OBESITY
• Obesity is a state in which there is
accumulation of excess adipose tissue in
the body leading to more than 20% of
the desired weight.
• Obesity is a chronic disease which also
causes many health problems like
diabetes, high blood pressure, gall
bladder disease.
• Excess body weight may also lead to
Obesity is a complex issue related to
lifestyle, environment, and genes.
In India, there has been an increased
migration of the rural population to urban
areas.
This shift also has been a contributing
factor to life style changes including
significant reduction in physical activity
leading to changes in weight.
The measurement of direct body fat is
difficult, so we use an indirect method , ratio
called the Body Mass Index (BMI) .
This ratio estimates dependence on frame
size and provides the most useful method of
measuring obesity in populations. BMI can
be calculated from the following equation:
BMI= Weight (kg)
Height (m)2
Where kg = kilogram; m = metre
ACCORDING TO WHO
WEIGHT STATUS BMI RANGE ( kg/m2 )
UNDERWEIGHT <18.5
NORMAL 18.5 to 24.9
PREOBESE 25 to 29.9
OBESITY (GRADE 1) 30 to 34.9
OBESITY (GRADE 2) 35 to 39.9
OBESITY (GRADE 3) Above 40
TYPES OF OBESITY
ANDROID/CENTRAL
/APPLE SHAPED
OBESITY
• This fat accumulates
around the central
trunk region.
• It can also include
chest and upper arms.
• Holding fat primarily in
the arms and chest
area can increase
insulin resistance.
• This means your body will not be able
to transport and use up extra sugar for
energy, versus leaving it free floating
in the blood (Diabetes).
• This can more readily support
processes that cause heart disease,
diabetes, hormonal imbalances, sleep
apnea and more.
• The reason that we see so many more
risk factors for disease in this type of
fat storage can be because this fat
directly correlates with a higher
amount of visceral fat.
GYNOID/PERIPHERAL/PEAR
SHAPED OBESITY
• This fat accumulates around the
hips and buttocks.
• Individuals who hold their excess
fat in this region tend to suffer
from mechanical problems such as
hip, knee and other joint issues,
versus metabolic or hormonal
issues.
• In addition, this distribution of fat
actually has a negative risk factor
for heart and metabolic disease.
ASSESSMENT
1. Body Weight:
An adult weighing 10% more than
standard weight is called overweight
and more than 20% is called obesity.
2. Body Mass Index (BMI):
BMI is also known as Quetlet Index.
This do not require any standard
tables.
BMI= weight in kg/ height in meter
3. Waist Circumference:
It is most practical tool a clinical can use to
evaluate a patients abdominal fat before and
during weight loss treatment.
High risk waist circumference
•Men: >40 inches (>120 cm)
•Women: >35 inches (>88cm)
4. Measurement Of Body Fat:
Various skinfold calipers have been devised
to measure body fat.
In practice: Harpender calipers, large
calipers are used to measure subcutaneous
fat at the triceps, abdomen and subscapular
and subcostal sites.
Harpender calipers measures fat at triceps
5. Ponderal Index:
The ponderal index is the ratio of the height
to be the cube root of weight. This index is
given by the formula
Adult Ponderal Index = Height in cm /
Cube root of body weight (Kg)
6. Waist to hip ratio:
• The predominant distribution of fat
in an obese person, whether in the
upper part or the lower part of the
body, may determine the disease
pattern.
• The ratio below 0.85 in women and
below 1.0 in males.
TYPES OF OBESITY
Grading of obesity can be done based on BMI
Grade 1:
• These people have BMI more than 25 and
less than 29.
• Over weight does not affect their health.
• People with this grade can lead normal
healthy life.
Grade 2:
• The BMI in this grade is ranging
from 30-39
• These people should be treated
by doctors and dieticians to
reduce weight.
• Although they appear to be good
in health but they have reduced
tolerance to exercise with
shortness of breath on exertion
• This happens due to increased weight and
they may also reduce circulatory and
respiratory systems that are messed up
with internal fat.
• Based on metabolic and other reasons
these patients are at increased risk of
diabetes, atherosclerosis, hypertension,
osteoarthritis, hernias, varicose veins, fatty
liver, gall bladder diseases and increased
Grade 3:
• At this grade, BMI is above 40
and these patients are in very
dangerous condition.
• They are more susceptible for
many diseases like that are
mention in grade 2.
The contributing factors of obesity
When the intake of calories is more than the
burning off energy (output) obesity is caused.
This is mainly because of physical inactivity
and lack of exercise.
Consuming high fat and calories contributing
foods, and sedentary or inactive lifestyle.
Sometime people may crave for certain high-
calorie foods since they feel more hungry by
the hormonal changes due to inadequate
sleep .
Genetics also causes obesity.
Obesity may be more common during
pregnancy. Once the weight is gained during
pregnancy it is not easily possible to reduce
weight and ultimately it results in obesity.
If the individual is taking
medications such as steroids and
certain antidepressants or birth
control pills it may contribute to a
greater risk for weight gain.
The risk of obesity is higher with a
complex means of genetic,
environmental, and psychological
factors.
Certain medical conditions may also lead to
weight gain. These include:
Poly Cystic Ovary Syndrome: a condition that
causes an imbalance of female reproductive
hormones
Prader-Willi syndrome: a rare condition that
an individual is born with which causes
excessive hunger
Cushing’s syndrome: a condition caused by
having an excessive amount of the hormone
cortisol in the system
Hypothyroidism (underactive thyroid): a
condition in which the thyroid gland does
not produce enough of thyroid hormones
Arthritis-It is a condition which causes pain
in the joints and the physical activity of the
person is reduced which in turn gains
weight.
ETIOLOGY
Genetic susceptibility
Dietary habits
Physical activity
Affluence and abundant availability of food
Psychological factors
Hormonal imbalance
Birth weight and childhood growth pattern
Genetic Susceptibility : Some people inheri
a tendency to become fat.
Our chances of inheriting our parent's BMI is
about 33%.
Obesity or thinness of an individual is
inherited, basically from the biological mother
If our biological mother has been overweight
as an adult, the likelihood of our being heavy
is about 75%.
Dietary habits: A positive energy balance
is one of the major contributory factors for
obesity.
Some people are in the habit of eating too
much food.
They may also be ignorant about the
caloric values of common foods like
butter,cheese, jam or rich baked snacks
and desserts, the extra helpings
Physical activity; Sedentary life style with lack
of an exercise schedule tends to make one
obese.
As we approach middle age, our physical
activity generally decreases without a
corresponding decrease in food consumption
leading to obesity.
Affluence and abundant availability of food:
With increasing affluence, increase in
purchasing power and abundance of food,
people tend to eat more.
Intake is more when people are offered a
variety of foods than when a single food is
Psychological factors: Lonely, bored and
depressed individuals may find solace in
eating.
When there is nothing else to do, eating
provides diversion resulting in increased
consumption of calories.
Hormonal imbalance: Certain diseases
associated with secretion of hormones, e.g.
hypothyroidism, hypogonadism and Cushing's
syndrome exhibit obesity as one of the
characteristic features.
Birth weight and childhood growth
pattern: It has been shown that slow
growth of the foetus in utero and
during infancy is followed by
accelerated weight gain in childhood.
This combination of small size at
birth and accelerated childhood
weight gain has been found to be
associated with exaggeration of
adiposity, as well as, insulin
resistance in later life.
CONSEQUENCES OF OBESITY
All-causes of death (mortality)
High blood pressure (hypertension)
High LDL cholesterol, low HDL cholesterol, o
high levels of triglycerides (Dyslipidaemia)
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis