or liver disease
 gastroesophageal reflux disease (GERD)
 high blood pressure
 high cholesterol
 joint disease (e.g., osteoarthritis)
 stroke
People who are obese may have the symptoms of the medical conditions mentioned above. High blood
pressure, high cholesterol levels, breathing problems, and joint pain (in the knees or lower back) are
common. The more obese a person is, the more likely they are to have medical problems related to
obesity.
Fig: 4 Fig: 5

Aside from the medical complications, obesity is also linked to psychosocial problems such as low
self-esteem, discrimination, difficulty finding employment, and reduced quality of life. Children who
have a television in their bedroom are much more likely to be obese or overweight than kids who do
not
Complications arising due to obesity
If you're obese, you're more likely to develop a number of potentially serious health problems,
including:
 High triglycerides and low high-density lipoprotein (HDL) cholesterol
 Type 2 diabetes
 High blood pressure
 Metabolic syndrome — a combination of high blood sugar, high blood pressure, high
triglycerides and low HDL cholesterol
 Heart disease
 Stroke
 Cancer, including cancer of the uterus, cervix, endometrium, ovaries, breast, colon, rectum,
esophagus, liver, gallbladder, pancreas, kidney and prostate
 Breathing disorders, including sleep apnea, a potentially serious sleep disorder in which
breathing repeatedly stops and starts
 Gallbladder disease
 Gynecological problems, such as infertility and irregular periods
 Erectile dysfunction and sexual health issues
 Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver and can cause
inflammation or scarring
 Osteoarthritis

Obesity and quality of life
When you're obese, your overall quality of life may be diminished. You may not be able to do things
you used to do, such as participating in enjoyable activities. You may avoid public places. Obese
people may even encounter discrimination.
Other weight-related issues that may affect your quality of life include:
 Depression
 Disability
 Sexual problems
 Shame and guilt
 Social isolation
 Lower work achievement
Tests and diagnosis
If your BMI is in the obese range, your health care provider will typically review your health history in
detail, perform a physical exam and recommend some tests.
These exams and tests generally include:
 Taking your health history. Your doctor may review your weight history, weight-loss efforts,
exercise habits, eating patterns, what other conditions you've had, medications, stress levels and
other issues about your health. Your doctor may also review your family's health history to see if
you may be predisposed to certain conditions.
 A general physical exam. This includes also measuring your height; checking vital signs, such
as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining
your abdomen.
 Calculating your BMI. Your doctor will check your body mass index (BMI) to determine your
level of obesity. This should be done at least once a year. Your BMI also helps determine your
overall health risk and what treatment may be appropriate.
 Measuring your waist circumference. Fat stored around your waist, sometimes called visceral
fat or abdominal fat, may further increase your risk of diseases, such as diabetes and heart disease.
Women with a waist measurement (circumference) of more than 35 inches (80 centimeters, or
10

cm) and men with a waist measurement of more than 40 inches (102 cm) may have more health
risks than do people with smaller waist measurements. Like the BMI measurement, your waist
circumference should be checked at least once a year.
 Checking for other health problems. If you have known health problems, your doctor will
evaluate them. Your doctor will also check for other possible health problems, such as high blood
pressure and diabetes.
 Blood tests. What tests you have depend on your health, risk factors and any current symptoms
you may be having. Tests may include a cholesterol test, liver function tests, a fasting glucose, a
thyroid test and others. Your doctor may also recommend certain heart tests, such as an
electrocardiogram.
Gathering all this information helps you and your doctor determine how much weight you need to lose
and what health conditions or risks you already have. And this will guide treatment decisions.
Obesity Causes, Treatment, and Prevention

