Over–weight

and
Obesity

1
 Over-weight and Obesity
 Over–weight major contributor to reduced life expectancy

 Strongly linked with development of coronary heart disease, diabetes,

gallbladder disease, hypertension, respiratory ailments and certain forms
of cancer

 Excessive weight also increases risk of arthritis, low back pain and
numerous other painful conditions

 Over–weight subjective term, depends upon body structure; Height and

weight charts usually give ideal weights of individuals for given height and
frame size

2
3
4
5
6
7
8
9
  If a person’s weight is 15-20% above ideal weight indicated, then person
usually classified over–weight

 Obesity - abnormal accumulation of adipose tissue throughout body

 Linked with amount and distribution of fat in body

 Body requires minimal amount of fat for insulation and

cushioning between parts of body and vital organs

 Men’s body should contain 11-15% total body fat and not below 3-4%

 Man considered obese if his total body fat exceeds 20%of body mass

 Women should be within 18-20% fat; ifexceeds 30%, then

woman obese
10
 In females body fat should not fall below 8%; may result in amenorrhea
(abnormal suppression or absence of menstruation)

 Too much or too little fat both potentially harmful

 Several methods used for determining amount of fat in body

 Pinch test, hydrostatic weighing technique, soft–tissue

roentgenogram, electrical impedance, etc.

 Pinch test useful and simple method

 Involves pinching fold of skin (not muscle) just behind triceps with thumb
and index finger
11
 If distance or size of pinch appears thicker than 1 inch, person generally
considered over–fat.

12
13
Body Density & Body Fat

For Body Density

Db=

Where: Db = Density of the body, Ma = "Mass in air" (i.e. dry weight), Mw = "Mass in
water" (i.e. underwater weight), Dw = Density of water (based on water temperature), RV
= Residual volume (the unfilled space enclosed by the body- e.g. volume of air in the
lungs + respiratory passages after a maximum exhalation).

Residual volume may also be estimated as a proportion of vital capacity (0.24 for men

and 0.28 for women).

For Body Fat

Siri (1956): Fat % = [4.950 /Density - 4.500]×100
Brozek et al. (1963): Fat % = [4.570 /Density - 4.142]×100
15
 Cause of Obesity
 Inherited trait or due to presence of excessive number of fat cells in
body

 Average weight adult probably has about 25-30 billion fat cells, a
moderately obese adult about 60-100 billion and extremely obese 200
billion

 Size of fat cells increases or decreases depending upon dietary habits

 Another cause attributed to underactive thyroid gland - produces

hormone to regulate metabolism, impedes ability to burn up calories

 Menopause leads to increased waist–to–hip ratio and 20% greater

body fat mass
16
 After 25 years age, BMR of individual decreases that also results in
accumulation of fat in body

 Lifestyle - labour saving devices, physical activity reduced

 Food - more concentrated, result of refining - high levels of fatty, high

calorie foods

 Relationship between activity level and calorie intake important; sedentary

person can easily consume food containing 3,000 kcal or more in a day;
Equivalent to about 400 g body fat

 Toget rid of this fat one requires walking at 4.5 km/h for about
80
minutes; Hence, is easier to gain weight than lose it
17
 Management of Obesity
Objective
 Diet for obese individual is planned to provide nutritionally balanced low
calorie intake to induce a weight loss of 1-2 pounds per week

Use
 The low energy diet plans for obese varies from person to person

18
 Obesity
Physiology
 Obesity is the consequences of an imbalance of energy intake and
energy
output

 It contributes to several chronic diseases and is associated with increased

mortality rate. It is expressed in various forms:

 Ideal Body
 Mild Weight/ desirable body
obesity: 120%weight
- 140%(IBW or BDW)
 Moderate obesity: IBW
 Morbid or severe obesity: 141% - 200%
 Super Obesity: IBW
> 200% IBW
19
> 250% IBW
 Obesity
 The nature and causes of obesity is the subject of intensive and continuing
research. Both environment and genetic factors are involved

Psychological factors
 Various psychological factors are associated with adolescent obesity

Developmental obesity
 This results from psychological factors within the family

 It is an eating disorder, which originates in the early life of the child

 The family’s attitudes and behavior serve as primary causes of the obesity
20
 Obesity
 The obesity itself further inhibits normal development, and this in turn
leads to maintenance or increase of body weight

Body Image
 The overweight teenager is vulnerable to body image disturbances

 The type and extent of the disturbance depend on the length of time the
person has been heavy, the amount of excessive weight carried, gender, and
the life situation surrounding the individual’s unique development

Associated psychological disorders

 In some teenagers, obesity may be associated with severe psychiatric
disorders
21
 Obesity
 In others, the overeating behavior may act as an emotionally stabilizing
influence helping to maintain the person at functioning level

 The obesity among teenagers leads to passive interactions with others

 This response further reinforces the weight problem and leads to social
isolation, lack of exercise, and disturbed patterns of eating and family
interaction

