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John MF Adam
Division of Endocrinology and Metabolism
Dept. of Internal Medicine, Faculty of Medicine
Hasanuddin University
Makassar
OBESITY
Criteria, etiology, and management
John MF Adam
Division of Endocrinology and Metabolism
Dept. of Internal Medicine, Faculty of Medicine
Hasanuddin University
Makassar 2006
DEFINITION
Secondary
Hypotyroidism
Cushing syndrome
Insulinoma
Hypothalamus disorders
Etc
EPIDEMIOLOGY
Android Obesity
Gynecoid
Obesity
Sharma 2002
MEASUREMENT of OBESITY
Regional Office for the Western Pacific of the World Organization, The International
Association for the Study of Obesity, The International Obesity Task Force. The Asia-
Pacific perspective: Redefining obesity and its treatment. WHO Collaborating Centre for
the epidemiology of Diabetes and Health Promotion for Noncommunicable Disease,
Melbourne 2000
The Asia-Pacific Perspective: Redefining Obesity and its Treatment.
Assessment Diagnosis. 2000
PREVALENCE of OVERWEIGHT / OBESITY
in SOME ASIAN COUNTRIES
Country Obese Overweight
(BMI >30 kg/m2) (BMI 25-29,9 kg/m2)
Anthropometric
Waist circumference
(N: Men < 90 cm, Women <80 cm)
Waist-to-hip ratio
(N: Men 1.0, Women 0.85)
Waist
Waist?
OBESITY
Body Mass Index
? Waist-to-Hip Ratio
Waist circumference
Waist
20 years
Hip
BMI = 24 BMI = 35
Waist = 80 cm Waist = 100 cm
Hip = 100 cm Hip = 125 cm
WH Ratio = 0.80 WH Ratio = 0.80
Desprs JP, dkk. BMJ 2001;322:716-720
128
140
Incidence/100,000 Person-years
Waist Circumference
106 110
120 83
Tertiles (cm)
97
Age-Adjusted CHD
89
100
80 77
46 55
60
40
20 High (>81.8)
Medium (73.7-81.7)
0 Low (<73.6)
High Medium Low
(>25.2) (22.2-25.1) (>22.1)
BMI Tertiles (kg / m2)
4
ODDS RATIO
0
22 23 24 25 26 27 28 29 30
BMI (kg/m2)
3
2
1
0
150 170 200 210 220 230 240 250 290
Cholesterol (mg/dl)
5
4
3
2
1
75 80 85 90 95 100 105 110 115 120
Diastolic Blood Pressure
Relationship of BMI, cholesterol, and blood pressure to risk of ill health. The
vertical lines accepted subdivisions for low, moderate, and high risk. All three
curves show a curvilinear increase with increasing level of risk factor
Bray GA, et al. Handbook of obesity, 1998
IS OBESITY A DISEASE
PROPORTION of DISEASE PREVALENCE
ATTRIBUTABLE to OBESITY
BMI TREATMENT
No treatment, diet and exercise to
18.5 - 24.9 maintain body weight
JMFA 52
80
Placebo (n=340)
68.5% Orlistat 120 mg tid (n=343
P > 0.05
60
49.2%
Patient (%)
40 38.8%
20
17.6%
0
> 5% weight loss > 10% weight loss
Percentage of obese patients achieving weight loss of > 5% or > 10% after 1
year of treatment with Xenical 120 mg or placebo tid plus a mildly hypocaloric
diet. Sjostrom L, Rissanen A, Andersen T. Lancet 1998;352:167-72
TREATMENT OF OBESITY
RESULTS OF SIBUTRAMINE TRIALS
JMFA 52
STORM: Waist Circumference
Reduction and Maintenance Over 2 Years
Sibutramine Placebo
109
Waist circumference (cm)
107
105
103
101
99
97
Month
95
0 2 4 6 8 10 12 14 16 18 20 22 24
JMFA 53
Sudden death is more common in those
who are naturally fat than in the slender
Hippocrates 410 B.C.
John MF Adam
Division of Endocrinology and Metabolism
Dept. of Internal Medicine, Faculty of Medicine
Hasanuddin University
Makassar
DEFINITION
Metabolic syndrome is a
constellation of lipid and nonlipid risk
factors of metabolic origin. This
syndrome is closely linked to a
generalized metabolic disorder
called insulin resistance in which the
normal actions of insulin are
impaired
CRITERIA
of METABOLIC SYNDROME
JMFA 21
World Health Organization, 1999
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and
its complication. Part 1: Diagnosis and classification of diabetes mellitus. Department of
Noncommunicable Disease Surveillance, World Health Organization, Geneva 1999
JMFA 22
CLINICAL IDENTIFICATION OF THE METABOLIC
SYNDROME NCEP ATP III 2001
Overweight: > 23
At risk 23-24.9 Increased Moderate
Obese I 25-29.9 Moderate Severe
Obese II > 30 Severe Very severe
CLINICAL IDENTIFICATION OF THE METABOLIC
SYNDROME Modified NCEP ATP III 2001
for Asian Adults
Abdominal obesity*
(waist circumference)
Men > 90 cm
Women > 80 cm
Plus two of the following :
Triglycerides > 150 mg/dl
HDL chol Men < 40 mg/dl
Women < 50 mg/dl
Blood pressure > 130 / > 85 mmHg
Fasting plasma glucose > 115 mg/dl
PREVALENCE OF METABOLIC SYNDROME
Men Women
50
Mean SE
40
Prevalence (%)
30
20
10
0
20-29 30-39 40-49 50-59 60-69 >70
Central
Obesity
Dyslipidaemia
Hypertension
(HyperTG, low HDL-C)
JMFA 27
Effect of Metabolic Syndrome
METABOLIC
SYNDROME
CVD
DM
TREATMENT OF
METABOLIC SYNDROME
DIET - EXERCISE
JMFA 41
TREATMENT OF METABOLIC SYNDROME
Treatment of Hyperglicemia
Treatment of Dyslipidemia
LDL-cholesterol, Triglycerides, HDL-cholesterol
Treatment of Hypertension
Treatment of Obesity
Calorie restriction, Exercise,
Pharmacotherapy
JMFA 43
TREATMENT OF METABOLIC SYNDROME
Diabetes Mellitus
Metformin, Thiazolidinedione
Dyslipidemia
Statins, Fibrate, Nicotinic acid
Hypertension
ACE inhibitor, Ca Channel blocker, HCT
JMFA 44