Obesity

Definition: Obesity may be defined as a condition in which there is excessive accumulation of fat in
the body. It usually occurs when the intake of food is more than the physiological need. A person who
posses higher body weight of 20% or more than normal for the height maybe considered obese.

Causes of obesity:

 Familial / genetic: Obesity tends to run in families (80% of the offspring of two obese
parents become obese).

 Age and sex: Prevalence of obesity increases with age in man and woman and it continues to
increase up to age 60.

 Energy balance: Excessive calories with less physical activity.

 Childhood fatness: Childhood fatness leads to obesity in adulthood.

 Social factor: Rich people usually take more food than the poor.

 Social awareness: Who have knowledge on food and nutrition eat healthy / balanced diet.

 Physiological: During pregnancy excessive average weight gain is nearly 12.4 kg.

 Behavioral factor: People have affinity to take more energy-dense and fatty food.

 Endocrine gland factor: Fat synthesizing enzymes act more due to the action of the
endocrine gland.

 Drugs: Oral contraceptive, steroids, anti-depressants drugs increase body weight.

 Smoking: Body gain 2.5 kg extra weight in smokers.

Assessment of obesity: Obesity can be assessed by the following ways -

 Body Mass Index (BMI)
 Body weight (Height-Weight table)
 Estimation of total body fat - (Total body fat by density method)
  Skin-fold thickness: Skin fold thickness in the three areas -
 On the back one inch below the angle of scapula
 On the chest over the lower rib in the mid- axillary line
 On the back of the arm over the triceps muscle

Assessment of obesity by calculating body mass index: Body Mass Index is calculated by
dividing the weight (in kg) by the square of the height (in meter).

BMI (kg / m2) Classification* Risk of obesity

¿ 18.5 Underweight None

18.5 - 24.9 Normal range Negligible
25.0 - 29.9 Over weight (Pre-obese) Mildly increased
¿ 30.0 Obese
30.0 - 34.9 Class l Moderate
35.0 - 39.9 Class ll Severe
¿ 40.0 Class lll Very severe
* Classification of World Health Organization (WHO)

Complications of obesity: Obesity is a major health threat. The extra weight puts added stress on
every part of the body. People with obesity are at risk for these health problems -

 Physical disability
 Bone and joint problems: Extra weight puts strain on the bones and joints. This can lead to
osteoarthritis, a disease that causes joint pain and stiffness.
 Hypertension
 Diabetes mellitus
 Low life expectancy
 Heart diseases
 Stroke
 Gall stone formation
 High cholesterol level
 High triglyceride
 Stopping breathing during sleep (sleep apnea). This can cause daytime fatigue or sleepiness,
poor attention, and problems at work.
Management of obesity:
 Dietary management
 Physical exercise
 Psychological management

 Medicine: Several prescription weight loss drugs are available. Most people lose between 5 and
10 pounds by taking these drugs. Most people also regain the weight when they stop taking the
medicine, unless they have made lasting lifestyle changes, such as exercising and cutting
unhealthy foods from their diet.
One medication, Orlistat (Xenical), is current widely available and approved for long term use.
However, other drugs such as Lorcaserin (Belviq), Rimonabant (Acomplia) are also somewhat
effective.

 Surgery: Surgery is only recommended for severely obese people (BMI > 40) who have failed to
lose weight following dietary modification and pharmacological treatment.
Surgical procedures of the upper gastrointestinal tract are collectively called bariatric surgery
(weight loss surgery). Bariatric surgery includes a variety of procedures performed on people
who are obese.

The two most common weight-loss surgeries are:

 Laparoscopic gastric banding (reducing the size of the stomach with an implanted
medical device)
 Gastric bypass surgery (resecting and re-routing the small intestines to a small stomach
pouch)

One may have complications from these surgeries. One problem some people have is throwing
up (nausea and vomiting) if they eat more than their new small stomach can hold.

Dietary management: Obesity may be managed by dietary management by following ways -

 Less intake of Carbohydrate (Not more than 55% of total daily diet)
 Less intake of fatty food (less than 20% - 30% )
 High quality protein (15% - 20%)
 More intake of vegetables and fruits (except banana)
 High fiber diet
 Stop cigarette smoking