What's Obesity all about?

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Garey Bradley
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1 Disclaimer This movie is an educational resource only and should not be used to make a decision on Obesity management. All decisions about obesity management should be made in conjunction with your doctor or a licensed healthcare provider.

2 MULTIMEDIA HEALTH EDUCATION MANUAL TABLE OF CONTENTS SECTION CONTENT 1. Introduction a. BMI b. GI Anatomy c. Overweight d. Obesity 2. Obesity a. Causes b. Consequences 3. Obesity Management a. Diet & Exercise b. Medications c. Surgical Options

3 INTRODUCTION Obesity is a serious, chronic disease and not a simple condition. Obesity is defined as an excessively high amount of body fat in relation to lean body mass.

4 Unit 1: Introduction Body Mass Index ( BMI ) Body Mass Index (BMI) is measure of body fat based on height and weight that applies to both adult men and women. BMI does not differentiate between body fat and muscle mass. Therefore, body builders and people who have a lot of muscle bulk will have a high BMI but are not overweight or obese. (Refer fig.1) BMI Basic Measure BMI: Less than to to to 39.9 Status: Underweight Normal Overweight Obese 40 and above Morbid Obesity (Fig.1) The Gastrointestinal System The gastrointestinal system is essentially a long tube running right through the body, with specialized sections that are capable of digesting material put in from the mouth and extracting any useful components from it, then expelling the waste products at the anus. Food after ingestion undergoes three types of processes in the body: Digestion Absorption Excretion The whole GI system is under hormonal control with the presence of food in the mouth triggering a cascade of hormonal actions. When food is in the stomach, different hormones are activated causing acid secretion, increased motility, and release of enzymes. Nutrients from the GI tract are not processed on-site but instead are absorbed into the blood circulation and taken to the liver to be broken down further, stored, or distributed. (Fig.2) (Refer fig.2)

5 Esophagus Food, after chewing and mixing with saliva in the mouth, is swallowed and passes down the esophagus. The esophagus has a stratified squamous epithelial lining (SE) which protects the esophagus from trauma; the submucosa (SM) secretes mucus from mucous glands (MG) which aid the passage of food down the esophagus. The esophageal wall muscle layer helps to push the food into the stomach by waves of peristalsis. Unit 1: Introduction Esophagus (Fig.3) (Refer fig.3) Stomach The stomach is a 'j'-shaped organ, with two openings- the esophagus and the duodenal- and four regions- the cardia, fundus, body and pylorus. Each region performs different functions including mixing of the food with digestive enzymes and strong acid. The layer of mucus produced prevents the stomach from digesting itself. Stomach (Fig.4) The stomach's major functions are: Temporary food storage Control the rate at which food enters the small intestine Acid secretion and antibacterial action Fluidization of stomach contents Preliminary digestion with pepsin, lipases etc. (Refer fig.4) Liver The liver is the largest organ in the body, normally weighing about 1.5kg or 3.3 lbs (although this can increase to over 10kg or 22 lbs in chronic cirrhosis). It is functionally divided into two lobes, right and left.

6 Unit 1: Introduction Liver The liver is the main organ of metabolism and energy production; its Digestion- through bile production. Storage organ- Storage of iron, glucose, vitamins and trace elements. Liver (Fig.5) Blood purification- Detoxification of poisons, alcohol, drugs and other products. Excretory organ- Conversion of waste products for excretion by the kidneys. Regulation, Synthesis and Secretion- The liver makes plasma proteins Albumin and fibrinogen. Albumin raises the osmotic pressure and Fibrinogen is needed for blood clotting. Anti-bacterial- Helps in eliminating bacteria from the blood. (Refer fig.5) Gall Bladder The gallbladder is a pear-shaped organ which lies just below the liver. It accepts bile from the liver, and stores it. Bile is a watery, greenish-yellowish fluid produced by the liver which aids in the digestion of fatty foods. Functions of the gall bladder: Concentration of bile by the reabsorption of water from it. Release bile for absorption of fats and fatsoluble vitamins. When food is digested, the gallbladder releases bile into the small intestine where it is able to help dissolve fats. Secretes an enzyme that helps in the digestion of fat. Gall Bladder (Fig.6) The most common disorder of the gall bladder is gallstones. (Refer fig.6)

