You are on page 1of 42

OBESITY

BAGIAN GIZI FK UNDIP

OBESITY:
DEFINITION & EPIDEMIOLOGY

Who is too fat


Ancestors were not over fat
Excess body fat is a by-product of
urbanization, mechanization, a
sedentary lifestyle and abundant highcalorie foods
Being fat is beautiful in some societies
Being fat represents a high socioeconomic class
Beautiful = Barbie doll

.

Obesity: Definition   A condition of abnormal or excessive fat accumulation in adipose tissue to the extent that health may be impaired Measuring body fat is difficult  surrogate measures such as BMI and waist circumference are commonly used .

lifelong treatment required Treatment controls do not cure disease No short-term solutions Disease recurs after treatment is withdrawn .Obesity : Definition      Metabolic disorder resulting from chronic imbalance between energy uptake and expenditure Chronic.

.

OBESITY : THE PATHOGENESIS .

but the role of leptin remains unclear . some people are genetically more susceptible to environmental factors which predispose to obesity Study in rats: obesity is a result of a defect in a gene which should produce leptin. Genetic factors in human obesity    Obesity tends to run in families.1. but does not prove the role genetic factors in the development of obesity However.

“Is it genetic?”  ob gene    Regulates production of leptin Leptin is secreted by fat cells and has dual activity of decreasing food intake and increasing metabolic rate Mice born without the ability to make leptin (ob/ob mice) eat without restraint .

ob/ob mouse normal mice .

ob/ob mouse .

ob/ob mouse ob/ob mous injected wi leptin .

just give obese humans leptin!!! In fact. but… 99.99% of obese humans have HIGH levels of leptin. this works in leptindeficient humans.So. . but have become insensitive to it.

Hereditary factors  The genetic contribution to body weight is estimated to be between 40 and 70 percent (with some rare cases of severe obesity linked to specific gene errors) .

 The epigenetics of increasing weight through the generations (“One hypothesis is that maternal obesity before and during pregnancy affects the establishment of body weight regulatory mechanisms in her baby." (Waterland. Maternal obesity could promote obesity in the next generation. 2008) .

2. Physical inactivity • • Data on the contribution of inactivity to the current epidemic of obesity is limited Evidence: – – People eat more than they did in the past Energy expenditure in manual labour or vigorous leisure activity has declined with the increase of TV viewing and labour saving appliances .

POPCORN 20 Years Ago 270 calories 5 cups Today 1700 calories 21 cups buttered .

Endocrine    Obese people have endocrine abnormalities Polycystic ovary syndrome (PCOS) is associated with obesity and ovarian function improves with weight loss Lack of evidence for primary endocrine defect as the cause of obesity .3.

Endocrine Changes     There are various endocrine changes associated with overweight. 32: 761-786. Rates of fertility may also be reduced. Irregular menses and frequent anovular cycles are common. 2003. 2009 Endocrinol Metab Clin N Am. Changes in the reproductive system are among the most common. .

Endocrine Changes Associated with Obesity Common hormonal abnormalities associated with obesity       Increased cortisol production Insulin resistance Decreased sex hormone-binding globulin in women Decreased progesterone levels in women Decreased testosterone levels in men Decreased growth hormone production 2009 Endocrinol Metab Clin N Am. 2003. . 32: 761-786.

This may be due to the societal pressure on women to be thin. . 32: 761-786. 2003.2005. obese women appear to be at a greater risk for psychological dysfunction. Higher BMI values are associated with greater adverse effects.Psychological Disorders Associations with Obesity     Obesity is associated with an impaired quality of life. J La State Med Soc . 157 (1): S42-49. When compared to obese men. 2009 Endocrinol Metab Clin N Am.

5. Macronutrient balance  Obesity is a result of excess of total energy intake relative to energy expenditure rather than a certain macronutrient .

inhibits orexigenic neuropeptides and thus. increasing fat oxidation and energy expenditure .Neuropeptides and Leptin in Food Intake and Obesity   BW homeostasis is maintained via a series of complex interactions of hypothalamus and the periphery via leptin Leptin is synthesised in and secreted from adipose tissue. decreasing food intake and body weight.

Orexigenic neuropeptides     Neuropeptides Y Melanin concentrating hormon Orexin A and B Opioids .

and AmphetamineRegulated Transcript (CART) Corticotropin-releasing Hormone (CRH) α-Melanocyte-stimulating hormone (α-MSH) .Anorexigenic peptides    Cocaine.

