Shivanshu Sharma - 418.pptxbubybuhyh6g6g7h

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1. What is Obesity?

¢ The term obesity is derived from the Latin
word “obseus” which means to eat
excessively.

+ Obesity is a metabolic disorder in which
excess body fat has accumulated to the extent
that it my lead to major health problems. It is
the result of taking in more calories in the
diet than are expected by the body’s energy
consuming activities.

2. Body Mass
Index
(BMD

Waist to-hip Skinfold
Circumference ratio Thickness

3. Body Mass Index (BMI)

« Body mass index is a value derived from
the weight and height of a person.

* The most widely used method to gauge
obesity is Body Mass Index (BMI) which
is equal to Weight in Kg/Height in m’.

BMI = weight inkg
(height in meters)?

4. BMI CLASSIFICATION
< 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0-34.9 Obesity (Class D
35.0-39.9 Obesity (Class IT)
>40 Extreme Obesity (Class III)

According to World Heath Organisation

(WHO).

5. Waist to-hip ratio

Like the waist circumference, the waist-to-
hip ratio(WHR) is also used to measure
abdominal obestiy.

It is 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.

6. Skinfold Thickness

In this method, researchers use a special
caliper to measure the thickness of a “Pinch” of
skin the fat beneath.

It is apply at specific areas of the body.

Such as the area of triceps, chest, abdominal,
suprailiac and thigh.

7. OBESITY

EPIDEMIC

it’s time to
stop its growth

® According to WHO about 13% of the
world’s adult population (11% of men
and 15% of women) were obese in 2014.

@ India is having 30 million obese people
where as Punjab and Delhi are the leading
states in number of obese people.

® Obesity is the root cause of many
diseases like Type-lI Diabetes,
Hypertension, Sleep Apnea and
fatty liver disease.

© The cost of obesity extends far beyond
basic health care expenses.

8. How many are
obese in India?

Children (2-19 years) Adults (20+ years)
= Males m Females

EB =: > Joel BEE 4.58%
(ES ES) MM 3.12% PTE MI 7.04%

Countries with the most
obese children”*

> —

China India
15 million 14 million

(This is due to the large population of these two countries)

9. Pathogenesis

Energy Imbalance
What is it?

« Energy balance can be compared to a scale.

+ An energy imbalance arises when the number of calories
consumed is not equal to the number of calories used by
the body.

* Weight gain usually involves the combination of consuming
too many calories and not expending enough through
physical activity.

10. Neutral Calorie Balance N
Calories Consumed = Calories Used | No change in Weight calories burned
Positive Calorie Balance

Calories Consumed > Calories Used | Weight Gain

Negative Calorie Balance
Calories Consumed < Calories Used | Weight Loss

calories in

Weight gained

11. Regulation of Energy Balance

Body weight regulation(Regulation of energy

balance) or dysregulation depends on a complex
interplay of both humoral (endocrine) and neural
mechanism that control appetite and regulation.

Neurohumoral mechanisms can be subdivided into
three components:

1 Peripheral or Afferent system
2 The central processing unit
3 The efferent system

12. 1. Peripheral or Afferent system

* Generate signals from various sites

+ Composed of

a) Peripheral appetite suppressing signals
* Leptin
* Adiponectin
Gut hormones
+ Insulin
+ peptide YY(PYY)
° Amylin
b) Peripheral appetite stimulating signals
* Gut hormones
+ Ghrelin
+ Obestatin

13. Leptin receptor 1. Food intake Y
in hypothalamus 2. Energy expenditure $
(Arc, VMH, PVN etc.) 4

Body weight 4

Adipose tissue

Fig. 3. Leptin as an adipocytokine that regulates food
intake and energy expenditure

Leptin

14. Complications

Morbidity or Mortality

Metabolic complications

Endocrine Manifestation of obesity
Mechanical complication of obesity
Pulmonary diseases

Cancer

GIT Disorder

Fatty Liver (Steatosis) and Non Alcoholic
steato hepatitis (NAFLD)

15. Morbidity or Mortality

Obesity has many adverse effects on health and is
associated with an increase in mortality and
morbidity. Obese individuals are risk of early death,
mainly from diabetes, coronary heart disease and
cerebrovascular disease.

