Kingdom of Saudi Arabia

King Saud Bin Abdul-Aziz University for Health

Sciences
College of Nursing

Behavioral Sciences for Nurses

NURS 302
Lecture: Obesity
EXPECTED LEARNING
OUTCOMES
At the end of this lecture the student should be able to:
 Define key concepts
 Explain the causes of obesity
 Explain the effects/complications of obesity
 Describe how obesity is measured
Introduction
The current national obesity epidemic is likely being driven by

a combination of genetic and psychosocial factors occurring in

an environment rife with calorie- dense/nutrient -poor foods.

Efforts to reverse the trends in overweight and obesity must

include interventions at many levels, ranging from individual

behavior modification to national policy changes
Definition of Obesity
It is excessive body fat accumulation results in a body

mass exceeding a recommended level that may impair

health.

It is a serious medical disease

An individual weight status is typically quantified by

calculating their (BMI).

Prevalence of obesity in KSA

Obesity and overweight are increasing in KSA with an

overall obesity prevalence of 35.5%. Reduction in

overweight and obesity are of considerable importance to
public health. Therefore, it is recommend a national
obesity prevention program at community level to be
implemented to promote leaner and consequently healthier
community.
How is obesity measured?
Body Mass Index (BMI) is the simplex index of weight-

for-height that is commonly used to classify over weight

and obesity in adults.
It is defined as a person's weight in kilograms divided by

the square of his height in meters (kg/m2).

Calculate BMI
To determine your BMI:
Weight in Kilograms divided by height in meters squared

Weight (Kgs) / Height (in meter)2

Eg; calculate BMI of 50 kgs weight and1.5meter height of man?
50

̶ ̶ = 22.22 kg/ m² Normal BMI ( Healthy weight)

(1.5)2
 Weight Classifications
Body mass index (BMI)
 Body mass index (BMI) is a mathematical
ratio which is calculated as weight With a BMI of: You are considered:
(kg)/ height squared (m2). It is Below 18.5 Underweight
used to describe an individuals relative
weight for height, and is significantly 18.5 - 24.9 Healthy Weight
correlated with total body fat 25.0 - 29.9 Overweight
content. BMI is intended for those 20 years
of age and older. 30 or higher Obese

You can find tables on the web that have done the math and metric conversions for you.
http://www.pbrc.edu/Division_of_Education/Tools/BMI_Calculator.asp
or
http://www.nhlbisupport.com/bmi

CDC
In summary
BMI is Calculated by Weight in Kilograms divided by
height in meters squared.

General guideline
<18.5 may increase health risk

18.5-24.9 healthy weight

25-29.9 overweight

30-34.9 obesity class 1

35-39.9 obesity class 2 (severely obese)

 40 and above - obesity class 3/ (morbidly obese)

Obesity in children and adolescents
There are also sever degrees of obesity among children and

adolescents .
Class II obesity is a BMI>120% up to 140%of the 95 th %.

Class III obesity or weight is a BMI >140% of the 95 th %.

Causes of obesity
Current evidence supports that the obesity is the result of a

complex interplay of genetic , environmental, and

psychological factors.
Genetic changes in human populations occur too slowly

to be responsible for the obesity epidemic. Nevertheless,

the variation in how people respond to the environment
that promotes physical inactivity and intake of high-
calorie foods suggests that genes do play a role in the
development of obesity.
 Energy Imbalance
What is it?
 Energy balance can be compared to a scale.
Weight Gain
Calories Consumed > Calories Used
 An energy imbalance arises when the number of
calories consumed is not equal to the number of
Weight Loss calories used by the body.
Calories Consumed < Calories Used
 Weight gain usually involves the combination of
No Weight Change
consuming too many calories and not expending
Calories Consumed = Calories Used enough through physical activity.

CDC
 How Could Genes Influence Obesity?

Genes give the body instructions for responding to changes in its

environment. Studies have identified variants in several genes that may

contribute to obesity by increasing hunger and food intake.
Rarely, a clear pattern of inherited obesity within a family is caused by

a specific variant of a single gene (monogenic obesity).

Most obesity, however, probably results from complex interactions

among multiple genes and environmental factors that remain poorly

understood (multifactorial obesity).
Gens associated with neurotransmitter action have been linked to food

intake and body weight or BMI.

It has been proposed that , for some obese people , eating is a form of

addiction in which food intake is reinforced by the pleasurable or

positive feeling that follow.
The action of neurotransmitter dopamine is known to be associated

with reinforcing and addictive behaviors.

Psychosocial stress in an “obesogenic ”environment

Several conceptual theories have been used to explain the

health behaviors that have led to the current obesity epidemic.

