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Obesity - Epidemiology of NCDs
The document discusses obesity, defining it as an abnormal growth of adipose tissue due to an enlargement of fat cell size or an increase in fat cell number. It describes several ways to measure obesity, including BMI, waist-to-hip ratio, and skin fold thickness. Obesity is a chronic disease that is increasing globally and contributes significantly to illness and mortality. Lifestyle modifications including a calorie-controlled diet, increased physical activity, and behavior therapy are recommended for obesity management.
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Introduction to obesity, its definition, and types: hypertrophic and hyperplastic obesity.
Difference between obesity and overweight, fat distribution, and classification based on shape (apple vs pear).
Obesity's prevalence as a chronic condition affecting both developed and developing nations, including childhood.
Discussion on obesity as a significant contributor to health issues, highlighting various epidemiological determinants.
Techniques to assess obesity: BMI, WHR, skinfold thickness, and more, with classifications and numerical data.
First adverse effects of obesity like hypertension, with co-morbidities and links to cardiovascular diseases and cancers.
Chronic condition management, lifestyle modifications, dietary plans, pharmacotherapy, and surgical options.
Empowerment message encouraging individuals to overcome obesity challenges and resources available.
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Obesity - Epidemiology of NCDs
- 1. OBESITY Dr. Jasminkumar Viramgami Reader& H.O.D., Dept. of Swasthavritta, Govt. Akhandanand Ayurved College, Ahmedabad, Gujarat
- 2. Latin word “OBESUS”meaning stout, fat, plump. • It is defined as a state of excess adipose tissue. Obesity may be defined as- an abnormal growth of the adipose tissue (hypertrophic obesity) • due to an enlargement of fat cell size or an increase in fat cell number (hyper-plastic obesity) or a combination of both. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 3. Obesity v/s Overweight Overweight– Fat Fluid Muscle mass Bone Tumours Obesity – Fat ( adipose tissue ) Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 4. Obese individuals differ •in the amount of excess fat that they store, • also in the regional distribution of the fat within the body. • The distribution of fat affects the risks associated with obesity, and the kind of disease that may results. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 5. Classification of Obesity(shape) Apples- Android • central abdominal obesity • clinically more important • disease are more correlated with this abdominal fat Pears – Gynecoid • accumulation of fat around hip and buttocks. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 6. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 7. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 8. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 9. Prevelence • a chronicdisease • most prevalent form of malnutrition. • in both developed and developing countries • Once a high-income country problem, now rising in low-and middle-income countries, particularly in urban settings Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 10. affects children aswell as adults (childhood Obesity) Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 11. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 12. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 13. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 14. Altitude of Problem •It is extremely difficult to assess the size of the problem • one of the most significant contributors to ill health. • obesity is a key risk factor in natural history of other chronic and NCDs • 44 % of the DM, 23 % of IHD and 7 to 41 % of certain cancer are attributable to overweight and obesity. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 15. • Overweight andobesity are the 5th leading risk of global deaths. • Obesity is the leading cause of preventable death, next to smoking • At least 3.4 million adults die each year as a result of being overweight or obese Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 16. Epidemiological determinants aetiology ofobesity is complex, and is one of multiple causation AGE : at any age, generally increases with age. SEX : Women generally have higher rate. woman's BMI increases with successive pregnancies. GENETIC FACTORS : amount of abdominal fat was influenced by a genetic component. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 17. SOCIO-ECONOMIC STATUS :clear inverse relationship between socio-economic status and obesity. FAMILIAL TENDENCY : runs in families , but not necessarily. PSYCHOSOCIAL FACTORS : emotional disturbances, anxiety, frustration, loneliness. Overeating may be a symptom of depression. secret eaters. ENDOCRINE FACTORS : may be involved, e.g. Cushing's syndrome, growth hormone deficiency. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 18. EATING HABITS :e.g., eating in between meals, sweets, refined foods and fats. • The composition of the diet, the periodicity and the amount of energy are all relevant. • fast food of energy-dense, micronutrient poor food and beverages. PHYSICAL INACTIVITY : sedentary lifestyle • particularly sedentary occupation and inactive recreation such as watching television • physical activity and physical fitness are important modifiers of obesity. