UGEB 2362 NUTRITION FOR

HEALTHY LIVING
Overweight, Obesity, and Diabetes

Peggy Yip, MPH, RDN(US), RNutr(UKVRN), AD(HKAAD)

 Overweight and Obesity in HK
• Persons aged 15-84:
• 32.6% (26.4% F & 39.4% M) were obese (i.e. BMI ≥ 25.0)
• 22.0% (19.7% F and 24.6% M) were overweight (i.e. BMI 23 - 24.9).
• Most common in females aged 65-84 (57.0%) and in males aged 45-54
(74.6%).

Reference:
• Hong Kong Association for the Study of Obesity. Obesity in Hong Kong. Accessed January 21, 2026. [Link]
• Centre for Health Protection, Department of Health, Hong Kong SAR Government. Report of Population Health Survey 2020–22 (Part
II). Published 2023. Accessed January 21, 2026. [Link]
 Central Obesity in HK
• Persons aged 15-84:
Female Male
Mean Waist Circumference 77.7cm 86.4cm
Mean waist-hip ratio 0.82 0.88
Central obesity (waist) 37.8% 38.7%
Central obesity (waist-hip) 31.4% 39.9%

Reference:
• Centre for Health Protection, Department of Health, Hong Kong SAR Government. Report of Population Health Survey 2020–22 (Part
II). Published 2023. Accessed January 21, 2026. [Link]
 Overweight and Obesity Worldwide
2016 2024
Adult aged 18 and above 1.9 billion overweight, ~2.5 billion overweight,
including 650 million including 890 obese (i.e.
obese 43% overweight & 16%
obese)
Children and adolescents 340 million Over 390 were
aged 5-19 overweight in 2022,
including 160 million
obesity
Children under the age of 5 41 million 35 million

Reference:
• World Health Organization, Obesity and overweight 2018.
• World Health Organization. Obesity and overweight. Updated December 8, 2025. Accessed January 21, 2026. [Link]
room/fact-sheets/detail/obesity-and-overweight
 Obesity is a disease
• “Obesity is a chronic, relapsing disease arising from complex
interactions between genetics, neurobiology, eating
behaviours…...” – WHO

• “Obesity is recognised as a chronic disease with excessive

body fat that can impair health.” – HK Department of Health

• A local survey found 44.2% were not aware that obesity as a

disease. – HKASO

Reference:
• Centre for Health Protection, Department of Health, Hong Kong SAR Government. Obesity. Non-Communicable Diseases Watch. Published
June 13, 2023. Accessed January 21, 2026. [Link]
• World Health Organization. Obesity and overweight. Updated December 8, 2025. Accessed January 21, 2026. [Link]
room/fact-sheets/detail/obesity-and-overweight
• Hong Kong Association for the Study of Obesity. Obesity in Hong Kong. Accessed January 21, 2026. [Link]
Definition of overweight & obesity
Abnormal or excessive fat accumulation in the body

BMI: an index to classify weight status

Body weight (kg)

Height (m)2

BMI Categories Asians Non-Asians

Underweight <18.5 <18.5
Healthy Weight 18.5 – 22.9 18.5-24.9
Overweight >22.9 >24.9
Obese >24.9 >29.9
What’s her BMI? Body weight (kg)
Height (m)2

39.64kg
1.6m x 1.6m

BMI = 15.48

What is 15.48 mean?

Height: 1.6m
Weight: 39.64kg
Does the BMI tell you everything about
your body weight?
• It is a good and easy-to-use tool to estimate weight status

• But……

• It does not tell you where the weight come from

• It does not tell you the fat distribution in the body

Waist circumference
• A measurement for central
obesity

• >90cm for men

• >80cm for women

Waist-to-hip ratio
• A measurement for fat stored in midsection

• Equation: waist circumference / hip circumference

• > 0.90 is high risk for men

• > 0.85 is high risk for women

So, what does your body weight
mean to you?
Factors influencing weight and body fat
• Sex • Diet
• Male require higher energy • You intake, that is, how much
intake due to more muscle energy you are taking in
mass
• Exercise
• Age • Your expenditure, that is, how
• Grow age, younger age much energy you are
population require higher spending
energy than older age
population
• Other factors: inadequate
sleep, stress, emotional
• Genes factors, microbiome
• Regulate how much food an
individual eats, how much
energy they expend, and the
way their body fat stored
Diet and Exercise
• The factors that influence one’s weight are CALORIES INTAKE and
EXPENDITURE

• Calories can be obtained from: Carbohydrate (4kcal/g), Protein

(4kcal/g), Fat (9kcal/g), and Alcohol (7kcal/g)

• Expenditure: Physical activity level (higher level  higher

expenditure), Age, Lifestyle, muscle mass

Gain : calories > expenditure

Maintenance : calories = expenditure

Loss : calories < expenditure

Adipocyte (Fat Cells) Development
• Adipocytes expands through 2 mechanisms:
(1) size (hypertrophic)
(2) number (hyperplasia)
Hypertrophic (Size of Fat Cells)
• Excessive energy intake causes fat cells to enlarge

• Inadequate energy intake leads to fat cell to shrink

• Fat cells can only decrease in size, but not the number
Hyperplasia (Number of Fat Cells)
• Fat cell number increases during development periods,
such as infancy, childhood, adolescences

• Number of fat cell normally stabilizes during adulthood

• What is excessive or inadequate energy intake?

• Obese people have more and larger fat cells

Fat Cell Metabolism
• Lipoprotein lipase (LPL), an enzyme, remove triglycerides from
the blood, store them in both adipose tissue and muscle cells

• Obese people have more LPL, making fat storage efficient

• Women: fat cells in the breasts, hips, and thigh produce

abundant LPL  pear shaped

• Men: fat cells in abdomen produce abundant LPL  apple

shaped

• When decrease in intake, body adjusts its metabolism to

restore the original weight  regain the lost weight making
sustain of weight loss difficult
The key is ...
PREVENTION
&
BALANCE between INTAKE and
EXPENDITURE

No foods or diet will magically burn fat, change your

genetic code, nor melt fat while you watch TV or sleep.
Overweight, Obesity, Poor Diet &
Physical Inactive --- WHY?
Socio-economic status
• Food price concern, limited food selection, meal frequency, etc.

Family influence
• Children’s behaviors influenced by their parents

• So, if parents engage in obesity-promoting behaviors, then it is

more likely that they will pass those behaviors on to their children
Workplace / work environment
• Sedentary jobs

• Busy work schedules & long working hours

• Lack of time for exercise

• Female labor participation, less time to cook

School / Study environment
• Academic performance

• P.E. lessons

• Tuck shops / vending machines

• Stress
Sleeping time
• Not getting enough sleep

• Hormone alteration
• Reduce leptine (satiety factor)
• Increase ghrelin (hunger-promoting hormone)

• Thus, increase intake

Technology
• Cars, elevators, escalators

• TVs, movies, video games, computers

• Remote controls, washing machines

• All contribute to sedentary lifestyle

Others
• Culture • Cooking equipment

• Food Advertisements • Educational level

• Lack of parks, sidewalks and

• Supermarkets, food stores,
sports / recreation facilities
food markets
• Low air quality / crime rate
What are the factors influencing your
eating habit?
Problems relating to overweight / obesity
• Type 2 Diabetes

• Cardiovascular Diseases (e.g. coronary heart disease,

high blood pressure, etc.)

• Cancers
“strong evidence that weight gain, overweight and obesity increases the risk of
11 cancers, including bowel, breast, prostate, pancreatic, endometrial,
kidney, liver, gallbladder, esophageal, ovarian and stomach cancers.”
WCRF-HK

• Sleep apnea, osteoarthritis, Alzheimer's

…and many more!
Diabetes
• Body unable to regulate blood sugar

• There are different types of diabetes

• Gestational Diabetes

• Type 1 Diabetes

• Prediabetes

• Type 2 Diabetes
Gestational Diabetes
What is it?

• High blood sugar during pregnancy, usually develop during the

3rd trimester, or as early as 20th week, but it can happen at any
stage

• Usually blood sugar level returns to normal after delivery

• During pregnancy, the body produces various hormones, which

impair the action of insulin (a hormone the regulars blood
sugar)

• Why some women develop gestational diabetes, but some do

not?
Common symptoms:

• Often no noticeable symptoms, which is why it's important

to be tested time during pregnancy

Possible consequences/complications:
• Large-for-gestational-age infants
• Increase risk of type 2 diabetes in mothers later in life
• Obesity and diabetes in child in future
Management:
• Diet modification
• Exercise
• Medication / Insulin Therapy

Can women with gestational diabetes during pregnancy

delivery a healthy baby?
Type 1 diabetes
What is it?

• It is a chronic condition that the pancreas produces only

little or no insulin, and this cannot be cured.

