Development and consequences of

obesity

Aim:
To understand the factors involved in the
development of obesity.

MP3 L10 1 IAM

Learning objectives-

At the end of this lecture you should be able

to:

• define obesity
• Understand how to measure levels of obesity
• Describe the co-morbidities associated with
obesity
• Outline the risk factors for development of obesity
 WHAT IS OBESITY?
Too much body fat

Too much fat in the ‘wrong’ place

Caused by chronic positive energy balance:

Results from:

too much energy intake

or too little energy expenditure

or a combination of both??
 How do we assess obesity?

Body Mass Index

BMI= weight (kg)/height2 (m2)
Risk of
co-morbidity
<18.5 underweight low
18.5-24.9 healthy average
> 25 overweight
25-29.9 pre-obese increased
30-34.9 grade I moderate
35-39.9 grade II severe
40 and above grade III very severe
(WHO)
BMI can also increase with increase muscle mass,
but generally BMI wouldn’t get beyond 32.

BMI 31
Also:

Asian population-

Different levels of BMI risks due to:

Greater amount of abdominal obesity

Increased CV risk

BMI >23 increased risk of CVD

>27.5 higher risk

Skin Folds

-Measurement of skin folds- assumes constant

relationship between subcutaneous and % body fat

-Can be measured all over the body. Common areas

are biceps & triceps

-Easily measured.
Body Shape:

•Waist circumference- may be a good

measure of intra abdominal fat.

Apples or pears- waist:hip ratio

Apples- greater risk of complications
MEN WOMEN
Waist circumference 94-102cm >102cm 80-88cm >88cm
Odds ratio for 1 or 2.2 4.6 1.6 2.6
more risk factors

Risk of: high total cholesterol (> 6.5 mmol/l)

low HDL cholesterol (< 0.9 mmol/l)
High b.p.(>160 diastolic or
>95 mmHg systolic)
Han et al. BMJ, 311, 1995
Incidence of metabolic syndrome in people with different categories of body mass index and
of waist circumference action levels. Adapted from Han TS et al. Obes Res 2002;10: 923-31

102cm
94cm

Waist:hip ratio and waist circumference more

closely related to visceral fat than BMI
Han, T. S et al. BMJ 2006;333:695-698

Copyright ©2006 BMJ Publishing Group Ltd.

Foresight model: by 2050 60% men, 40% women
obese
1 in 4 11-15 yr olds are obese
~ 500 million worldwide
Levels of obesity in children in UK 2008

% overweight % obese

4-5 years 13.2% 9.6%

10-11 years 14.3% 18.3%

 UK figures
% levels of obesity per age group, 2008

16-24 25-34 35-44 45-54 55-64 65-74

8 19 28 32 36 35

61% UK population overweight or obese (2018)

Consequences of Obesity

Obesity is a major risk factor for CHD

Also: Increases bp

Increases plasma cholesterol levels

Increases risk of type II diabetes

additional risk factors for CHD

Respiratory problems

Osteoarthritis

Increase cost to NHS est. £45.5 billion by 2050

WHO Report 2002:

7% of world disease burden caused by raised BMI

1/3 CHD and ischaemic stroke & 60% hypertension

due to levels of BMI > 21 (ie minimum)

63% of heart attacks in Western Europe due to

abdominal obesity (INTERHEART study)
- abdominal obesity more significant risk factor
for heart attack than raised BMI
Obesity 'biggest threat
to women's health' in
England
“Tackling obesity in the whole population is
an accepted public health priority. However,
I advocate recognising obesity at the level
of a “national risk”. “

Annual Report of the

Chief Medical Officer, December 2015

The Health of the 51%: Women

 WCRF Report 2018- Systematic Review

Risk Risk
Exposure Cancer Exposure Cancer

Body fatness Oesophagus

Pancreas
Convincing Liver
Colorectal
Breast (postmen)
Endometrium
Kidney
Abdominal Fat Colorectal

Probable Body fat Breast Body fatness Mouth

(premen) Stomach
Gall bladder
Ovary
Prostate
Adult weight Breast (postmen)
gain
Skirt size increase linked to breast cancer
risk, says study
Obesity:

energy intake> energy requirements

over a long period of time

Causes?