Understanding obesity causes, treatment and prevention is one of the best things that you can
do for yourself. Over the course of the last several decades, America has suffered from an increase in
obesity due to a variety of factors. With more peopleeating fast food regularly and not getting enough
exercise, it's no wonder that obesity has become a real epidemic. But there is more to it than just that.
Find out the causes of obesity as well as the treatment and prevention of it in order to gain a better
understanding of how it could affect you or someone you love.
Causes of Obesity
Obesity occurs when your body consumes more calories than it burns. In the past, many people
thought that obesity was simply caused by overeating and under-exercising, resulting from a lack of
will power and self-control. Although these are significant contributing factors, doctors recognize that
obesity is a complex medical problem that involves genetic, environmental, behavioral, and social
factors. All these factors play a role in determining a person's weight.
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Recent research shows that in some cases, certain genetic factors may cause the changes in
appetite and fat metabolism that lead to obesity. For a person who is genetically prone to weight
gain (e.g., has a lower metabolism) and who leads an inactive and unhealthy lifestyle, the risk of
becoming obese is high.
Although a person's genetic makeup may contribute to obesity, it's not the primary cause.
Environmental and behavioral factors have a greater influence – consuming excess calories from high-
fat foods and doing little or no daily physical activity over the long run will lead to weight gain.
Psychological factors may also foster obesity. Low self-esteem, guilt, emotional stress, or trauma can
lead to overeating as a means to cope with the problem.
Although there are genetic, behavioral and hormonal influences on body weight, obesity occurs
when you take in more calories than you burn through exercise and normal daily activities. Your body
stores these excess calories as fat.
Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing's
syndrome, and other diseases and conditions. However, these disorders are rare and, in general, the
principal causes of obesity are:
 Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle,
you can easily take in more calories every day than you use through exercise and normal daily
activities.
 Unhealthy diet and eating habits. Weight gain is inevitable if you regularly eat more calories
than you burn. And most Americans' diets are too high in calories and are full of fast food and
high-calorie beverages.
 Risk factors
Obesity usually results from a combination of causes and contributing factors,
including:
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 Genetics. Your genes may affect the amount of body fat you store, and where that fat is
distributed. Genetics may also play a role in how efficiently your body converts food into energy
and how your body burns calories during exercise.
 Family lifestyle. Obesity tends to run in families. If one or both of your parents are obese, your
risk of being obese is increased. That's not just because of genetics. Family members tend to share
similar eating and activity habits.
 Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle,
you can easily take in more calories every day than you burn through exercise and routine daily
activities. Having medical problems, such as arthritis, can lead to decreased activity, which
contributes to weight gain.
 Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food,
and laden with high-calorie beverages and oversized portions contributes to weight gain.
 Medical problems. In some people, obesity can be traced to a medical cause, such as Prader-
Willi syndrome, Cushing's syndrome and other conditions. Medical problems, such as arthritis,
also can lead to decreased activity, which may result in weight gain.
 Certain medications. Some medications can lead to weight gain if you don't compensate
through diet or activity. These medications include some antidepressants, anti-seizure
medications, diabetes medications, antipsychotic medications, steroids and beta blockers.
 Social and economic issues. Research has linked social and economic factors to obesity.
Avoiding obesity is difficult if you don't have safe areas to exercise. Similarly, you may not have
been taught healthy ways of cooking, or you may not have money to buy healthier foods. In
addition, the people you spend time with may influence your weight — you're more likely to
become obese if you have obese friends or relatives.
 Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes
and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your
body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These
changes also reduce calorie needs, and can make it harder to keep off excess weight. If you don't
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consciously control what you eat and become more physically active as you age, you'll likely gain
weight.
 Pregnancy. During pregnancy, a woman's weight necessarily increases. Some women find this
weight difficult to lose after the baby is born. This weight gain may contribute to the development
of obesity in women.
 Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can
lead to enough weight gain that the person becomes obese. In the long run, however, quitting
smoking is still a greater benefit to your health than continuing to smoke.
 Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in
hormones that increase your appetite. You may also crave foods high in calories and
carbohydrates, which can contribute to weight gain.
Even if you have one or more of these risk factors, it doesn't mean that you're destined to become
obese. You can counteract most risk factors through diet, physical activity and exercise, and behavior
changes.
CAUSES OF OBESITY according to WHO
Energy Balance in the Development of Obesity can result from a minor energy imbalance, which lead
to a gradual but persistent weight gain over a considerable period. Some researchers have hypothesized
that energy imbalance is the result of inherited metabolic characteristics; whereas others believe it is
caused by poor eating and lifestyle habits, that is “gluttony and sloth”. Positive energy balance occurs
when energy intake is greater than energy expenditure and promotes weight gain (Figure 4).
Conversely, negative energy balance promotes decrease in body fat stores and weight loss. Body
weight is regulated by a series of physiological processes, which have the capacity to maintain weight
within a relatively narrow range (stable weight). It is thought that the body exerts a stronger defense
against under nutrition and weight loss than it does against over-consumption and weight gain. Figure
4 also suggests that positive energy balance and weight gains are influenced by powerful societal and
environmental forces which may overwhelm the physiological regulatory mechanisms that operate to
keep weight stable. These include increasing automation, lack of recreational facilities and
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opportunities, increase in food variety and availability. Moreover, the susceptibility of individuals to
these influences is affected by genetic and other biological factors such as sex, age and hormonal
activities, over which they have little or no control (WHO 1998).
Treatments of Obesity
Obesity treatments have two objectives:
1. To achieve a healthy weight.