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 19. ALCOHOL : relationshipbetween alcohol consumption and adiposity EDUCATION : inverse relationship between educational level and prevalence of overweight ETHNICITY : may be due to a genetic predisposition to obesity when exposed to a lifestyle DRUGS : Use of certain drugs can promote weight gain (cortico-steroids, contraceptives, insulin, P- adrenergic blockers etc). Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 20. Obesity How do wemeasure If someone is obese? Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 21. Measurement Of Obesity •BMI • Waist hip ratio • Skin fold thickness • Biometric impedance • Ultrasound • CT / MRI • DEXA (Dual Energy Xray Absorptiometry) • Air displacement Plethysmography • Total body electrical conductivity • Hydro-densometry (most accurate)Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 22. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 23. Body Mass Index(BMI) • BMI measures individual’s total weight relative to his height. • Correlation btwn rise in BMI and Complications. BMI may be misleading in certain cases • BMI may be high in a muscular person • For similar BMIs, women have greater fat mass than their male counterparts Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 24. Category BMI Weightof a person with this BMI(Kg) Severely underweight Less than 16.5 Less than 53.5 Underweight 16.5 to 18.5 53.5 to 60 Normal 18.5 to 25 60 to 81 Overweight 25 to 30 81 to 97 Obese I 30 to 35 97 to 113 Obese II 35 to 40 113 to 130 Severely Obese 40 to 45 130 to 146 Morbid Obese 45 to 50 146 to 162 Super Obese 50 to 60 162 to 194 Hyper Obese Above 60 Above 194Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 25. Classification of Obesity(BMI) • Underweight - BMI < 18.5 • Normal weight - BMI between 18.5 to 24.9 • Overweight - BMI between 25.0 to 29.9 • Obese grade I - BMI between 30.0 to 34.9 • Obese grade II - BMI between 35.0 to 39.0 • Obese grade III - BMI ≥ 40 ( morbid obese) Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 26. Waist To HipRatio (WHR) • Central or abdominal obesity • associated with more co-morbid conditions. • So measuring central obesity is of greater significance • W/H ratio is taken by a simple measure tape • in men > 102 cm (40 inch) /90 • in women > 88 cm (34 inch) /80 High WHR ( > 1.0 in men and > 0.85 in women) indicates abdominal fat accumulationDr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 27. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 28. Skin fold thickness •Harpenders callipers / MRNL callipers • measured at biceps/triceps/illiac and interscapular. • Total of all four sites is considered 15-45 mm – 8-22 % of total body fat 46-75 mm – 23-30 % “ 76-150 mm – 31-40 % “ 151-170 mm – 41-45 % “ Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 29. Classification of Obesity(FAT) Upto 22% it is normal (males) Upto 30% it is normal (females) • Body fat 25% in men obese • Body fat 30% in women obese Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 30. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 31. Biometric Impedance analysis(BIA) • a commonly used method for estimating body composition, and in particular body fat. • used to calculate an estimate of total body water (TBW). • Radio frequency current is introduced in body through electrodes • Fat has less number of electrolytes • Water is less conductive Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 32. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 33. CT/MRI • They candifferentiate subcutaneous from visceral fat • so are important in research purposes. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 34. A DEXA scanis a special type of X-ray that measures bone mineral density (BMD). DEXA (Dual Energy Xray Absorptiometry) Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 35. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 36. Air displacement Plethysmography •a recognized and scientifically validated densito- metric method • to measure human body composition. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 37. Total body electricalconductivity Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 38. Hydro-densitometry Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 39. Adverse Effects ofObesity The first adverse effects to emerge in population are • hypertension, • hyper lipidaemia and • glucose intolerence CHD and the long-term complications begin to emerge several years (or decades) later Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 40. Co morbidities ofObesity • Insulin resistance & Type II DM • Reproductive disorders • Cardiovascular disorders • Pulmonary disorders • Gastrointestinal diseases • Renal diseases • Cancers • Bone, joint and cutaneous diseases • Retinal diseases • Psychological problems Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 41. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 42. Obesity and Cardiovasculardisease • W/H ratio may be the best predictor • BMI > 29…..3 fold rise in MI • Obesity is responsible for 17% of all CVD • Angina increases by 1.8 times • MI increases by 3.2 and 1.5 fold in woman and men respectively. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 43. Obesity and Cancers •Obesity is the biggest preventable cause of Cancer after smoking. • Accounts for 14% of cancer deaths in Men and 20% in women. Males : Esophagus Colon Rectum Pancreas Liver Prostrate Females : Gall bladder Bile ducts Breasts Endometrium Cervix Ovaries Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 44. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 45. Obesity and OrthopaedicDisease • OA • Hyper Uricemia • Gout • Accidental injury • decrased mobility Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 46. Obesity and Psychologicalproblems Are obese people more jolly? NO Obesity psychological problems Psychological problems obesity Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 47. Obesity and Psychologicalproblems • 50% overweight lack self confidence • Depression Obesity has more risk of depression in Women • More physical and sexual abuse • Lack of attention • Low education • Low self esteem Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 48. Management of Obesity Itis a chronic medical condition Aim of successful treatment: • Attainment of normal weight • No treatment induced morbidity This is rarely achieved in clinical practice. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 49. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 50. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 51. Life Style Modification Dr.Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 52. Diet • Low caloriediet • Low saturated fats • Normal protein intake • Increased fibers in diet • Low density foods • 1000 K cal deficit produces 1 kg wt loss per week Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 53. Low Calorie Diet •800-1000 Kcal • Applicable to most of the patients • Fewer restrictions than VLCD. • Supplementation of vitamins and minerals is required • Over a year there is reduction of 6 to 7 kgs. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 54. Very Low CalorieDiet • 400 – 600 calorie diet. • Even below one’s basal metabolic rate • Used for period of 1 to 2 months • under medical supervision • 45 to 70 % protein • 30 to 50 % carbohydrates • 2g fat • Supplemented with vitamins, minerals and trace elements • Greater wt loss compared to restrictive diets Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 55. Very Low CalorieDiet • Complications -fatigue, hair loss, dry skin, dizziness difficulty concentrating, cholelithiasis, pancreatitis, gall stones. • Contraindications – pregnancy, cancer, MI, hepatic disease, CV Stroke. Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 56. Total Fasting • Notrecommended • There is diuresis, natriuresis • All deficiencies Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 57. Fat Intake Decreased fatintake without decreased calories is of no use • Because if fat is replaced by carbohydrates there is rise in triglycerides. • Instead saturated fats should be replaced by MUFA or PUFA Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 58. Physical Activity Dr. JasminkumarM Viramgami, Reader, Swasthavritta, GAAC
- 59. Bariatric surgical techniques Dividedinto two groups Mal-absorptive procedures – • Induce decreased absorption of nutrients • by shortening the functional length of the small intestine Restrictive procedures – • Reduce the storage capacity of the stomach • as a result early satiety arises, • leading to a decreasedcaloric intake Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 60. Mal-absorptiveprocedures • Jejuno-ileal bypass • Bilio- pancreatic diversion •Bilio- pancreatic diversion with duodenal switch Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 61. Restrictive procedures • Verticalbanded gastroplasty • Laparoscopic adjustable gastric band Dr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
- 62. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 63. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 64. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 65. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 66. Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 67. IF THEY CAN, SO CAN YOU Dr. Jasminkumar MViramgami, Reader, Swasthavritta, GAAC
- 68. THANK YOU Follow us: Facebook: •https://fb.me/SwasthavrittaGAAC Youtube: • https://www.youtube.com/channel/UCPvrBlyheQcqwBXs1egxzWw SlideShare: • https://www.slideshare.net/SwasthvrittaAkhandanDr. Jasminkumar M Viramgami, Reader, Swasthavritta, GAAC
Editor's Notes
- #21 Body Mass Index is defined as weight in kilos divided by height, squared..so it looks like this: kg/m2 Body mass index (BMI) is measure of body fat based on height and weight that applies to both adult men and women. BMI Categories: Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater Reference: US Department of Health and Human Services, retrieved from: http://www.nhlbisupport.com/bmi/bminojs.htm The information you need is someone's weight in kilograms and then their height. The formula is: Metric BMI Formula BMI = ( Weight in Kilograms / ( Height in Meters ) x ( Height in Meters ) ) For example: BMI = (75 kg/ 1.6 m) x (1.6 m) = 75/2.56 =29.29 BMI, which then rounds up to 29.3…This BMI indicates this person is overweight…not quite obese, but getting close! Exercise: Calculate your own BMI, where are you on the BMI scale?