Epidemiology, Prevention & Control of

Obesity

Dr Praveer Kumar
Associate Professor
 Epidemiology

• In India, 1.3 per cent males and 2.5 per cent

females aged more than 20 years were obese
in the year 2008
 INTRODUCTION
• Obesity is major health problem in adults, as well as
among children and adolescents.

• Central accumulation of body fat is associated with

insulin resistance.

• Distribution of body fat in a peripheral pattern is

metabolically less important
• Total adiposity and truncal subcutaneous fat
accumulation during adolescence are positively and
independently associated with atherosclerosis.

• Abdominal obesity leads to metabolic syndrome

i.e. clustering of abdominal obesity,
Hyperlipidemia, Hyperglycemia and Hypertension is
a major public health challenge.

• Obesity is associated with a large decrease in life

expectancy.
 Obesity
• Types –
• Hypertrophic obesity - Abnormal growth of the
adipose tissue due to an enlargement of fat cell
size.
• Hyperplastic obesity -An increase in fat cell
number .
• or a combination of both.
• The distribution of fat induced by the weight gain
affects the risk associated with obesity, and the kind
of disease that results.

• “Abdominal Fat Distribution" or “Android Obesity”

– Fat is centrally accumulated. More serious

• “Gynoid Fat Distribution” - - Fat is more evenly and

peripherally distributed around the body, less
serious
 Childhood Obesity
• Childhood obesity is associated with future risk of
increased -
• Breathing difficulties
• Increased risk of fractures
• Hypertension
• Cardiovascular disease
• Insulin resistance
• Psychological effects.
 Adverse Effects of Obesity

• Early Adverse Effects - Hypertension,

Hyperlipidemia and glucose intolerance

• Late Adverse Effects - Coronary heart disease and

the long term complications of diabetes, such as
renal failure
 Epidemiological Determinants
AGE :Obesity can occur at any age, and generally
increases with age.
Infants with excessive weight gain have an increased
incidence of obesity in later life.
• Most adipose cells are formed early in life and the
obese infant lays down more of these cells
(hyperplastic obesity) than the normal infant.
• Hyperplastic obesity in adults is extremely difficult
to treat.
 SEX
Women generally have higher rate of obesity
than men, men have higher rates of overweight.
• Most men weight between the ages of 29 and
35 years
• Most women gain weight between 45 and 49
years of age, i.e. at menopausal age
 Physical Inactivity

• Sedentary lifestyle particularly sedentary

occupation and watching television promote it.

• Regular physical activity is protective against

unhealthy weight gain.
 Socio-economic Status

There is a clear inverse relationship between

socio-economic status and obesity.
 Eating Habits

• Eating habits (e.g., eating in between meals,

preference to sweets, refined foods and fats) are
riskful.

• A diet containing more energy than needed may

lead to prolonged post—prandial hyperlipidaemia
and to deposition of triglycerides in the adipose
tissue resulting in obesity
• Television and print media is playing an important
role in producing obesity by heavy advertisement of
fast food outlets of energy-dense, micronutrient
poor food and beverages .

• It has been calculated that a child whose energy

requirement is 2000 kcal/day and who consumes
100 kcal/day extra will gain about 5 kg a year. The
accumulation of one kilo of fat corresponds to 7,700
kcal of energy
 Psychosocial Factors

Psychosocial factors (e.g., emotional disturbances) are

deeply involved in the etiology of obesity.

Overeating may be a symptom of depression, anxiety,

frustration and loneliness in childhood as it is in adult
life.
 Familial Tendency

Obesity frequently runs in families (obese parents

frequently having obese children).
 Endocrine Factors

These may be involved in occasional cases, e.g.,

Cushing's syndrome, growth hormone deficiency.
 Alcohol

Relationship between alcohol consumption and

adiposity was generally positive for men and
negative for women.
 Education

There is an inverse relationship between

educational level and prevalence of overweight.
 Smoking

Use of tobacco lowers body weight

 Ethnicity

Ethnicity is also related with development of

obesity and its complications.
 Drugs

Use of certain drugs, e.g., cortico-steroids,

contraceptives, insulin, (3-adrenergic blockers,
etc.) can promote weight gain.
• Overweight and obesity are more common in in
low-and middle-income countries as compared to
high income countries

