Download obesity

Obesity and Risk
Factors
Dr . Mouna Dakar
Definition

Obesity is defined as an excess accumulation of body fat

This excess accumulation is the result of a positive
energy balance where caloric intake exceeds caloric
expenditure

It is the most common nutritional disorder in
industrialized countries and is becoming increasingly
prevalent in developing countries due to changing
lifestyles.
Overweight and obesity among adults
Health Survey for England 2011-2013
More than 6 out of 10 men are overweight or obese (66.2%)
More than 5 out of 10 women are overweight or obese (57.6%)
Adult (aged 16+) overweight and obesity: BMI ≥ 25kg/m2
4
Patterns and trends in adult obesity
Adult BMI status by sex
Health Survey for England 2011-2013
Adult (aged 16+) BMI thresholds:
Underweight: <18.5kg/m2
Healthy weight: 18.5 to <25kg/m2
5
Overweight: 25 to <30kg/m2
Obese: ≥30kg/m2
Patterns and trends in adult obesity
Adult obesity prevalence by age
Health Survey for England 2011-2013
Adult (aged 16+) obesity: BMI ≥ 30kg/m2
6
Patterns and trends in adult obesity
Dietary Management for Older
Subjects with Obesity
http://www.learnwell.org/nutri.htm
Etiology


Multifactorial disorders
Genetics:

polygenic, each gene having a small contribution in the presence of precipitating
environmental factors
 It has been long known that the tendency to gain weight runs in families.
However, family members share not only genes but also diet and life style habits
that may contribute to obesity.
 morbid obesity has a stronger genetic component than moderate level of excess
overweight


Energy imbalance
Diet



obesity is associated with increased food consumption
Intake of excess dietary fat has been implicated as a major cause of obesity
Exercises

For a decades A strong link exists between physical inactivity and weight gain
Cont.

Diseases
Hypothyroidism, Cushing’s syndrome, pancreatic insulinoma, growth
hormone deficiency, and hypothalamic insufficiency
 A variety of psychosocial factors contribute to the development of
obesity and to difficulty losing weight


Drugs

antipsychotics (phenothiazines, butyrophenones); antidepressants
and antiepileptics, (tricyclic antidepressants, lithium, valproate,
carbamazepine); and insulin and some oral hypoglycemics.
Whereas most of these medications contribute modestly to obesity,
 the large doses of steroids sometimes used to treat autoimmune
diseases can cause true obesity
Health Effects of Obesity

Obesity is associated with more than 30 medical
conditions, and scientific evidence has established a
strong relationship with at least 15 of those conditions

It has been established that obesity is associated with an
increased prevalence of coronary artery disease,
hypertension, diabetes mellitus, and other diseases.

In addition, life expectancy is shown to be reduced in
those who are obese or overweight.
Cont.

Diabetes (Type 2)

As many as 90% of individuals with type 2 diabetes are reported
to be overweight or obese.

Obesity has been found to be the largest environmental
influence on the prevalence of diabetes in a population.

Obesity complicates the management of type 2 diabetes by
increasing insulin resistance and glucose intolerance, which
makes drug treatment for type 2 diabetes less effective.

A weight loss of as little as 5% can reduce high blood sugar.
Cont.

Hypertension

Over 75% of hypertension cases are reported to be directly attributed to
obesity.

Weight or BMI in association with age is the strongest indicator of blood
pressure in humans.

The association between obesity and high blood pressure has been
observed in virtually all societies, ages, ethnic groups, and in both
genders.

The risk of developing hypertension is five to six times greater in obese
adult Americans, age 20 to 45, compared to non-obese individuals of
the same age.
Cont.

Cardiovascular Disease (CVD)






Obesity increases CVD risk due to its effect on blood lipid levels.
Weight loss improves blood lipid levels by lowering triglycerides
and LDL (“bad”) cholesterol and increasing HDL (“good”)
cholesterol.
Weight loss of 5% to 10% can reduce total blood cholesterol.
The effects of obesity on cardiovascular health can begin in
childhood, which increases the risk of developing CVD as an
adult.
Overweight and obesity increase the risk of illness and death
associated with coronary heart disease.
Obesity is a major risk factor for heart attack, and is now
recognized as such by the American Heart Association.
Multiple cardiovascular risk factors drive
adverse clinical outcomes
Increased Cardiometabolic Risk
Dyslipidaemia
Hypertension
Abdominal
obesity
Metabolic Syndrome
Glucose intolerance
Insulin resistance
Abdominal obesity and
increased risk of CHD
Waist circumference was independently associated with
increased age-adjusted risk of CHD, even after adjusting for
BMI and other CV risk factors
3.0
Relative risk
2.5
2.31
p for trend = 0.007
2.44
2.06
2.0
1.5
1.27
1.0
0.5
0.0
<69.8
69.8-<74.2
74.2-<79.2
79.2-<86.3
Quintiles of waist circumference (cm)
Rexrode et al 1998
86.3-<139.7
Unmet clinical need associated with
abdominal obesity
CV risk factors in a typical patient with abdominal obesity
Patients with
abdominal obesity
(high waist
circumference) often
present with one or
more additional
CV risk factors
Cont.