2. To maintain that healthy weight.
Because a poor diet and a lack of exercise are the most common causes of obesity, there are some
fairly simple treatments for obesity. By incorporating more natural foods into your diet, drinking more
water, cutting out junk food and getting into the habit of exercising several times every week, you can
drastically lower your weight and decrease your chances of becoming obese. If you suffer from a
disease like hypothyroidism, though, you will need to see your doctor to seek out other options. There
are medications that can help regulate your thyroid gland and improve your rate of metabolism. This
can help you to break down foods more efficiently and prevent you from gaining anymore weight in
the future. It essentially helps to treat you and protect you from obesity.
Fig: 6
Treatment tools include:
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 Dietary changes
 Exercise and activity
 Behavior change
 Prescription weight-loss medications
 Weight-loss surgery
Dietary changes
Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you
may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest
way to lose weight and the best way to keep it off permanently.
Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you
keep excess weight off for the long term.
Plan to participate in a comprehensive weight-loss program for at least six months and in the
maintenance phase of a program for at least a year to boost your odds of weight-loss success.
There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for
you. Dietary changes to treat obesity include:
 Cutting calories. The key to weight loss is reducing how many calories you take in. You and
your health care providers can review your typical eating and drinking habits to see how many
calories you normally consume and where you can cut back. You and your doctor can decide how
many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500
calories for women and 1,500 to 1,800 for men.
 Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer
calories. All foods have a certain number of calories within a given amount (volume). Some foods
— such as desserts, candies, fats and processed foods — are high in energy density. This means
that a small volume of that food has a large number of calories. In contrast, other foods, such as
fruits and vegetables, have lower energy density. These foods provide a larger portion size with a
fewer number of calories. By eating larger portions of foods that have fewer calories, you reduce
hunger pangs, take in fewer calories and feel better about your meal, which contributes to how
satisfied you feel overall.
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 Making healthier choices. To make your overall diet healthier, eat more plant-based foods,
such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein
— such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a
week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and
make sure they come from heart-healthy sources, such as olive, canola and nut oils.
 Restricting certain foods. Certain diets limit the amount of a particular food group, such as
high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective
and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume
more calories than you intended, and limiting these drinks or eliminating them altogether is a good
place to start cutting calories.
 Meal replacements. These plans suggest that you replace one or two meals with their products
— such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third
meal that's low in fat and calories. In the short term, this type of diet can help you lose weight.
Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though,
so you may have to keep this up if you want to keep your weight off.
Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The
reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term,
but the long-term results don't appear to be any better than other diets.
Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To
lose weight — and keep it off — you have to adopt healthy-eating habits that you can maintain over
time.
Exercise and activity
Increased physical activity or exercise is an essential part of obesity treatment. Most people who are
able to maintain their weight loss for more than a year get regular exercise, even simply walking.
To boost your activity level:
 Exercise. People who are overweight or obese need to get at least 150 minutes a week of
moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a
modest amount of weight. To achieve more-significant weight loss, you may need to exercise 300
17

