Obesityfinal hyper1د حاتم البيطار القمة اكاديمي 01202389028.pdf

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1. Obesity
By

Dr hatem el bitar
01005684344

2. Definition :
Obesity is defined as a
condition of abnormal or
excessive fat accumulation in
the adipose tissue to the extent
that health may be impaired
Obesity is derived from the
Latin (to overeat )

3. Anatomical Classification of Obesity:
An anatomical classification of obesity can be based on the number
of adipocytes, on the regional distribution of body fat, or on the
characteristics of localized fat deposits.

A- Number of Fat Cells:
In adults, the upper limit of normal fat cell number ranges from 40 to
60 x 10
9
cells..
Hypercellular obesity shows an increase of number of fat cells. This
type begins in early or middle childhood, but may also occur in adult
life.
Hypertrophic obesity tends to correlate with an android or central fat
distribution and is often associated with metabolic disorders .

B-Fat Distribution:
There are two types of fat distribution :
1.Upper body obesity with excess subcutaneous abdominal fat
(android).
2.Lower body obesity with excess gluteofemoral fat (gynacoid type).

4. Evaluation of Obesity:
1- Weight and Height
2- Body Mass Index (BMI):
Body Mass Index (BMI), or Quetelet’s index, introduced by the world’s first
biostatistician, L, J. Quetelet of Belgium in 1835.).
BMI (kg/m²) is defined as weight in kg divided by the square of height in
meter (m²).
Table 1: classification of overweight and obesity by BMI.






3- Waist circumfence
4- Waist- to- hip ratio (WHR) or abdominal- to- gluteal
circumference ratio (AGR) is calculated by dividing waist girth by hip
girth. Most researches follow the procedures of measuring waist and hip
circumferences of the subject while standing, using a cloth tape measure at
the waist and the hip.
5-Wrist circumference
BMI (kg/M
2
) Obesity class
>20 Underweight
20 – 24.9 Normal
25.0 – 29.9 overweight
30.0 – 34.9

35.0 – 39.9
Grade I

Grade II
obesity
>40 Grade III Extreme obesity

5. 6 -Body fat Analysis (Computerised )
Input : Weight , Height , Age , and Sex.
Output: Fat % Fat mass
Lean % Lean mass
Water BMR
Ideal Weight.
Deurenberg et al., (1991) established that one can
quite accurately estimate the body fat percentage in
adults with the following equation :
Body fat percentage = 1.2 ( BMI ) + 0.23 ( age )
– 10.8 ( gender )- 5.4 .
In this equation , the value for gender is 1 for men
and 0 for women. In adult men with an average weight
the percentage body fat is in the order of 15 –20 %. In
women this percentage is higher (about 25-30 %).
7- Under Water Weighting
8 -CT and MRI for Visceral Fat

6. Predictors of Obesity (Causes)

Several factors that are associated with a high risk
of obesity have been identified. Some are metabolic
and others are socioeconomic.
Among the former are:
1- Low metabolic rate,
2- Increased carbohydrate oxidation,
3- Insulin resistance,
4- Low sympathetic activity.
Among the latter:
1- lower socioeconomic class,
2- lower education level,
3- cessation of smoking,
Other factors as
1- Pregnancy
2- Oral contraceptive

7. Complications of Obesity
1- Cardiovascular Diseases:
2- Hypertension and Strok
3- Diabetes Mellitus:
4- Certain Types of Cancer:
5 -Gall Bladder Disease:
6- Endocrine Disturbance Associated With Obesity
Insulin resistance and increased insulin secretion.
Decreased progesterone levels in women.
Decreased testosterone levels in men.
Increased cortisol production.
7- Metabolic Disturbances:
(a) Dyslipidaemia
(b) The Metabolic Syndrome
8- Osteoarthritis and Gout
9- Pulmonary Diseases

8. Management of Obesity
1- Life style Modification.
2- Diet : The corner stone of treatment
-Low Caloric Diet ( 1000-1200 K cal /day )
-The diet must supply all
MACRO- and MACRONUTRIENTS
-The patient must eat 3 times or more per day .
-↑Unrefined Complex Carbohydrates.
-↓Saturated Fatty Acids
-↑↓Fibers in the diet.
-NO PEPSI or COLA
- NO CHEPSI .
-NO MARGARINE.
- DRINK WATER ( before , at meals ,or after )

9. 3- EXERCISE : Aerobics (WALKING).
4- Electrolipolysis .
5- ACCUPUNCTURE.
6- DRUGS.