Obesity

Dr. Sawsan A. Omer

 Contents of the lecture
- Introduction
- Definition and Measurement of obesity -

- Causes of Obesity -
- Health consequences of Obesity- -
- Medical Evaluation of Obesity -
- management & prevention of obesity -
 Nutritional Requirements
◆ Fiber
– Indigestible
– Keeps digestive tract flowing
◆ Micronutrients
– Only need small amounts for good health
– Vitamins & Minerals
◆ Macronutrients
– Need large amounts for good health
– Carbohydrates, Lipids, & Proteins
 Carbohydrates
◆ Most dominant energy source
◆ Simple carbohydrates
– Monosaccharides (glucose)
– Disaccharides (sucrose)
◆ Complex carbohydrates
– Cellulose
– Starches
 Lipids
◆ Concentrated source of energy

◆ Providestwice the amount of energy as

an equal mass of carbohydrates

◆ Essential fatty acids

– Linoleic acid
– Linolenic acid
 Proteins
◆ Production of new tissue
◆ Maintains & Repairs cells for production
of
– Enzymes
– Hormones
– Other nitrogen compounds the body needs

◆ There are several Essential amino acids

that the body doesn’t produce
 Catabolism of Food
◆ Stage One
– Digestion

◆ Stage Two
– Acetyl Coenzyme A

◆ Stage Three
– Catabolic Pathway
– Citric Acid Cycle
 HUMAN NUTRITION
◆ Obesity & under-nutrition are the 2
ends of the spectrum of
malnutrition.
◆ A healthy diet provides a balanced
nutrients that satisfy the metabolic
needs of the body without excess
or shortage.
◆ Dietary requirements of children
vary according to age, sex &
development.
 Obesity
◆ Obesity is one of the most
common disorders in practice and
difficult to manage
◆ The WHO estimates that over a billion
adults are overweight and over 300
million are obese worldwide.
Definition and Measurement
◆ Obesity is defined as an excess of
adipose tissue .
◆ Physical examination is usually
sufficient to detect excess body fat
but :
◆ Body mass index (BMI) is used more
accurately to reflect the presence of
excess adipose tissue
◆ BMI is calculated by dividing
measured body weight in
kilograms by the height in
meters squared .
 Cont….
◆ Normal BMI = 18.5-24.9.
◆ Overweight is defined as BMI
=25-29.9
◆ Class 1 obesity 30-34.9
◆ Class 2 obesity 35-39.9
◆ Class 3 (extreme) obesity is BMI
> 40
◆ Upperbody obesity (excess fat
around the waist & flank) is a
greater health hazard than lower
body obesity (fat in the thighs
and buttocks)
 Cont…
◆ Obese patients with increased
abdominal circumference (> 102
cm in men and 88 cm in women)
or with high waist-hip ratio (>
1.0 in men and > .85 in women)
have a greater risk of diseases
than equally obese patients with
lower ratios.
◆ Excessvisceral fat around the
abdominal cavity is more hazard
than subcutaneous fat around
the abdomen
 Obesity
What are the Causes?
Overweight and obesity are the result of an
energy imbalance over a long period of time.
While the whole picture is still unclear how obesity ◆
develops, it is believed to involve the integration of
social, behavioral, cultural, physiological,
metabolic, and genetic factors.
Behavior and environment appear to play a large ◆
role the development of obesity, and are often the
focus for prevention and treatment actions.
 Etiology of Obesity

◆ Although these factors are the

principal cause there is now
evidence for strong genetic
influence (40%-70% of obesity).
◆ Five
genes affecting control of
appetite have been identified in
mice .
◆ Mutation of each gene result in
obesity and each has human
homolog.
 Cont…
◆ One gene codes for a protein
expressed by adipose tissue –
Leptin- and another for leptin
receptors in the brain .
◆ The other 3 genes affect brain
pathway downstream from the
leptin receptor.
 Causes of Obesity
◆A Mutant Gene?
◆ What is leptin?

–A satiety hormone that influences the

appetite control in the hypothalamus.
–A defective gene may cause inadequate
leptin production.
–The brain receives an under assessment
of body’s adipose stores & urge to eat.
 Normally leptin blunts the urge
Causes of Obesityto eat when caloric intake
maintains ideal fat stores.
In essence, leptin availability,
or its lack, affects the
neurochemistry of appetite and
the brain’s dynamic “wiring” to
possibly impact appetite and
obesity in adulthood.
Leptin alone does not
determine obesity or explain
why some people eat whatever
they want and gain little weight
while others become overfat
with the same caloric intake.
 Causes of Obesity
Physical Inactivity: ◆
an important
component
Each hour increase ◆
in TV by adolescents
2% increase obesity.
 Cont…
Causes of secondary Obesity:
◆ Cushing syndrome