minutes or more a week. You probably will need to gradually increase the amount you exercise as
your endurance and fitness improve.
 Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories
and shed excess weight, any extra movement helps burn calories. Making simple changes
throughout your day can add up to big benefits. Park farther from store entrances, rev up your
household chores, garden, get up and move around periodically, and wear a pedometer to track how
many steps you actually take over the course of a day.
Behavior changes
A behavior modification program can help you make lifestyle changes and lose weight and keep it off.
Steps to take include examining your current habits to find out what factors, stresses or situations may
have contributed to your obesity.
Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise
or late-night eating. Tailor your behavior changes to address your individual concerns.
Behavior modification, sometimes called behavior therapy, can include:
 Counseling. Therapy or interventions with trained mental health or other professionals can help
you address emotional and behavioral issues related to eating. Therapy can help you understand
why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor
your diet and activity, understand eating triggers, and cope with food cravings. Therapy can take
place on both an individual and group basis. More-intensive programs — those that include 12 to
26 sessions a year — may be more helpful in achieving your weight-loss goals.
 Support groups. You can find camaraderie and understanding in support groups where others
share similar challenges with obesity. Check with your doctor, local hospitals or commercial
weight-loss programs for support groups in your area, such as Weight Watchers.
Prescription weight-loss medication
Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription
weight-loss medication may help.
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Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and
behavior changes, not instead of them. If you don't make these other changes in your life, medication is
unlikely to work.
Your doctor may recommend weight-loss medication if other methods of weight loss haven't worked
for you and you meet one of the following criteria:
 Your body mass index (BMI) is 30 or greater
 Your BMI is greater than 27, and you also have medical complications of obesity, such as
diabetes, high blood pressure or sleep apnea
Before selecting a medication for you, your doctor will consider your health history, as well as possible
side effects. Some weight-loss medications can't be used by women who are pregnant, or people who
take certain medications or have chronic health conditions.
Commonly prescribed weight-loss medications include orlistat (Xenical), lorcaserin (Belviq),
phentermine and topiramate (Qsymia), buproprion and naltrexone (Contrave), and liraglutide
(Saxenda).
Close medical monitoring is advised while taking a prescription weight-loss medication. Also, keep in
mind that a weight-loss medication may not work for everyone, and the effects may wane over time.
When you stop taking a weight-loss medication, you may regain much or all of the weight you lost.
Weight-loss surgery
In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery
limits the amount of food you're able to comfortably eat or decreases the absorption of food and
calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can pose
serious risks.
Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that
haven't worked and:
 You have extreme obesity (BMI of 40 or higher)
 Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as
diabetes or high blood pressure
 You're committed to making the lifestyle changes that are necessary for surgery to work
19

It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term.
Weight-loss success after surgery depends on your commitment to making lifelong changes in your
eating and exercise habits.
It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term.
Weight-loss success after surgery depends on your commitment to making lifelong changes in your
eating and exercise habits.
Common weight-loss surgeries include:
 Gastric bypass surgery. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a
small pouch at the top of your stomach. The small intestine is then cut a short distance below the
main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into
this part of the intestine, bypassing most of your stomach.
 Laparoscopic adjustable gastric banding (LAGB). In this procedure, your stomach is
separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon
creates a tiny channel between the two pouches. The band keeps the opening from expanding and is
generally designed to stay in place permanently.
 Biliopancreatic diversion with duodenal switch. This procedure begins with the surgeon
removing a large part of the stomach. The surgeon leaves the valve that releases food to the small
intestine and the first part of the small intestine (duodenum). Then the surgeon closes off the
middle section of the intestine and attaches the last part directly to the duodenum. The separated
section of the intestine is reattached to the end of the intestine to allow bile and digestive juices to
flow into this part of the intestine.
 Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir
for food. It's a less complicated surgery than gastric bypass or biliopancreatic diversion with
duodenal switch.
Other treatments
Vagal nerve blockade is another treatment for obesity. It involves implanting a device under the skin of
the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the
brain when the stomach feels empty or full. This new technology received FDA approval in 2014 for
20

use by adults who have not been able to lose weight with a weight-loss program and who have a BMI
of 35 to 45 with at least one obesity-related condition, such as type 2 diabetes.
Lifestyle and home remedies
Your effort to overcome obesity is more likely to be successful if you follow strategies at home in
addition to your formal treatment plan. These can include:
 Learning about your condition. Education about obesity can help you learn more about why
you became obese and what you can do about it. You may feel more empowered to take control
and stick to your treatment plan. Read reputable self-help books and consider talking about them
with your doctor or therapist.
 Setting realistic goals. When you have to lose a significant amount of weight, you may set
goals that are unrealistic, such as trying to lose too much too fast. Don't set yourself up for failure.
Set daily or weekly goals for exercise and weight loss. Make small changes in your diet instead of
attempting drastic changes that you're not likely to stick with for the long haul.
 Sticking to your treatment plan. Changing a lifestyle you may have lived with for many years
can be difficult. Be honest with your doctor, therapist or other health care providers if you find
your activity or eating goals slipping. You can work together to come up with new ideas or new
approaches.
 Enlisting support. Get your family and friends on board with your weight-loss goals. Surround
yourself with people who will support you and help you, not sabotage your efforts. Make sure they
understand how important weight loss is to your health. You might also want to join a weight-loss
support group.
 Keeping a record. Keep a food and activity log. This record can help you remain accountable
for your eating and exercise habits. You can discover behavior that may be holding you back and,
conversely, what works well for you. You can also use your log to track other important health
parameters such as blood pressure and cholesterol levels and overall fitness.
 Identifying and avoiding food triggers. Distract yourself from your desire to eat with
something positive, such as calling a friend. Practice saying no to unhealthy foods and big portions.
Eat when you're actually hungry — not simply when the clock says it's time to eat.
21