.

Mortality Weight. . and Activity  The following factors have been shown to increase mortality in individuals:     Excess body weight Regional fat distribution Weight gain patterns Sedentary Lifestyle 2009 Endocrinol Metab Clin N Am. 32: 761-786. Fat Distribution. 2003.

This was first noted in the beginning of the 20th century. 2003. 2009 Endocrinol Metab Clin N Am.Mortality Regional Fat Distribution Android    Gynoid Regional fat distribution can contribute to mortality. Obese individuals with an android (or apple) distribution of body fat are at a greater risk for diabetes and heart disease than were those with a gynoid distribution (pear). . 32: 761-786.

Centralisation of Body Fat  Fat accumulates predominantly in central deposit  Serves as an easily available substrate for important liver and periphery functions  Reserve depot for periods when the surrounding milieu is threatening .

Android fat distribution results in  higher free fatty acid levels.  higher blood pressure and inflammatory markers. .  higher glucose and insulin levels and reduced HDL levels.

000 years.  It was Hippocrates who recognized that “sudden death is more common in those who are naturally fat than in the lean.Mortality and Morbidity Associated with Obesity The effects of excess weight on mortality and morbidity have been recognized for more than 2. . 2003. 32: 761-786.”  2009 Endocrinol Metab Clin N Am.

Mortality Weight Gain  In addition to overweight and central fatness. 32: 761-786.  The Nurses’ Health Study and the Health Professionals Follow-up Study showed that a marked increase in mortality from heart disease is associated with increasing degrees of weight gain. . 2009 Endocrinol Metab Clin N Am. 2003. the amount of weight gain after ages 18 to 20 also predicts mortality.

Morbidity Associated with Obesity Individuals who are obese are at a greater risk of developing:      Obstructive sleep apnea Osteoarthritis Cardiovascular disorders Gastrointestinal disorders Metabolic disorders     Endometrial. prostate and breast cancers Complications of pregnancy Menstrual irregularities Psychological disorders 2009 CDC .

Cardiovascular Disorders Associated with Obesity Obese individuals are at a greater risk of developing these cardiovascular disorders: Hypertension Stroke Coronary Artery Disease 2009 .

Overweight and hypertension interact with cardiac function.2005.Hypertension    Blood pressure is often increased in overweight individuals. 2009 J La State Med Soc . leading to thickening of the ventricular wall and larger heart volume. Estimates suggest that control of overweight would eliminate 48% of the hypertension in Caucasians and 28% in African Americans. 157 (1): S42-49. and thus to a greater likelihood of cardiac failure. .

2009 NCI .  An increased risk of colon cancer has been consistently reported for men with high BMIs.  Women with high BMI are not at increased risk of colon cancer. There is evidence that abdominal obesity may be important in colon cancer risk.Colon Cancer Findings Relating to Obesity  Colon cancer has been shown to occur more frequently in people who are obese than in people who are of a healthy weight.

32: 761-786. 2003.Gallstones Findings Related to Obesity     Obesity appears to be associated with the development of gallstones. High cholesterol concentrations relative to bile acids and phospholipids in bile increase the likelihood of precipitation of cholesterol gallstones in the gallbladder. More cholesterol is produced at higher body fat levels. . 2009 Endocrinol Metab Clin N Am. Approximately 20 mg of additional cholesterol is synthesized for each kg of extra body fat.

 Women with a BMI > 45 kg/m 2 had a 7-fold increased risk for symptomatic gallstones. 157 (1): S42-49.  The relative increased risk of symptomatic gallstone development with increasing BMI appears to be less for men than for women.2005. . 2009 J La State Med Soc .  Women with a BMI > 30 kg/m 2 had a 2-fold increased risk for symptomatic gallstones. when compared to those having a BMI of 24 or less.Gallstones Findings Related to Obesity  In the Nurses’ Health Study.

uterine.2005. gallbladder. cervical. kidney. pancreatic. and prostate cancers. breast. .  Obesity and physical inactivity may account for 25 to 30 percent of several major cancers. endometrial. 2009 J La State Med Soc . renal. and cancer of the esophagus.Cancer Findings Relating to Obesity  Overweight and obesity are associated with an increased risk of: esophageal. 157 (1): S42-49. breast (postmenopausal). including--colon.

Thomas Moffett. .“[People] dig their graves with their own teeth and die more by those fatal instruments than the weapons of their enemies.” 1600 -.