Physiological factors
 In certain individuals, physiologic factors are
following principally
responsible for their obesity:
22
 Obesity
Physiological factors
 Genetic predisposition: Certain inherited biochemical, morphological,
and histological features foster excess storage of energy as fat

 Sodium pump activity: Less activity in cells of obese individuals

to
maintain normal core temperature by obese individuals

 Adipose tissue lipoprotein lipase activity: Rate-limiting enzyme in

triglycerides storage is more active in the obese individual, enhancing
adipose tissue synthesis

 Insulin resistance: Obese bodies are less sensitive to insulin; Resulting

23 hyperinsulinemia tends to maintain obese state
 Obesity
Physiological factors
 Thermogenesis: Less energy is spent in obligatory (food processing) or
facultative (response to sympathetic nervous system) thermosclines in
obese individuals

 Adipocyte hypertrophy: When energy is available for storage, fat cells

enlarge

24
 Obesity
Problems associated to obesity
 Mortality risk increases with a body mass index (BMI) of 22 or greater

 An ideal body weight (IBW) of more than 120% is associated with

increased risk for hypertension, coronary artery disease ,cerebrovascular
disease , lipid disorder, non-insulin-dependent diabetes mellitus, gout,
gallbladder disease, infertility and menstrual irregularities

 The people with high waist hip ration (indicating that fat is largely in the
abdominal cavity, rather than subcutaneously on the limbs) had a greater
risk of the hearth disease and diabetes than people with a similar amount of
fat distributed peripherally

25
 Obesity
Problems associated to obesity
 Other penalties of obesity include osteoarthritis of the weight bearing
joints (especially back, hips and knees), problems with anesthesia and
surgery and social discrimination

26
 Dietary Modifications
 A well-balanced energy control diets is the most widely prescribed method
for weight reduction

 Reduction of body weight involves loss of both protein and fat and steady
losses over a longer period favor reduction of fat stores, limiting the loss of
vital protein

 The energy level varies with the individual's size and activities

 A goal should be set for a patient to loose 1-2 pound per week

 The fiber intake should be increased because it takes longer to chew, is low
in energy and increases satiety
27
 Dietary Modifications
 Maintain a normal or slightly higher protein intake to maintain nitrogen
balance, especially with calorie- restricted diets

 Gradually reduce excess food intake and increase activity

 Decrease the use of sweets as snack foods or as dessert

 Decrease fatty or fried foods

 Serve small portions and limit additional helpings

28
 Adequacy
 Providing the calorie level is about 1200 kcal/day and food choices are
optimal, the diet is usually adequate in all nutrients

 More restrictive diets may be inadequate in some nutrients and therefore,

should be supplemented with the appropriate vitamins and minerals

29
 Food Choices
Food Groups Foods Allowed Foods Restricted
Bread, Cereals All types of All cereal and
and Whole grain
grains meal,bread,roti with lots of added
and rice with added fat such
fat as paratha
and
puree
Milk and milk Milk and milk products Milk and milk products
products without balai/cream with full cream milk
Meat(red/white All lean All meat cuts
meat and egg) meat with
preparation with visible fat and
small meat
30 quantity of oil dishes with lots
 Food Choices
Food Groups Foods Allowed Foods Restricted
Vegetables (green All:raw,fresh Fried vegetables
leafy/starchy) seasonal
vegetable cooked
in little oil
Fresh fruits All fresh fruit None
Dry fruits, nuts and Controlled None
seeds consumption of
dry fruits,nuts and
seeds
Fats and oils Polyunsaturated oils Limit the consumption
such as canola oil, of banaspatighee
sunflower soybean oil , and desi ghee
corn oil and limited
31
consumption of
 Food Choices
Food Groups Foods Allowed Foods Restricted
Desserts and sweets All types of All types of
sweet refined
dishes and dairy sugar based food and
ice cream in food products such as
reasonably sweets
small quantity and
confectionary items
Fluids and drinks Small quantity of Drinks with lots
soft of
drinks ,sherbets added cream
and milk shakes

32
 Selecting a Weight-loss Program
 Combination of diet–exercise–behaviour modification programmes most
widely accepted

 Weight loss plan must fit priorities, personality, lifestyle (smoking, stress,
sedentary life)

 Select foods high in fibre, rich in vitamins and minerals, low in calories -
fruits, vegetables, whole wheat flour chapati, whole legumes, lean meat,
fish, poultry, skim milk

 Avoid highly refined foods

 Normal diet with energy value reduced to 1500, 1200 or 800 calories
recommended depending on person
33
  Protein levels normal, between 60 to 100g per day

 Limit fats to reduce calories

 Supplement with vitamin and mineral tablets.

 Eat three meals in a day

 Drink water before breakfast, before each meal,

before retiring at night and frequently during day

 Consume fruit juices with breakfast and at least once during

day, between lunch and dinner

 Discontinue eating before feel “full”

34
  Select physical exercise that you enjoy

 Maintain a record of food, activities and weight

 Not advisable to lose more than 2 to 3 kg weight per

month

 Losing weight requires hard work and patience

35