 Taking your medications as directed. If you take weight-loss medications or medications to
treat obesity-related conditions, such as high blood pressure or diabetes, take them exactly as
prescribed. If you have a problem sticking with your medication regimen or have unpleasant side
effects, talk to your doctor.
Alternative medicine
Numerous dietary supplements that promise to help you shed weight quickly are available. The
effectiveness, particularly the long-term effectiveness, and safety of these products are often
questionable.
Herbal remedies, vitamins and minerals, all considered dietary supplements by the Food and Drug
Administration, don't have the same rigorous testing and labeling process as over-the-counter and
prescription medications do.
Yet some of these substances, including products labeled as "natural," have drug-like effects that can
be dangerous. Even some vitamins and minerals can cause problems when taken in excessive amounts.
Ingredients may not be standard, and they can cause unpredictable and harmful side effects. Dietary
supplements also can cause dangerous interactions with prescription medications you take. Talk to
your doctor before taking any dietary supplements.
Mind-body therapies — such as acupuncture, mindfulness meditation and yoga — may complement
other obesity treatments. However, these therapies generally haven't been well-studied in the treatment
of weight loss. Talk to your doctor if you're interested in adding a mind-body therapy to your
treatment.
Prevention of Obesity
If you are concerned about obesity, there are some things you can do to prevent it. First, make sure you
are maintaining a healthy diet and getting enough exercise. Next, see you doctor regularly and make
sure that you have her check your Body Mass Index, or BMI, to make sure you're not suffering from
obesity. This is a test that takes your height and weight into account to determine your level of health.
Regardless of how you do it, make sure you do everything you can to steer clear of obesity. Obesity
risks range from heart attacks to diabetes. Obesity effects can also impact your everyday life and make
it harder for you to enjoy it.
22

Whether you're at risk of becoming obese, currently overweight or at a healthy weight, you can
take steps to prevent unhealthy weight gain and related health problems. Not surprisingly, the steps to
prevent weight gain are the same as the steps to lose weight: daily exercise, a healthy diet, and a long-
term commitment to watch what you eat and drink.
 Exercise regularly. You need to get 150 to 300 minutes of moderate-intensity activity a week
to prevent weight gain. Moderately intense physical activities include fast walking and swimming.
 Follow a healthy eating plan. Focus on low-calorie, nutrient-dense foods, such as fruits,
vegetables and whole grains. Avoid saturated fat and limit sweets and alcohol. Eat three regular
meals a day with limited snacking. You can still enjoy small amounts of high-fat, high-calorie
foods as an infrequent treat. Just be sure to choose foods that promote a healthy weight and good
health most of the time.
 Know and avoid the food traps that cause you to eat.Identify situations that trigger out-of-
control eating. Try keeping a journal and write down what you eat, how much you eat, when you
eat, how you're feeling and how hungry you are. After a while, you should see patterns emerge.
You can plan ahead and develop strategies for handling these types of situations and stay in control
of your eating behaviors.
 Monitor your weight regularly. People who weigh themselves at least once a week are more
successful in keeping off excess pounds. Monitoring your weight can tell you whether your efforts
are working and can help you detect small weight gains before they become big problems.
 Be consistent. Sticking to your healthy-weight plan during the week, on the weekends, and
amidst vacation and holidays as much as possible increases your chances of long-term success.
Preventing weight regain after obesity treatment
Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. If you
take weight-loss medications, you'll probably regain weight when you stop taking them. You might
even regain weight after weight-loss surgery if you continue to overeat or overindulge in high-calorie
foods. But that doesn't mean your weight-loss efforts are futile.
One of the best ways to prevent regaining the weight you've lost is to get regular physical activity. Aim
for 60 minutes a day.
23

Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight
and gain better health, talk to your doctor about what additional activities you might be able to do and,
if appropriate, how to give your activity and exercise a boost.
You may always have to remain vigilant about your weight. Combining a healthier diet and more
activity in a practical and sustainable manner are the best ways to keep the weight you lost off for the
long term.
Take your weight loss and weight maintenance one day at a time and surround yourself with supportive
resources to help ensure your success. Find a healthier way of living that you can stick with for the
long term.
Fig: 7
24