Obesity and Mortality Risk

Mortality
Ratio 15

16. Metabolic complications

* Central obesity or Metabolic Complications of Obesity
upper body fat
distribution is Connery haart
associated with A disease
increased
concentration of FFA ]
which can produce Se

several metabolic
complications of
obesity.

Dyslipidemia

| (Increased TG-rich lipoproteins)

17. Insulin resistant and Type 2 diabetes mellitus

* Insulin resistance is the decrease/failure of target
(peripheral) tissues to insulin action.

+ Normally, insulin promotes glucose utilization (i.e.
glucose uptake, oxidation and storage) as well as
to inhibit the release of glucose into the
circulation.

* Insulin resistance can develop in obesity and may
produce type 2 diabetes mellitus.

° Central/ upper body/ visceral obesity are found in
more than 80 % of patients with type 2 diabetes
mellitus.

18. Life style and other Le Genetic and expressional
environmental factors regulation

19. Management

1. Obesity is a serious medical condition requiring long-
term management.

2. Management needs to be flexible and intergrate
different therapeutic approaches according to
individual patient needs including.

Obesity Treatment Pyramid

» Lifestyle Modification
* Pharmaco Therapy

+ Surgery ; E, cx

‘Pharmacotherapy

Lifestyle Modification

Diet Physical Activity

20. “AS Lifestyle

management
Y obesity

21. Food Selection

Portion size control
Avoidance of snackling
regular meals to
encourage satiety
Regular support from
the dietician ata
weight loss group may
be helpful.

22. DIETARY MANAGEMENT

Obesity may be managed by dietary management by
following ways:

Less intake of Carbohydrate (Not more than 55% of total
daily diet)

Less intake of fatty food (less than 20%-30% )

High quality protein (15%-20%)

More intake of vegetables and fruits (except banana)
High fiber diet

Stop cigarette smoking.

Low carbohydrate, High Protein diets appear to be more effective in
lowering BMI.

Improving coronary heart disease risk factors, including an
increase in HDL cholesterol and a decrease in triglyceride levels.

23. 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
reduced body fat.

» Exercise affects macronutrient balance. During moderate
exercise, equivalent to a brisk walk, there is a shift to greater
use of fat as a fuel.

+ To maintain health the American Heart Association
recommends a minimum of 30 minutes of moderate exercise
at least 5 days a week.

24. Pharmaco Therapy

Anti-Obesity medication or weight loss drugs are all
pharmacological agents that reduce or control weight.

These drugs alter one of the fundamental processes of the human
body, weight regulation, by altering either appetite, or absorption
of calories.

ORLISTAT is the only drug currently licensed for long- term use.

Mode of Action

Orlistat inhibits pancreatic and gastric lipases and thereby
decreases the hydrolysis fat absorption by approximately 30%
The drug is not absorbed.

25. Surgery

Bariatric surgery to reduce the size of the stomach is by far
the most effective long-term treatment for obesity.

Bariatric surgery should be offered to those a BMI of 40
kg/m2 or over and Also to those with a BMI of 35-40 kg/m2
who also have obesity related complications, such as DM.

Bariatric surgery should be contemplated in motivated
patients who have very high risks of complications of
obesity, in whom extensive dietary and drug therapy has
been inadequately effective.

This reduces the overall mortality by approx 40%

26. Management of Childhood Obesity

PROMOTE INTAKE OF
HEALTHY FOODS

WEIGHT PROMOTE
MANAGEMENT PHYSICAL ACTIVITY

ENDING
CHILDHOOD

OBESITY

HEALTH, NUTRITION PRECONCEPTION AND
AND PHYSICAL PREGNANCY CARE
ACTIVITY FOR SCHOOL-
AGE CHILDREN

EARLY CHILDHOOD
DIET AND PHYSICAL
ACTIVITY

27. CONCEPT OF STHAULYA
(OBESITY)

28. CONCLUSIONS

+ Obesity, although it has reached the scale of the
world epidemic, is no longer just a health issue. In
addition to the consequences as obvious as the
development of biochemical and physiological
disorders of the body and shortening the life
expectancy, it is also an economic and social
problem, which has to be managed not only by
well developed countries, but also those
developing and with low income.

29. F_T
BODY

it’s your choice.

30. #FightAgainstObesity

FIGHT AGAINST OBESITY EPIDEMIC
ON THE OCCASION OF

e WORLD

BESITY
DAY EEE]

31. -End of Presentation-
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Thank You