◆ Hypothyroidism

◆ Genetic syndromes associated with

hypogonadism e.g. Laurence-Moon-
Biedl syndrome.
◆ Drug induced (e.g. corticosteroids)

◆ Hypothalmaic damage (e.g. due to

trauma or tumor)
To sum up :
◆ Most human obesity develops
from the interactions of multiple
genes, environmental factors,
and behavior.
Health consequences of Obesity
◆ Obesity is associated with
significant increase in both
morbidity and mortality.
◆ Many disorders are related to
obesity like:
◆ Type 2 DM, hypertension,
hyperlipidemia, IHD
◆ degenerative joint disease,

◆ gall stones, reflux oesphagitis,

◆ psychological disorder.
◆ Certain
cancers are more
prevalent in obese like colon
rectum, breast & ovary.
Medical Evaluation of Obesity
◆ History should include age of
onset, recent weight changes, FH
of obesity, eating and exercise
behavior ,occupational history.
◆ Particular attention should be
directed to use of medication
such as laxative, diuretics, and
hormones.
◆ O/E look for degree and
distribution of body fat, overall
nutritional status and signs of
secondary obesity.
◆ B.P and waist circumference
should be measured
 Management of Obesity

◆ Fasting glucose and fasting lipids

should be measured.
◆ Treatment

◆ Only 20% of patients will lose 20

Ib and maintain the loss for 2
year.
◆ Most successful programs
employ a multidisciplinary
approach to weight loss:
◆ 1.Hypocaloric diet

◆ 2.Change of eating behavior

◆ 3.Aerobic exercise and social

support
 Cont..
◆ Dietary Control
◆ Obese patients do not necessarily eat
more than others but they eat more
than they need.
◆ Healthy balanced food consists of low
fat ,high complex CHO such as
vegetables and fruits rather than
simple sugars, high fiber diet and
moderate protein intake.
◆ Dieting
◆ Dietsto promote weight loss are
generally divided into four
categories: low-fat, low-
carbohydrate, low-calorie, and very
low calorie.
◆ There is no difference between the
main diet types, with a 2–4 kilogram
weight loss in all studies.
 Exercise
Physical exercise
◆ With use, muscles consume energy
derived from both fat and glycogen .
◆ Due to the large size of leg muscles,
walking, running, and cycling are the most
effective means of exercise to reduce body
fat .
◆ Exercise affects macronutrient balance.
During exercise, there is a shift to greater
use of fat as a fuel
◆A meta-analysis of 43 randomized
controlled trials by the Cochrane
Collaboration found that exercising
alone led to limited weight loss.
◆ In combination with diet, however, it
resulted in a 1 kilogram weight loss
over dieting alone.
◆ A 1.5-kilogram loss was observed
with a greater degree of exercise.
◆ During 20 weeks of basic military
training with no dietary restriction,
obese military recruits lost 12.5 kg.
High levels of physical activity seem
to be necessary to maintain weight
loss.
Drug therapy
◆ Used for short term as an
adjunct to diet control but do
not substitute for strict dieting .
 Drug for treatment of obesity
◆ Only two anti-obesity medications
are currently approve for long term
use
◆ .One is orlistat ( Xenical), which
reduces intestinal fat absorption by
inhibiting pancreatic lipase
◆ The other is sibutramine (Meridia),
which acts in the brain to inhibit
deactivation of the
neurotransmitters norepinephrine ,
serotonin ,and dopamine( very similar
to some anti-depressants ,)therefore
decreasing appetite .
 Cont…
Surgical treatment
◆ Used for morbid obesity (BMI >
40)
◆ They consist of GIT procedures
to restrict the ability to eat (e.g.
gastric banding ).
◆ Jaw wiring: this procedure
permits liquid feeds only ,
requires good dental hygiene.
◆ It is only a temporary measure
since weight regain after wires
removal and therefore it is rarely
practiced.
Diet Plus Exercise
The Ideal
Combination
Exercise enhances ◆
fat mobilization
from body’s
adipose depots and
fat catabolism by
active muscles.
Protects against ◆
protein loss in
skeletal muscle
 Prevention
◆All too often, obesity prompts a strenuous
diet in the hopes of reaching the "ideal body
weight." Some amount of weight loss may
be accomplished, but the lost weight usually
quickly returns.
◆ More than 95% of the people who lose
weight regain the weight within five years. It
is clear that a more effective, long-lasting
treatment for obesity must be found, until
then, the goal should be prevention.
 Prevention of Obesity
◆ Prevention should be the goal
because treatment is difficult
◆ Encourage children, young
adults, as well as older adults
from gaining too much weight.
◆ Public health policies should
include creation of public places
to encourage physical activity
and fitness
◆ Education about the benefits of
not gaining weight through
healthy eating and physical
ativity.
◆ Changes in food composition
(alternative to high fat ,high
energy food).
 In Summary…