25

Measuring Obesity
From Calipers to CAT Scans, Ten Ways to Tell Whether a Body Is Fat or Lean
What’s the best way to determine whether a body is fat or fit? Body fat can be measured in several
ways, with each body fat assessment method having pros and cons.
 The most basic method, and the most common, is the body mass index (BMI). Doctors can
easily calculate BMI from the heights and weights they gather at each checkup; BMI tables and
online calculators also make it easy for individuals to determine their own BMIs.
 The BMI and other so-called “field methods”—among them, waist circumference, waist-to-hip
ratio, skinfold thicknesses, and bioelectrical impedance—are useful in clinics and community
settings, as well as in large research studies.
 More sophisticated methods, such as magnetic resonance imaging or dual energy X-ray
absorptiometry, are so-called “reference measurements”—techniques that are typically only
used in research studies to confirm the accuracy of (or as scientists say, to “validate”) body
measurement techniques.
 Several methods can’t be used in children or pregnant women, due to safety concerns, or are
less accurate in people who are very overweight.
Here is a brief overview of some of the most popular methods for measuring body fat—from basic
body measurements to high-tech body scans—along with their strengths and limitations.
 Body Mass Index

 Waist Circumference
 Waist-to-Hip Ratio
 Skin fold thickness
 Bioelectric Impedance
 Underwater Weighing
 Air-Displacement Plethysmography
 Dilution Method
 DEXA
26

 CT and MRI Scans
Body Mass Index (BMI)
Body mass index (BMI) is the ratio of weight to height, calculated as weight (kg)/height (m2), or
weight (lb)/height (in2) multiplied by 703.
Strengths
 Easy to measure
 Inexpensive
 Standardized cutoff points for overweight and obesity: Normal weight is a BMI between 18.5
and 24.9; overweight is a BMI between 25.0 and 29.9; obesity is a BMI of 30.0 or higher
 Strongly correlated with body fat levels, as measured by the most accurate methods
 Hundreds of studies show that a high BMI predicts higher risk of chronic disease and early
death.
Limitations
 Indirect and imperfect measurement—does not distinguish between body fat and lean body
mass
 Not as accurate a predictor of body fat in the elderly as it is in younger and middle-aged adults
 At the same BMI, women have, on average, more body fat than men, and Asians have more
body fat than whites
Waist Circumference
Waist circumference is the simplest and most common way to measure “abdominal obesity”—the extra
fat found around the middle that is an important factor in health, even independent of BMI. It’s the
circumference of the abdomen, measured at the natural waist (in between the lowest rib and the top of
the hip bone), the umbilicus (belly button), or at the narrowest point of the midsection.
Strengths
 Easy to measure
 Inexpensive
 Strongly correlated with body fat in adults as measured by the most accurate methods
 Studies show waist circumference predicts development of disease and death
27

Limitations
 Measurement procedure has not been standardized
 Lack of good comparison standards (reference data) for waist circumference in children
 May be difficult to measure and less accurate in individuals with a BMI of 35 or higher
Waist-to-Hip Ratio
Like the waist circumference, the waist-to-hip ratio (WHR) is also used to measure abdominal obesity.
It’s calculated by measuring the waist and the hip (at the widest diameter of the buttocks), and then
dividing the waist measurement by the hip measurement.
Strengths
 Good correlation with body fat as measured by the most accurate methods
 Inexpensive
 Studies show waist-to-hip ratio predicts development of disease and death in adults
Limitations
 More prone to measurement error because it requires two measurements
 More difficult to measure hip than it is to measure waist
 More complex to interpret than waist circumference, since increased waist-to-hip ratio can be
caused by increased abdominal fat or decrease in lean muscle mass around the hips
 Turning the measurements into a ratio leads to a loss of information: Two people with very
different BMIs could have the same WHR
 May be difficult to measure and less accurate in individuals with a BMI of 35 or higher
Skin-fold Thickness
In this method, researchers use a special caliper to measure the thickness of a “pinch” of skin and the
fat beneath it in specific areas of the body (the trunk, the thighs, front and back of the upper arm, and
under the shoulder blade). Equations are used to predict body fat percentage based on these
measurements.
Strengths
 Convenient
 Safe
28

