Science of Obesity (I-2.28)

Transcription

1 Science of Obesity (I-2.28) Dr Noha Nooh Lasheen Lecturer of Physiology Date :16 / 10 / 2016

2 Objectives By the end of this lecture, the student should be able to: Define energy, energy balance and obesity. Describe the nutritional pyramid. Identify the health consequences of obesity and its complications. Recognize strategies to reduce obesity. Date : 16 / 10 / 2016

3 Energy: the power used: - to work - to brush teeth - to go for a walk - to think The fuel of the body's cells is called 'Glucose' or 'Blood Sugar' Energy for the body comes from food

4 NUTRITIONAL PYRAMID

5 Energy balance the balance between energy taken (in food and drink), and energy expended Energy input = Energy output Energy expenditure is influenced by: genetics, body size, amount of muscle, and physical activity.

6 Obesity is a heterogeneous complex disorder of multiple etiologies characterized by excess body fat threatening socioeconomic, mental or physical health. Sharma 2007

7 Definition of obesity: excessive weight gain that may impair health

8 Types of obesity:

9 Obesity Measures 1) Skinfold measurements Skinfold caliper from selected sites Use of formulas to calculate % of body fat 2) Body Mass Index (BMI) BMI = wt/ (ht)2 Normal weight = Overweight = Obesity = BMI of 30 or greater 3) Waist circumference 4) Waist/ Hip ratio

10 Predisposing Factors of obesity: Genetic familial tendency. Sex women more susceptible. Activity lack of physical activity. Psychogenic emotional deprivation, depression. Social class poorer classes in Egypt (may be also in higher classes). Prescribed drugs tricyclic derivatives. Causes Global shift in what we eat Western diet of processed food Higher sugar, fat and calories in what we eat Less physical exercise

11 Energy imbalance calories consumed not equal to calories used Over a long period of time Due to a combination of several factors Individual behaviors Social interactions Environmental factors Genetics "EAT TO LIVE" Intake = Expenditure Weight Stable "LIVE TO EAT" Intake > Expenditure Obese

12 Consequences of obesity:

13 Consequences of obesity: Cardiovascular Hypertension, Congestive heart failure, Varicose veins, Pulmonary embolism, Coronary artery disease Endocrine Metabolic syndrome, Type 2 diabetes, Dyslipidemia, Polycystic ovarian syndrome, Amenorrhea/infertility/ menstrual disorders Gastointestinal Gastroesophageai reflux disease (GERD), Non-alcoholic fatty liver disease (NAFLD), Cholelithiasis, Hernias, Colon cancer Genitourinary Urinary stress incontinence, Obesity-related glomerulopathy, Hypogonadism(male), Breast and uterine cancer, Pregnancy complications Kushner RF and Roth JL, 2003

14 Consequences of obesity: Cutaneous stretch marks, Hyperpigmentation of legs, Cellulitis, carbuncles, skin tags Musculoskeletal Hyperuricemia and gout, Immobility Osteoarthritis (knees, hips), Low back pain Neurologic Stroke, Idiopathic intracranial hypertension Psychological Depression/low self esteem, Body image disturbance, Social stigmatization Respiratory Dyspnea, Obstructive lung diseases, Hypoventilation syndrome, Asthma (Kushner RF and Roth JL, 2003)

15 Obesity: A Chronic Metabolic disease

16 Risk of Diseases related to BMI &Waist circumference Risk of Associated Disease According to BMI and Waist circumference BMI Waist less than or equal to 40 in. (men) or 35 in. (women) Waist greater than 40 in. (men) or 35 in. (women) 18.5 or less Underweight -- N/A Normal -- N/A Overweight Increased High Obese High Very High Obese Very High Very High 40 or greater Extremely Obese Extremely High Extremely High

17 Assessment of obesity: Weight/BMI Waist Circumference: Men>40 inches, Women>35 inches Blood pressure: >130/85mm Hg Fasting glucose: >110 mg/dl Triglycerides: >150mg/dL HDL: Men <40mg,dL; Women <50 mg/dl Any 3 of the above = Metabolic Syndrome Other risks: Cigarette smoking, Age, Gender, Family History

18 Edmonton Obesity Staging System (EOSS) Mental Psychological

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20 Activity (1): (5 min) How to treat a person with obesity?

21 Treatment of Obesity 1) Dietary Recommendations: Caloric restrictions /day to promote weight loss Low carb-more weight loss in short-term; no difference in losses in long-term Fat, Fiber, and Protein all shown to be helpful in satiety. Protein especially important in maintaining lean body tissue during weight loss

22 The Key To Successful Weight Loss With Other Health Benefits Is To: - Enjoy your food and limit any hunger by choosing a bulkier but appetising diet. Eat the variety of foods. Plan your meals ahead. Have regular meals: do not skip meals. Eat the recommended quantities of food. Reduce the intake of fat and fatty foods. Restrict all sugary foods and drinks. Vegetables and fruit are essential elements of the menus. Eat fibre-rich whole-grain, unrefined, cereal foods with substantial amounts of vegetables and fruit every day. Choose low-salt varieties of food and limit the amount of salt used in cooking. Do not add salt to food at table. Good Food is Good Medicine!

23 Treatment of obesity: 2)Physical Activity: prevents weight gain enhances weight loss Ultimate goal in behavioral interventions is to promote long term adherence

24 Treatment of obesity: 3) Pharmacotherapy for Weight Loss When to use? Adjunct to diet & physical activity at BMI 30 Or, BMI 27 with other risk factors Should not be used for cosmetic weight loss Only for risk reduction Use only when 6-month trial of diet & physical activity fails to achieve weight loss

25 Treatment of obesity: 3) Pharmacotherapy for Weight Loss It includes: Enhancing satiety Decreasing fat absorption Fat soluble vitamins absorption (S/E) Increasing energy expenditure Decrease appetite blood pressure (S/E) Note: These drugs are only modestly effective 2 to 10 kilogram loss Most occurs in the first 6 months If patient does not lose 2 kilograms in the first 4 weeks, success is unlikely If the first 6 months is successful, continue medication

26 Treatment of obesity: 4) Surgical Treatment: Bypass surgery criteria are: BMI>40 OR BMI>35 with comorbidities

27 Case Study 43 years old female, mother of 3 children (ages 15, 13, 8), works full-time. Height 160 cm, weight 86 Kg. Family history of Diabetes mellitus type II, hypertension. Pre-pregnancy weight was 65 Kg, she gained weight with each pregnancy, but she was unsuccessful in taking it off. She is complaining of fatigue and feeling stressed with work, home and responsibilities. She stated, I know that losing weight will help me have more energy and feel better about myself, but the idea of making changes seems overwhelming at this point. Questions? 1) Assess her BMI? 2) Mention the causes of her weight gain? 3) Mention the complications she could face in the near future? 4) Suggest the treatment plan for her?

28 Answers of the case??

29 Summary Obesity is a complex and heterogeneous disorder BMI is a poor measure of obesity related health risks. The Edmonton Obesity Staging System may provide a clinically more rational approach to manage obesity. Obesity management should be based on an etiological assessment of weight gain in addition to life style modification.

30 References World Health Organization.(2008). Obesity and overweight. Fact sheet #311. National Institutes of Health Publication No The Practical Guide: Identification, Evaluation, and Treatment of overweight and obesity in adults Case Study: CLINICAL DIABETES; 17 (3), 1999 Guyton and Hall: Textbook of Medical Physiology, 13 th edition. Peck C presentation: Obesity Treatment: How to make a difference with your clients

31 Any Question?

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