Disorders of Adipose Tissue and Obesity

Presenter Moderator
Dr Shyam amda Dr E Siva Rami Reddy
PG part 1 HOD
Practice of medicine Practice of medicine
MNRHMC MNRHMC
Homeostatic
regulation of
body weight
• Obesity is one of the most
serious global public health
challenges of the 21st
century
• Preventing obesity has direct
benefits for health and
wellbeing, in childhood and
continuing into adulthood
Effects of
obesity
• Obesity in adulthood is a major risk
factor for the world’s leading causes
of poor health and early death
including cardiovascular disease,
several common cancers, diabetes and
osteoarthritis.
 PREVALENCE
• The rapid spread of urbanization and
industrialization and dramatic lifestyle
changes has led to the pandemic of
obesity,
• Obesity is emerging as an important
health problem in India. It is estimated
that 22 million Indians are obese,
especially abdominally obese.
• National family health survey-4 reported
that socioeconomically backward states
having low rate of prevalence of obesity
as compared to higher socioeconomic
states
 Methods of estimating obesity

• Body mass index

There are three (BMI)
commonly used • Waist-to-hip ratio
objective methods of (WHR), waist
estimating obesity in circumference (WC)
clinical practice : • Body fat distribution
Body mass index (BMI)
• BMI is a measurement of a person's
leanness or corpulence based on their
height and weight, and is intended to
quantify tissue mass.
• It is widely used as a general indicator
of whether a person has a healthy body
weight for their height
Waist-to-Hip Ratio and Waist Circumference
• The WHR provides information
about the distribution of body fat.
The desired WHR for men and
women is less than 1.0 and 0.8,
respectively.

• The waist circumference cut-offs for

Indians are more than 80 cm for
women and more than 90 cm for
men
Body Fat Distribution (Fat Phenotypes)
“obesities” may be categorized across four groups:
• metabolic unhealthy normal weight (MUNW) – weight is normal but
persons are more prone to get diabetes and other metabolic disorders
• metabolically healthy overweight/obese (MHO) – persons are obese
with absence of metabolic disorders and cardiovascular abnormality
• metabolically unhealthy overweight/obese (MUO) – persons are obese
and in risk with metabolic and cardiac disorders
• sarcopenic obesity (SO) – combination of high body fat percentage and
Sarcopenia
Causes of Obesity
• 1. Energy Imbalance: Obesity primarily
results from an imbalance between energy
intake (calories consumed) and energy
expenditure (calories burned). When more
energy is consumed than expended, excess
energy is stored as fat, leading to obesity.
• 2. Genetics: Genetic factors play a
significant role. Although obesity doesn't
follow simple Mendelian inheritance, it does
tend to run in families. Numerous genes are
associated with adiposity and weight gain.
• 3. Environmental Factors: Socioeconomic, cultural, and
behavioural influences contribute to obesity. Sedentary
lifestyles, excessive food intake, and accessibility to high-
sugar foods play a role.
• 4. Hormonal Regulation: The endocrine system plays a
crucial role. Hormones related to appetite, metabolism,
and fat storage impact obesity. Leptin, ghrelin, insulin,
and other signals influence energy balance.
• 5. inflammation: Obesity is characterized by chronic
inflammation within adipose tissue. Excessive fat
deposition leads to the secretion of inflammatory markers.
These markers contribute to conditions like hypertension,
diabetes and dyslipidaemia
• 6. Psychological Factors: Emotional eating, stress, and
psychological well-being influence eating habits and
weight gain.

• 7. Medications: Certain drugs, such as steroids and

some psychiatric medications, can cause weight gain.

• 8. Physiological Factors: Each person has a set point

weight that the body resists moving away from.
Metabolic rates also vary among individuals.

• 9. Lifestyle Choices: Lack of physical activity, poor

sleep, and dietary habits contribute to obesity.

• 10. Metabolic Disorders: Conditions like

hypothyroidism or Cushing's syndrome can lead to
weight gain.
 Goals of Weight Loss and Management

The overall goals of weight loss management are:

• to prevent further weight gain
• to lose weight to achieve a realistic target BMI
• to maintain a lower body weight over the long term

A reasonable time period for a 10% reduction in body weight is 6 months of therapy
 Strategies for Weight Loss and Weight Maintenance

Dietary therapy -
• The diet should be nutritionally adequate. It
must be tailored to a person’s tastes and
habits. It should create a deficit of 500 to
1000 kcal per day. The fat content should
be 30% or less of total calories
• Satiety index is defined as a quantification
of the duration of hunger suppression by a
given amount of food (containing 1000 kJ).
Protein is most satiating, followed by
carbohydrates. Fat is poor at switching off
appetite and very easy to store.
 Intermittent fasting (IF)

It is an eating pattern that cycles between periods of fasting and eating. It doesn’t
specify which foods you should eat but rather when you should eat them. Here are
some common methods of intermittent fasting:
• 16/8 method: Also known as the Lean-gains protocol, it involves skipping
breakfast and restricting your daily eating period to 8 hours (e.g., 1–9 p.m.). Then
you fast for 16 hours in between.
• Eat-Stop-Eat: This method involves fasting for 24 hours once or twice a week
(e.g., not eating from dinner one day until dinner the next day).
• The 5:2 diet: You consume only 500–600 calories on two non consecutive days of
the week but eat normally on the other 5 days.
 Exercise and physical activity

• Global guidelines recommend adults

engage in 30 minutes of moderate-
intensity physical activity daily,
gradually increasing over time.
• Encourage dynamic yoga,
encourage children to engage in 60
minutes of outdoor activity daily, and
limit screen time to less than 2 hours
daily.
 Behavioural therapy

• Behavioural therapy is a key

component of weight loss
programs, involving food intake
diaries and periodic analysis to
suggest new eating habits. It
involves avoiding triggers and
controlling situations. This therapy
is typically conducted in groups,
with dialogue between the group
leader and the patient.
 Drug therapy
• Pharmacotherapy must be used in
conjunction with diet and physical activity
to achieve and maintain a realistic degree of
weight loss. This is merely an adjuvant and
most drugs are now banned except orlistat.
• Drug therapy should be considered for
patients with a BMI greater than 27 kg/m2
and associated obesity-related
complications (i.e. hypertension, coronary
heart disease, hyperlipidaemia, diabetes and
sleep apnoea) or for those with a BMI
greater than 30 kg/m2 .
 Homoeopathic Therapeutics
• Calcarea carb – leucophlegmatic temparament , children fat flabby fair, pot belly,
craves eggs and indigestible things , Ravenous hunger , increased abdominal fat
• Graphitis – fat chilly costive persons stout and fair complexion fullness and
hardness in abdomen
• Ammonium mur – fat and sluggish patients with respiratory troubles excess fat
around the abdomen , ailments from grief
• Lycopodium – carbonitrogenoid constitution , hurried when eating , great weakness
of digestion excessive hunger with bloating
• Abies canadensis – canine hunger with torpid liver gnawing hunger faint feeling in
epigastrium craving for meat pickles and raddish , tendency to eat far beyond
capacity of digestion
• Nux vomica, phytolacca berry , antimonium crudum are some of the remedies
indicated in obesity
Ok Bye !