 Inexpensive
 Portable
 Fast and easy (except in individuals with a BMI of 35 or higher)
Limitations
 Not as accurate or reproducible as other methods
 Very hard to measure in individuals with a BMI of 35 or higher
Bioelectric Impedance (BIA)
BIA equipment sends a small, imperceptible, safe electric current through the body, measuring he
resistance. The current faces more resistance passing through body fat than it
does passing through lean body mass and water. Equations are used to estimate body fat percentage
and fat-free mass.
Strengths
 Convenient
 Safe
 Relatively inexpensive
 Portable
 Fast and easy
Limitations
 Hard to calibrate
 The ratio of body water to fat may be change during illness, dehydration or weight loss,
decreasing accuracy
 Not as accurate as other methods, especially in individuals with a BMI of 35 or higher
Underwater Weighing (Densitometry)
Individuals are weighed in air and while submerged in a tank. (1) Researchers use formulas to estimate
body volume, body density, and body fat percentage. Fat is more buoyant (less dense) than water, so
someone with high body fat will have a lower body density than someone with low body fat. This
method is typically only used in a research setting.
Strengths
29

 Accurate
Limitations
 Time consuming
 Requires individuals to be submerged in water
 Generally not a good option for children, older adults, and individuals with a BMI of 40 or
higher
Air-Displacement Plethysmography
This method uses a similar principle to underwater weighing but can be done in the air instead of
in water. Individuals sit in a small chamber wearing a bathing suit; one commercial example is the
“Bod Pod.” The machine estimates body volume based on air pressure
differences between the empty chamber and the occupied chamber.

Strengths
 Relatively quick and comfortable
 Accurate
 Safe
 Good choice for children, older adults, pregnant women, individuals with a BMI of 40 or
higher, and other individuals who would not want to be submerged in water
Limitations
 Expensive
Dilution Method (Hydrometry)
Individuals drink isotope-labeled water and give body fluid samples. Researchers analyze these
samples for isotope levels, which are then used to calculate total body water, fat-free body mass and in
turn, body fat mass.
Strengths
 Relatively low cost
 Accurate
 Safe
30

 Can be used in individuals with a BMI of 40 or higher, as well as in children and pregnant
women
Limitations
 The ratio of body water to fat-free mass may change during illness, dehydration, or weight loss,
decreasing accuracy
Dual Energy X-ray Absorptiometry (DEXA)
X-ray beams pass through different body tissues at different rates. So DEXA uses two low-level X-ray
beams to develop estimates of fat-free mass, fat mass, and bone mineral density.
DEXA is typically only used for this purpose in research settings.
Strengths
 Accurate
Limitations
 Equipment is expensive and cannot be moved
 Cannot accurately distinguish between different types of fat (fat under the skin, also known as
“subcutaneous” fat vs. fat around the internal organs, or “visceral” fat)
 Cannot be used with pregnant women, since it requires exposure to a small dose of radiation
 Most current systems cannot accommodate individuals with a BMI of 35 or higher
Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI)
These two imaging techniques are now considered to be the most accurate methods for
measuring tissue, organ, and whole-body fat mass as well as lean muscle mass and bone mass.
CT and MRI scans are typically only used for this purpose in research settings.
Strengths
 Accurate
 Allows for measurement of specific body fat compartments, such as abdominal fat and
subcutaneous fat
Limitations
 Equipment is extremely expensive and cannot be moved
31

 CT scans cannot be used with pregnant women or children, due to the high amounts of ionizing
radiation used
 Some MRI and CT scanners may not be able to accommodate individuals with a BMI of 35 or
higher
Child Obesity
The World Health Organization (WHO) regards childhood obesity as one of the most serious global
public health challenges for the 21st century. Obese children and adolescents are at an increased risk of
developing various health problems, and are also more likely to become obese adults.
Cause
• Genetic Link
– Multifactorial condition related to sedentary lifestyle, too much good intake and choice
of foods actually alter genetic make-up, creating higher risk of obesity
• Behavioral
– Children will more likely choose heal thier foods if they are offered to them at young
ages and in the home
• Environment
– In homes where healthy food is not available or the food choices are not healthy.
Obesity can occur
Fig: 8
32