• There are different factors causing type 1 diabetes, such

as genetics and environmental factors

• Immune-mediate (autoimmune destruction of beta cells)

• Idiopathic (no known etiology)

Immune-Mediate Diabetes Mellitus
• Destruction of beta cells of pancreas, the only cell make insulin

• Insulin is to regulate blood glucose

• Without insulin (or without enough insulin), the body will not able to
regulate blood sugar

• Medication and diet management are required to maintain blood

sugar at normal level

• Usually diagnosed at young age, some can diagnose at older age

(Latent Autoimmune Diabetes of Aging)
Common symptoms

• Polydipsia (excessive thirst)

• Polyuria (frequent urination)

• Extreme hunger

• Significant weight loss

• Fatigue and weakness

Possible consequences/complications

• Cardiovascular diseases

• Nerve damage (neuropathy)

• Vision loss

• Foot damage

• Kidney damage (nephropathy)

Management

• Eat regularly and healthy

• Medication / insulin injection

Prediabetes
What is it?

• Blood sugar levels that are higher than normal but not yet
high enough to be diagnosed as diabetes

• With diet modification, exercise, and weight loss, type 2

diabetes may not be developed or may be delayed
Common symptoms

• No noticeable symptoms

Possible consequences/complications

• Development of type 2 diabetes

Management

• Eat healthy

• Exercise

• Weight loss if overweight

Type 2 Diabetes
What is it?
• Excessive amount of body
• Body unable to stabilize fat lower insulin sensitivity or
blood sugar the body doesn’t produce
enough insulin
• 90-95% of all diagnosing
cases • However, not all obese
people develop type 2
• Develop gradually, and no diabetes
noticeable symptoms at
early stage • Other causes include pre-
diabetes, gene, family
• It cannot be cured history, physical inactivity,
prior history of gestational
diabetes, etc.
• Caused by eating too much
sugar?
Common symptoms:

• Polydipsia (excessive thirst)

• Polyuria (frequent urination)

• Increased hunger

• Unintended weight loss

• Fatigue
Possible consequences/complications

• High blood pressure, high cholesterol

• Heart disease, stroke
• Kidney disease
• Vision Loss
• Amputations
Management

• Medications / Insulin Therapy

• Weight loss

• Diet modification

• Physical activity
Type 5 Diabetes (Malnutrition-related)
• Officially recognized in April 2025.

• Long-term undernutrition, especially during childhood or

adolescence, leading to impairs pancreatic development;
and therefore, insufficient insulin.

Reference:
International Diabetes Federation. Type 5 Diabetes. Accessed December 12, 2025. [Link]
of-diabetes/type-5-diabetes/
Diet modification for managing blood sugar
• Carbohydrate influences blood sugar
• Starch
• Fruits and some vegetables
• Milk and dairy
• Beans
• Sugar

• So, should people with diabetes consume carbohydrate or avoid

carbohydrate?

• Emphasize fiber and whole grain, reduce fat intake

Glycemic Index
• Glycemic Index (GI) is developed to measure the effect of
carbohydrate on glucose

• High GI (70 or more), white bread, instant oatmeal

• Medium GI (55-69) – whole wheat bread, brown rice

• Low GI (55 or less) - most fruit, non-starchy vegetables

Reference:
National Library of Medicine. Glycemic index and diabetes. MedlinePlus. Reviewed August 3, 2023. Accessed January
21, 2026. [Link]
Carbohydrate exchange
• A way to count carbohydrate
• 1 exchange = 15g carbohydrate(or 10g)

Example
• 60g of carbohydrate is required at each meal

1 exchange equals to Meal plan 1 Meal plan 2

• 1 slice of bread, 2 slices of bread (2) 1 slice of bread (1)
• 1 cup milk, 1 slice of cheese (1) 1 tsp butter (0)
• 1 orange, 1 slice of ham (0) 1 scramble egg (0)
• Half banana 1 apple (1) 1 cup milk (1)
• 1 apple, or
1 banana (2)
• 1 slice of cheese
Goals
• Improve eating pattern

• Weight improvement

• Blood glucose stable

• Delay or prevent complications of diabetes

Management
• Oral medications

• Insulin injection, by needle or pump (a medical device

attaches to body to provide insulin)
• How does it affect daily life (for example, taking shower)?

• Artificial pancreas (device monitoring blood sugar and

injecting insulin)
Treating diabetes with bariatric surgery?

• Diabetes is considered as an untreatable disease

• No treatment, but only control

• Bariatric surgery may be a hope for diabetic patients

• Diet modification is the KEY!

Key Messages
• Overweight and obesity is a common health problem
worldwide

• Balancing energy intake and expenditure is the key to

prevent overweight or obesity

• There are many factors influences one’s eating behavior,

making adopting a balanced diet difficult

• Consequences of obesity include type 2 diabetes

• There are also other types of diabetes, gestational
diabetes, type 1 diabetes and prediabetes

• Server and irreversible consequences can occur if fail to

maintain blood glucose

• Diet modification, exercise, maintaining a healthy weight,

and taking medications are vital for maintain blood
glucose stable