7 The Pancreas The pancreas consists mainly of exocrine glands that secrete enzymes to aid in the digestion of food in the small intestine. The main enzymes produced are lipases, peptidases and amylases for fats, proteins and carbohydrates respectively. These are released into the small intestine via the duodenal ampulla, the same place that bile from the liver drains into. Unit 1: Introduction Pancreas (Fig.7) Pancreatic exocrine secretion is hormonally regulated, and the same hormone that encourages secretion (cholecystokinin) also encourages discharge of the gall bladder's store of bile. As bile is essentially an emulsifying agent, it makes fats water soluble and gives the pancreatic enzymes lots of surface area to work on. Structurally, the pancreas has four sections; head, neck, body and tail; the tail stretches back to just in front of the spleen. (Refer fig.7) Small intestine The small intestine is the site where most of the chemical and mechanical digestion is carried out, and where virtually all of the absorption of useful materials is carried out. The whole small intestine is lined with an absorptive mucosal lining, with certain modifications for each section. Small Intestine (Fig.8) The intestine also has a smooth muscle wall with two layers of muscle. Rhythmical contractions, referred to as peristalsis, force products of digestion through the intestine. The duodenum forms a 'C' shape around the head of the pancreas. Its main function is to neutralize the acidic gastric contents (called 'chyme') and to initiate further digestion; Brunner's glands in the submucosa secrete an alkaline mucus which neutralize the acidic chyme of stomach and protects the surface of the duodenum. (Refer fig.8)

8 Unit 1: Introduction The jejunum & The ileum. The jejunum and the ileum are the greatly coiled parts of the small intestine, and together are about 4-6 metres long; the junction between the two sections is not well-defined. The mucosa of these sections are highly folded. These folds are called plicae and dramatically increase the surface area available for Absorption. (Refer fig.8) Large intestine The large intestine is the last part of the digestive tube and the location of the terminal phases of digestion. It is located between the terminal small intestine and the anus. Within the large intestine, three major segments are recognized: Functions of Large Intestine: Large Intestine (Fig.9) The cecum is a blind-ended pouch that in humans carries a worm-like extension called the vermiform appendix. The colon constitutes the majority of the length of the large intestine and is subclassified into ascending, transverse and descending segments. The rectum is the short, terminal segment of the digestive tube, continuous with the anal canal. (Refer fig.9) Overweight Overweight is defined as a Body Mass Index (BMI) of 25 to Overweight refers to Increased body weight in relation to height. NOTE : Overweight may or may not be due to increases in body fat. It may also be due to an increase in lean muscle. For example, professional athletes may be very lean and muscular, with very little body fat, yet they may weigh more than others of the same height. While they may qualify as "overweight" due to their large muscle mass, they are not necessarily "over fat," regardless of BMI. Obesity Obesity is a serious, chronic disease and not a simple condition. Obesity is defined as an excessively high amount of body fat in relation to lean body mass. Obesity is the second leading cause of preventable death following smoking.

9 Causes of Obesity Obesity could be a combination of the following: The genes you inherited from your parents How well your body turns food into energy Your eating and exercising habits Your surroundings Psychological factors Consequences of Obesity If you are obese, severely obese, or morbidly obese, you may have: Major health risks Shorter Life Expectancy Unit 1: 2: Surgical Procedure Obesity Compared to people of normal weight, obese people have a 50% to 100% increased risk of dying prematurely Obese people have more risk for Diabetes (type 2) Joint problems (e.g., arthritis) High blood pressure Heart disease Gallbladder problems Certain types of cancer (breast, uterine, colon) Digestive disorders (e.g., gastroesophageal reflux disease, or GERD) Breathing difficulties (e.g., sleep apnea, asthma) Psychological problems such as depression Major health risks Problems with fertility and pregnancy Incontinence

10 Unit 3: Unit 1: 2: 3: Gastric Surgical Bypass Procedure Surgery Obesity Risks to psychological and social well-being Negative self-image Social isolation Discrimination Difficulties with day-to-day living Normal tasks become harder when you are obese, as movement is more difficult You tend to tire more quickly and you find yourself short of breath Public transport seats and car seats may be too small for you You may find it difficult to maintain personal hygiene

Unit 3: Surgical Procedure Unit 1: 3: Obesity Surgical Management Procedure Obesity Management Diet and Exercises Your body weight is regulated by the

Everything you eat contains calories, and everything you do uses calories, including sleeping, breathing, and digesting food.

your weight. Physical activity helps to control your weight by using excess calories that otherwise would be stored as fat.