One often –cited theory is the social ecological model of

behavior (figure 22.2) which posits that individual health

behaviors(e.g. eating, exercise) occur within a multilayered
context including interpersonal relations within a community
governed by public policies.
The social ecological model of behavior
Environmental factors can play a role in determining energy intake and

physical activity.
Our modern society could be classed as an “obesogenic environment”,

which is a combination of the effects that our surroundings (the towns

and cities we live in) and opportunities (how easily we can access food)
have in promoting obesity in individuals and populations.
The term relates to the social, cultural and infrastructural (e.g.

transportation) conditions that influence our ability to adopt a healthy

lifestyle.
Availability and consumption of different foods and levels of physical

activity are shaped by these environmental factors.

Although it is not possible to show a direct relationship between

obesity and any single technology, technological advancements such

as television, cars and computers have engineered a lot of physical
effort out of our lives.

It is certainly true that physical activity has declined significantly,

with people walking and cycling less and driving more (even for
short journeys).

How we perceive our environment is important, with concerns about

safety, convenience and access to playgrounds or sports facilities

being key considerations.
Psychosocial stressors

 Studies have found several types of psychosocial stress to be

associated with weight gain , including job demands, difficulty

paying bills , depression, generalized anxiety and perceived
constraints in life .

Chronic psychosocial stress may contribute to weight gain in

two ways :
1-Increasing pleasure-seeking behaviors like consumption of

highly palatable unhealthy food .

2-By affecting the production of hormones involved in energy

metabolism, namely cortisol and glucocorticoid levels .

***Acute and chronic stress lead to elevated glucocorticoid

levels which stimulate , in turn insulin secretion , promoting

both emotionally induced food intake (COMFORT FEEDING )
and fat deposition.
Health consequences of obesity
It has become increasingly evident that overweight and

obesity are much more than just aesthetic problems.

Excess body weight and fat significantly increase an

individual risk for a number of other diseases and

conditions .
Serious diseases and health conditions, including the following:

All-causes of death (mortality)

High blood pressure (Hypertension)

High LDL cholesterol, low HDL cholesterol, or high levels of

triglycerides (Dyslipidemia)
Type 2 diabetes

Coronary heart disease

Stroke

Gallbladder disease

Osteoarthritis (a breakdown of cartilage and bone within a joint)

Sleep apnea and breathing problems

Some cancers (endometrial, breast, colon, kidney, gallbladder,

and liver)
Low quality of life

Body pain and difficulty with physical functioning.

The risk of premature death from any cause is estimated to be

50% to 100% greater among overweight or obese individuals

compared with those who are normal weight .
Economically , the cost associated with obesity in any country

are substantial. Medical costs associated with overweight and

obesity may involve direct and indirect costs. Direct medical
costs may include preventive, diagnostic, and treatment
services related to obesity.
Indirect costs relate to morbidity and mortality costs including

productivity.
Productivity measures include ‘absenteeism’ (costs due to

employees being absent from work for obesity-related health

reasons) and ‘presentism’ (decreased productivity of
employees while at work) as well as premature mortality and
disability.
Treatment
dietary therapy,

 physical activity,

behavior therapy,

drug therapy,

combined therapy and surgery- Dietary Supplements and

Liposuction
Ideal weight
 Calculate the ideal weight of a man and a woman who is
160 cm tall/ height?
Formula is Height in cm – 100
160 cm -100 = 60 Kgs

For Woman

160 cm -105 = 55 kgs

What can be done to reverse the current obesity epidemic

Maintaining energy balance through a healthy diet and regular

physical activity.
Recent community initiatives include improving health food

options and physical activity in childcare and school

environment passing laws to limit sales and marketing of
unhealthy foods and beverages to children.
Healthy foods must be available in corner stores of low income

communities .
Recommended Daily activity – for obesity

Daily activity (exercise or lifestyle) is moderate physical

activity at least 30 minutes per day for adults

 and 60 minutes per day for children.

balanced diet
Summary
In conclusion ending the country's weight problem must

become a national priority ,and it will need collaboration

among many sectors of society to achieve.
 References
 National Institute of Neurological Disorders and Stroke. NINDS Stroke Information Page.
Available at: http://www.ninds.nih.gov/disorders/stroke/stroke.htm
 National Heart, Lung, and Blood Institute (NHLBI). What is Coronary Artery Disease?
Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html
 American Cancer Society (ACS). What is Colorectal Cancer? Available at:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1x_What_Is_Colon_and_Rectu
m_Cancer.asp?rnav=cri

 National Cancer Institute (NCI). Obesity and Cancer. Available at:

http://www.cancer.gov/cancertopics/factsheet/Risk/obesity
 References
 American Liver Foundation. Diet and Your Liver. Available at:
http://www.liverfoundation.org/cgi-bin/dbs/articles.cgi?db=articles&uid=default&ID=1022
&view_records=1

 Mayo Clinic. Your Liver: An Owner’s Guide. Available at:

http://www.mayoclinic.com/health/liver/DG00038
 American Academy of Family Physicians (AAFP). Obstructive Sleep Apnea. Available
at: http://www.aafp.org/afp/991115ap/2279.html
 National Synchrotron Light Source (NSLS). Osteoarthritis. Available at:
http://www.nsls.bnl.gov/about/everyday/osteoarthritis.html
QUESTIONS?