1 Genetics?
2Diet - high fat, high energy density
3Low physical activity
4Pregnancy
5Ageing
Role of Physical Activity in the
Development of Obesity
 Diet Activity

Prentice, A. M et al.
BMJ 1995;311:437-439

Energy intake decreases. Fat intake same as 1950, but obesity

increased.

Increase in obesity correlates with increase in cars and

television.

Copyright ©1995 BMJ Publishing Group Ltd.

 Trends in Physical Activity
Differences between social classes
Obesity

Inactivity

Energy
intake

Men Women

Energy intake is equal, but difference in inactivity.

Jebb & Moore, 1999
Number of miles travelled per person per year
1975 2002 2010

Walking 255 198 179

Bike 51 36 42

Car 1971 3661 3416

No. of Televisions per house

Year Number of houses with TV

1961 12.3 million
1975 18.6 million
1985 20.6 million
2000 24.1 million
2010 26 million
 Dietary Factors in Development of Obesity

High fat/energy dense diets-

Can lead to overconsumption of energy
(+ve energy balance)

Energy dense foods mean that there is an increase in

energy intake, without increase in volume of food.

Energy intake- energy use = change in energy stores

MP3 L10 12 IAM

Fat v CHO

•Fat- energy dense- encourage over consumption

•Fat increases palatability of food

•Conversion of xs fat to body fat is very efficient

•Increase in CHO intake (with increase in energy

intake) will lead to increase in conversion of fat in
diet to body fat
Fat intake lower than 1950, but obesity
increased.
•Average energy intake in UK has fallen over past
50 years

•Levels of fatness have increased

•Energy intake has fallen more slowly than energy

expenditure
Activity and Obesity

•Reduced requirement for physical activity

• -occupations, cars, televisions, computers etc

•Inactivity leads to weight gain

•Weight gain leads to reduced activity…

Reduced activity is a major cause of increased

level of obesity
 Genetic aspects of obesity
Rare genetic disorders - e.g.
Prader-Willi syndrome.
Commonest of the genetic disorders (1:25,000)
Hypothalamic disorder- excessive appetite

Genetics not really changed- some disorders easily put

And increase obesity (eg leptin deficiency= leptin brea

MP3 L10 10 IAM

Leptin Deficiency?

•Leptin- reduces appetite

•However, very few people have been found to be

leptin deficient (rare genetic disorder)

• Persons lacking leptin are massively obese.

•Obese patients- raised leptin levels

 FIG. 1. Effects of recombinant human leptin treatment in leptin deficiency

Farooqi, I. S. et al. Endocr Rev 2006;27:710-718

Copyright ©2006 The Endocrine Society

Genetic susceptibility?
Adoption Studies

strong relationship between biological parents and

adoptee for the whole range of body fatness.

No relationship between adoptive parents and adoptee

in relation to body weight class.

Suggests body weight caused by genetics not

environment ie some people may be more susceptible

Recent increase in obesity cannot be due to genetic

change of population- lifestyle changes
eg:

Pima Indians:

Arizona- high level of obesity

Mexico- low level of obesity

Genetically similar

Environment different:

Arizona- sedentary, high fat diet

Mexico- physically-active
Genetics may make them more susceptible
eg reduced BMR:

Weight Gain Compared to RMR

Cumulative Incidence of 10kg Body 30
Low RMR
25 Intermediate RMR
High RMR
Weight Gain (%)

20

15

10

0
0 1 2 3 4 5
Years

Ravussin et al (1988) Study of RMR and weight gain in Pima Indians(New England Journal of
Medicine318,467-72, (1988))

MP3 L10 15 IAM

Psychological Aspects of Obesity

Food reinforcement

Eating is a pleasurable activity- stimulation of reward

centres?

Food deprivation may increase reinforcing value of

food- increases motivation to eat. NB weight loss

Foresight report- our biology causes us to seek food.

- if food/ high energy food is
available, we will eat it

-obesogenic society
 Summary

Although genetics do play a role in obesity, the

increased global prevalence of obesity unlikely to be
due to dramatic change in gene pool.

Most likely reason is change in behaviour:

Balance between energy intake and energy

utilisation:

Increased sedentary behaviour without reduction in

energy intake.
Chronic positive energy balance is required for
obesity.

But, not everyone who overconsumes puts on weight

at same rate.

Energy balance related to both PA and energy

intake- balance between the two.