Treatment
Weight reduction is achieved by:
 Consuming fewer calories
 Increasing activity and exercise
Structured approaches and therapies to reduce weight include:
 A modified diet. A reasonable weight loss goal is 1 to 2 pounds per week. This can usually be
achieved by eating 500 to 1,000 fewer calories each day. Whether you concentrate on eating less fat
or fewer carbohydrates is up to you. Fats have more than twice as many calories per ounce than
33

carbohydrates or protein. If you cut out carbohydrates, you still need to limit fat intake. Choose
healthy fats, such as monounsaturated and polyunsaturated oils.
 Regular exercise. To effectively lose weight, most people need to do moderate intensity
exercise for 60 minutes most days of the week. Add more activity during the day. Take the stairs
and get up often from your desk or sofa.
 Non-prescription orlistat (Alli). Orlistat inhibits fat absorption in the intestine. Until recently,
this medication was only available by prescription (Xenical). The over-the-counter medicine is sold
at a lower dose than Xenical. But the active ingredient is the same.
 Other non-prescription diet pills. Over-the-counter diet pills often contain ingredients that
can increase heart rate and blood pressure. It is not clear how effective they are in producing weight
loss that can be maintained over time. Common side effects include feeling jittery and nervous and
having heart palpitations. Some experts believe they may be associated with an increased risk of
stroke.
 Prescription diet pills. To help you lose weight, your doctor may prescribe medications along
with a calorie-restricted diet. Almost all people regain weight when they stop using these
medications. The effects of long-term use of these drugs have not been determined.
 Surgery. In general, weight-loss surgery (called bariatric surgery) may be considered if your
BMI is 40 or greater, or your BMI is 30-35 or greater and you have at least one medical condition
directly related to obesity. In addition, you must have participated in a structured weight loss
program without success.
The more common types of surgical procedures include:
o Gastroplasty – also known as stomach stapling. A surgeon creates a small pouch in the
stomach that allows only limited amounts of food to be eaten at one time.
o Laparoscopic adjustable gastric banding. A surgeon places an adjustable band
around the stomach with minimally invasive surgery.
 Gastric bypass. This is the most effective weight loss surgery. However, it also carries a
greater risk of complications, both short term and long term. A surgeon creates a small pouch in the
upper part of the stomach. A hole is made in the small intestine beyond the normal stomach
34

attachment. The pouch is attached to the hole, bypassing the rest of the stomach and the top part of
the small intestine.
35

Fig:
36

9
Summary
 The need for prevention and management of obesity is at its highest the world over and it is
very clear that a lot more needs to be done than what is prevailing today.
 With the advent of technology and invasion of television, the problem of the average human
being seems to have only increased.
 Though the role of genetics is high in determining the body weight of a person, his or her
lifestyle is a great contributing factor too in the cause, management and prevention of obesity.
 People of earlier times had to do physical labor as machines and technologies did not dominate
their lives. But, today all that has changed and everything seems to be at peoples reach just at
the press of a button.
 Thus, the need to exert physically for day to day activities has significantly decreased and today
people have to engage willfully or not so willfully in some kind of physical activities to keep a
check on obesity and related diseases.
 Correspondingly the diet the people consume today is definitely not in proportion to the
physical activity that we engage in.
 Moreover, the concept of fast food is getting too popular that it seen as one of the major cause
for explosion of obesity around the globe.
 Therefore, it is time for people to seriously contemplate on their lifestyles and choose how they
could manage the epidemic of obesity to the best of their ability and health.
CONCLUSION
People have become more and more inactive without corresponding adjustment in their calorific
intake. This has lead to this serious problem and if not addressed in the war footing, we may never be
able to reverse this trend. It is in the individual persons hands to make suitable adjustments in their
respective lifestyles so that there can be effective management of this serious epidemic.
37

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Obesity treatment, prevention and management

Chapter · October 2018

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Principal Investigator Prof. Anup Kumar Kapoor

Paper Coordinator Dr Rashmi Sinha

Content Writer Dr. Ajeet Jaiswal & Dr. RRM SIngh

Content Reviewer Prof. Satwanti Kapoor

Physiology and Sports Anthropology

Subject Name Anthropology

Paper Name 09 Physiology and Sports Anthropology

Module Name/Title Obesity treatment, prevention and management

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• Obesity means having too much body fat.

 Obese: Body fatness above population norm

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Physiology and Sports Anthropology

Symptoms and Complications of Obesity

The health risks associated with obesity include:

 breathing disorders (e.g., sleep apnea, chronic obstructive pulmonary disease)

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Complications arising due to obesity

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Obesity Causes, Treatment, and Prevention

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CAUSES OF OBESITY according to WHO

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1. To achieve a healthy weight.

Treatment tools include:

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 Body Mass Index

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differences between the empty chamber and the occupied chamber.

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