• Overweight prevalence was higher in urban areas

than in rural areas.
 Use of BMI To Classify Obesity

• Body mass index (BMI) is a simple index of

weight-for height that is commonly used to
classify underweight, overweight and obesity
in adults.
Classification BMI Risk of Co-
morbidities

Underweight < 18.50 Low

Normal Range 18.50 – 24.99 Average
Overweight ≥ 25.00
Pre - obese 25.00 - 29.99 Increased
Obese Class 1 30.00 – 34.99 Moderate
Obese Class 2 35.00 - 39.99 Severe
Obese Class 3 ≥ 40. 00 Very Severe
 Abdominal Obesity

• Abdominal obesity is important in the development

of insuline resistance, and in the metabolic
syndrome (hyperinsulinaemia, dyslipidaemia,
glucose intolerance, and hypertension).
 Assessment of Obesity
• Before considering assessment of obesity, it
will be useful to first look at body composition
as according-
1. The active mass (muscle, liver, heart etc.)
2. The fatty mass (fat)
3. The extracellular fluid (blood, lymph, etc.)
4. The connective tissue (skin, bones,
connective tissue)
 Body Weight
(1) Body mass Index (Quetelet's index) -
Weight (kg)
Height2 (m)
(2) Ponderal Index -
Height (cm)
Cube root of body weight (kg)
(3) Brocca Index = Height (cm) - 100
(4) Lorentz's Formula
Ht (cm) — 150
= Ht (cm) — 100 —
2 (women) or 4 (men)
(5) Corpulence Index
Actual weight
Desirable weight
This should not exceed 1.2
 Skinfold Thickness
• The sum of the measurements should be less
than 40 mm in boys and 50 mm in girls
 3. WAIST CIRCUMFERENCE AND WAIST :
HIP RATIO (WHR)
• There is an increased risk of metabolic
complications for men with a waist circumference
≥102 cm, and women with a waist circumference ≥
88 cm .
• A high WHR ( > 1.0 in men and > 0.85 in women)
indicates abdominal fat accumulation.
 Hazards of Obesity
(a) INCREASED MORBIDITY - Varicose veins,
abdominal hernia, osteoarthritis of the knees, hips
and lumbar spine, flat feet and psychological
stresses particularly during adolescence.

(b) INCREASED MORTALITY – The increased mortality

is due to mainly by the increased incidence of
hypertension and coronary heart disease.
Obesity lowers life expectancy.
 Health Problems Associated with Obesity
Greatly Increased Moderately Slightly Increased
Increased
Type 2 Diabetes CHD Breast Cancer, Colon
Gallbladder Disease Hypertension Cancer, Endometrial
Dyslipidaemia Osteoarthritis Cancer
Insulin Resistance Hyperuricaemia Reproductive Hormone
Breathlessness & Abnormalities
Sleep Apnea Gout PCOS

Impaired Fertility

Low back pain

Prevention and Control
• Weight control is widely defined as
approaches to maintaining weight within the
'healthy' (i.e. 'normal' or acceptable') range of
body mass index of 18.5 to 24.9 kg/m 2
throughout adulthood
• The diet should be increased –
• Consumption of common un-refined foods i.e.
fruits, green leafy vegetables.
• Adequate levels of essential nutrients in the low
energy diets should be ensured
• Reducing diets should be as close as possible to
existing nutritional patterns.
 EXERCISE PROMOTION
Regular physical activity leads to a fall in body weight,
lipid levels.
Regular physical activity should be encouraged as part
of the strategy for weight control .
As per WHO , Physical Activity more than 150-300 mts
Moderate Intensity or > 75-150 mts Vigorous
Intensity/week) is Inversely related with obesity
Hypertension, Type 2 Diabetes, Stress, Depression
OTHERS:
• Appetite suppressing drugs

• Surgical treatment (gastric bypass, gastroplasty)

Thank you