Stroke

Elevated BMI is reported to increase the risk of ischemic stroke
independent of other risk factors including age and systolic blood
pressure.

Abdominal obesity appears to predict the risk of stroke in men.

Obesity and weight gain are risk factors for ischemic and total
stroke in women.

Osteoarthritis (OA)

Obesity is associated with the development of OA of the hand,
hip, back and especially the knee.

At a Body Mass Index (BMI) of > 25, the incidence of OA has
been shown to steadily increase.

Modest weight loss of 10 to 15 pounds is likely to relieve
symptoms and delay disease progression of knee OA.

Sleep Apnea

Obesity, particularly upper body obesity, is the most significant
risk factor for obstructive sleep apnea.

There is a 12 to 30-fold higher incidence of obstructive sleep
apnea among morbidly obese patients compared to the general
population.

Among patients with obstructive sleep apnea, at least 60% to
70% are obese.
Cont.


Impaired Respiratory Function
Infertility

Liver Disease

Low Back Pain

Surgical Complications

Daytime Sleepiness
Cont.

Cancers

Carpal Tunnel Syndrome (CTS)

Chronic Venous Insufficiency (CVI) & Deep Vein Thrombosis (DVT)



Gallbladder Disease
Gout
abdominal hernias
Risk Factors for Cancers
•
•
•
•
•
•
Cigarettes/Tobacco
Betel Nut (lime?)
Hepatitis B
Obesity
Hyperglycaemia
Physical Activity
• Dietary Factors
– Fat
– Fibre
– Meat (cooking
methods)
– Alcohol
– Vegetables and Fruits
– Omega 3 fatty acids
Obesity and Cancer
Obesity is associated with the following types of
cancer:
 colon
 breast (postmenopausal)
 endometrium (the lining of the uterus)
 kidney
 gallbladder
 pancreas
 esophagus
National Cancer Institute
Obesity and Cancer

Obesity and physical inactivity may account
for 25%-30% of cancer of the colon, breast
(postmenopausal), endometrial, kidney, and
esophagus

Preventing weight gain can reduce the risk of
many cancers. Healthy eating and physical
activity early in life can prevent overweight
and obesity.
National Cancer Institute
HISTORY
History :
You must take full Hx
 with out forgetting to ask about obesity
cause(s) … ( Etiology )

•
•
•
•
-Energy imbalance
-familial
-Diseases
-Medications
And ask about diseases which arising from
obesity like:
 DM II
 HTN
 CVD
 OA
 Sleep apnea….
& Other diseases


All of the systems that make the body
function are affected by morbid obesity










Cardiovascular System
Digestive System
Endocrine System
Musculoskeletal System
Nervous System
Reproductive System
Respiratory System
Urinary System
Dermatology System (Skin)
Immune System
Examination
Examination:


1st impressions.
Vital signs:








PR
RR
BP
and Temperature
General examination.
Size of thyroid
size of abdominal organs e.g. liver…
Heart and lung sounds.
Evaluation :

Also you must evaluate the patient obesity by
calculating BMI.
BMI =
weight (kg) / [ height (m) ]²
Although several classifications and definitions for degrees of
obesity are accepted, the most widely accepted classifications
are those from the World Health Organization (WHO), based on
body mass index (BMI). The WHO designations are as follows:
Grade 1 overweight (commonly and simply called overweight) BMI of 25-29.9 kg/m 2
Grade 2 overweight (commonly called obesity) - BMI of 30-39.9
kg/m 2
Grade 3 overweight (commonly called severe or morbid obesity)
- BMI ≥40 kg/m 2
Investigations

Laboratory Data:
Parameter
Normal Range
Blood glucose
Cholesterol
Triglycerides
HDL
LDL
Hemoglobin
Hematocrit
TSH
Cortisole
Serum iron
Uric acid
Hemoglobin A1c*
80-100 mg/dl
< 200 mg/dl
< 150 mg/dl
40 - 60 mg/dl
< 100 mg/dl
13-16 mg/dl
36-44%
0.35-5.50
5-25 am 3-16 pm µg/dl
40-140 mg/dl
(3.5-7.8)
4.8-6.3%
Additional Tests :
 ECG
 x-ray
 U.S

The “Toxic Environment”
• Physical
Activity is…
– To be avoided
– Nearly
unnecessary
– Limited by
infrastructure
Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.