11 Unit 3: Surgical Procedure Unit 1: 3: Obesity Surgical Management Procedure Obesity Management Diet and Exercises Your body weight is regulated by the number of calories you eat and use each day. Everything you eat contains calories, and everything you do uses calories, including sleeping, breathing, and digesting food. Research consistently shows that regular physical activity, combined with healthy eating habits, is the most efficient and healthful way to control your weight. Physical activity helps to control your weight by using excess calories that otherwise would be stored as fat. Any physical activity in addition to what you normally do will use extra calories. (Refer fig. 10 to 12) Weight Gain (Fig.10) Calories in food > Calories used = Weight Gain Weight Loss (Fig.11) Calories in food < Calories used = Weight Loss Weight Control (Fig.12) Calories in food = Calories used = Weight Control

Medications Unit 3: 1: 3: Gastric Obesity Surgical Bypass Management Procedure Surgery Most available weight-loss medications are "appetite-suppressant" medications.

These medications decrease appetite by increasing serotonin or catecholamine - two brain chemicals that affect mood and appetite.

12 Medications Unit 3: 1: 3: Gastric Obesity Surgical Bypass Management Procedure Surgery Most available weight-loss medications are "appetite-suppressant" medications. Appetitesuppressant medications promote weight loss by decreasing appetite or increasing the feeling of being full. These medications decrease appetite by increasing serotonin or catecholamine - two brain chemicals that affect mood and appetite. Surgical Options Gastrointestinal surgery for obesity, also called Bariatric Surgery, changes the normal digestive process.the operations promote weight loss by decreasing absorption of nutrients and thereby reducing the calorie intake. Adjustable Gastric Banding Sleeve Gastrectomy Biliopancreatic diversion (BPD) Gastric Bypass Adjustable Gastric Banding In this procedure, a hollow band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The band is then inflated with a salt solution. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution. (Refer fig. 13) Sleeve Gastrectomy Sleeve Gastrectomy, also referred to as Tube Gastrectomy, involves removing the lateral 2/3rds of the stomach with a stapling device. It can be done laparoscopically ( keyhole surgery) but is not reversible. It basically leaves a stomach tube instead of a stomach Sack. (Refer fig. 14) Adjustable Gastric Banding (Fig.13) Sleeve Gastrectomy (Fig.14)

intestine). Although this procedure successfully promotes weight loss it may lead to nutritional deficiencies. Biliopancreatic diversion (Fig.15) (Refer fig.

13 Unit 1: 3: Obesity Surgical Management Procedure Biliopancreatic diversion (BPD) In this procedure, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine (Ileum), completely bypassing the duodenum and the jejunum (the first and second section of small intestine). Although this procedure successfully promotes weight loss it may lead to nutritional deficiencies. Biliopancreatic diversion (Fig.15) (Refer fig. 15) Roux en Y Gastric Bypass Here a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the Roux en Y Gastric Bypass (Refer fig. 16) (Fig.16)

14 Unit 1: 3: Surgical Disclaimer Procedure Although every effort is made to educate you about Obesity and Obesity management, there will be specific information that will not be discussed. Talk to your doctor or health care provider about any questions you may have.

15 YOUR SURGERY DATE READ YOUR BOOK AND MATERIAL VIEW YOUR VIDEO /CD / DVD / WEBSITE PRE - HABILITATION ARRANGE FOR BLOOD MEDICAL CHECK UP ADVANCE MEDICAL DIRECTIVE PRE - ADMISSION TESTING FAMILY SUPPORT REVIEW Physician's Name : Physician's Signature: Date : Patient s Name : Patient s Signature: Date :

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