OBESITY (OVERWEIG

HT)

OBESITY

Excess body fat

accumulated to the extend

of causing adverse effect

WORLDWIDE OBESITY RATES

Obesity in Asia

Incidence rate of Obesity in Malaysia

Journal of Obesity in Malaysia by University Kebangsaan Malaysia states that:

5.8% of 29,179,952-obeseNumber of people obese are

1,692,437Higher rate-Malays and Indians

Risk factors

Environmental factors

Genetic factorsLack of sleepAgeGender

PATHOPHYSIOLOGY

Childhood Obesity

Adult Obesity

Genetic Factors

•Parental obesity•Prader-Willi syndrome

Environmental Factors

•Lack of physical activity •Sedentary lifestyle•Over eating

Childhood Obesity

Adult Obesity

Expansion of the adipose tissue during weight gain leads tissue undergoes a continuous remodeling process that normally maintains tissue health, but may spin out of control and lead to adipocyte death in association with the recruitment and activation of macrophages, and systemic insulin resistance.

Adipose tissue located beneath the skin (subcutaneous fat), around internal organs (visceral fat), in bone marrow (yellow bone marrow) and in breast tissue.

Adipose depots in different parts of the body have different biochemical profiles.

Under normal conditions, it provides feedback for hunger and diet to the brain.

Diseased fat tissue surrounding various organs can cause illness.

Aromatase which is involved in sex hormone metabolism.  TNF Alpha, IL-6 and leptin which are collectively termed ‘cytokines’ and are involved in sending messages between cells.  Plasminogen activator inhibitor-1 which is involved in the clotting of blood.  Angiotensin which is involved in blood pressure control.  Adiponectin which improves the body’s sensitivity to insulin and so helps to protect against developing type 2 diabetes.  Lipoprotein lipase and apolipoprotein E which are involved in storage and metabolism of fat to release energy.

Type 2 diabetes

Excess body fat 

Difficulty

sleeping

extremely large

waistline 

Heavy sweating

Lack of energy

Pain and soreness in joints and muscles

Symptoms

Consequences of obesity

Coronary heart disease

stroke

Type 2 diabetes

Non alcoholic fatty liver

disease(NAFLD)

cancer

High blood pressure

Screening Obesity

Body mass index BMI : BW / H2Where :-

BW = Body Weight (kilograms)H = Height (meters)

Measure waist circumferenceApple shape ( risk of DM, CVD,

HTN ) Waist larger than 40 inch menWaist larger than 35 inch women

1998 NIH-NHLBI Guidelines

Overweight: BMI 25 - 29.9 Obese: BMI > 30

Obesity Class I: 30 - 34.9 Obesity Class II: 35 - 39.9 Extreme Obesity: >40

Weight Loss Strategies

Diet therapy Increased Physical Activity Pharmacotherapy Behavioral Therapy Surgery

Dieting

Highly ineffective rate 95 % long term failure Often result in increase weight than before diet

Slow weight loss – stable Rapid weight loss – gain weight Rapid weight loss – increase risk of gallstones

Low calorie step 1 diet

Women Men

1000 – 1200 kcal/day 1200-1600 kcal/day

How much people should eat?Male Age 20-49 2900 calories/day

50 + 2500 calories/day

Female Age 20-49 2300 calories/day

50 + 1900 calories/day

Guideline Daily Amount Values

Typical values Women MenChildren (5-10

years)

Calories 2,000 kcal 2,500 kcal 1,800 kcal

Protein 45 g 55 g 24 g

Carbohydrate 230 g 300g 220 g

Sugars 90 g 120 g 85 gFat 70 g 95 g 70 g

Saturates 20 g 30 g 20 g

Fibre 24 g 24 g 15 gSalt 6 g 6 g 4 g

Physical Activity

Integral part of weight loss Increase activity never loss weight Sustained activity does prevent weight regain Reduces risk of getting HD & DM

Recommended activities

Pharmacotherapy

A) Sibutramine(Serotonin Nor-epinephrine Reuptake Inhibitor) : initial dose 10mg/day, max 20mg/day. Reduces food intake, increase HR and BP.

B) Orlistat: Lipase inhibitor : 120mg PO TID. Alters metabolism, dec absorption of dietary fat.

Behavariol Strategies

Keep a journal of diet/diary Set spesific goals Keep track of improvement

Weight loss surgery

Surgery Restrictive

Combined restrictive &

malabsorption

Vertical band gastroplasty

Gastric Banding

Laproscopic gastric banding

Roux-en-y gastric bypass

Biliopancreatic diversion

VBG

GASTRIC BANDING (LGB)

Case study (True incident)

P. Thamilselvi suffered obesity for yearsShe had several complications due to

obesity for instance; She had difficulties of breathing while

doing heaving activities Stress and depression

Treatment

Thamilselvi consulted her physical dietician She started a strict diet :

Oats Green tea Green apple Cut down rice intake, oily foods and food

contain high fat

After treatment…..

The latest Thamilselvi

Conclusion

“Sebab mulut badan binasa” – “Body perish because of the mouth”

obesity is best tackled at home through improved self involvement, increased physical exercise, better diet and restraint from eating.

REFERENCES

Ismail MN. The nutrition and health transition in Malaysia.Public Health Nutrition 2002; 5: 191–195. World Health Organization. Obesity: Preventing and Managingthe Global Epidemic. WHO Obesity Technical Report Seriesno. 894. WHO: Geneva, 2000. Ismail MN, Tan CL. Prevalence of obesity in Malaysia. In:Inoue & Zimmet (eds). The Asia–Pacific Perspective: RedefiningObesity and its Treatment. WHO(WPRO)/IASO/IOTF: HealthCommunications Australia, 2000 pp 10–13. Ismail MN, Vickneswary EN. Prevalence of obesity inMalaysia: data from three ethnic populations. In: Inoue & Zimmet(eds). The Asia – Pacific Perspective: Redefining Obesity and itsTreatment. WHO (WRRO)/IASO/10TF: Health CommunicationAustralia, 2000.