OBESITY

Obesity is defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell size(hypertrophic obesity)or an increase in fat cell number(hyperplastic obesity)or a combination of both.

Central obesity is defined as waist circumference ≥ 90 cm in males and ≥ 80 cm in females. +Any two of the following-Increased triglycerides ≥ 150 mg/dl (1.70 mmol/L)-reduced HDL cholesterol <40 mg/dl in males and < 50 mg/dl in females.-raised blood pressure systolic bp ≥ 130 mm Hg and diastolic bp ≥ 85mm Hg.-raised fasting plasma glucose ≥ 100 mg/dl.

Or treatment for previously diagnosed any of the above condition.

Classification BMI(kg/m2)

Risk of Co-morbidities

Underweight <18.5 Low (Risks are increased in other areas)

Desirable 18.5-22.9

Average

Overweight 22.9-29.9

Mildly Increased

Obese >30.0

Class 1 Obesity

30.0-34.9

Moderate

Class 11 Obesity

35.0-39.9

Severe

Class 111 (morbid obesity)

>40.0 Very severe

Obesity is primarily driven

by individual decisions, and

the way society influences them

Human biology - genetics plays a part but does not pre-destine us to be obese

Culture/Individual psychology - it is difficult to break habituated unhealthy eating patterns, especially when common to those around us

The food environment - there has also been a huge increase in the quantity of quick convenience foods, which tend to be high in saturated fat, salt and sugar.

The physical environment - our lives have become increasingly sedentary. For e.g. last two decades have seen marked reduction in school walking.

RISK

FACTO

RS

RELATIVE RISK OF HEALTH PROBLEMS ASSOCIATED WITH OBESITY

Greatly increased(relative risk >>3)

•Diabetes•Gall bladder diseases•Hypertension•Dyslipidemia•Insulin resistance•Sleep apnea•Breathlessness

Moderately increased

(relative risk 2-3)

•Coronary heart disease •Osteoarthritis (knees)•Hyperuricemia and gout

Slightly increased(1-2)

•Cancer(breast cancer in postmenopausal women, endometrial cancer, colon cancer)•Reproductive hormone abnormalities•Polycystic ovarian syndrome•Infertility•Low back ache•Increased anesthetic risk•Foetal defect arising from maternal obesity.

TREATMENT AND

MANAGEMENT

Primary interventio

n

• Moderate calorie restriction.(to achieve a 5-10% loss of body weight in 1st yr)

• Moderate increase in physical activity.• Change in dietary composition.

Secondary intervention

• Drug therapy is required to treat the metabolic syndrome associated with obesity.

• There is a definite need for treatment that can modulate the underlying mechanism of metabolic syndrome as a whole and thereby reduce the impact of all the risk factors and the long term metabolic and cardiovascular consequences.

Cut down on salt and sugar.

Do not skip meals

Do not eat while reading, watching TV, playing video games.

Eat little at dinner.

Walk after night meals.

Avoid foods high in saturated fat and cholesterol.

Take fruits in between meals for snacking.

Take at least 7-10 glasses of water every day.

Use skimmed milk instead of full fat milk.

AVOID

•Alcoholic drinks.•Butter , margarine•Cakes, pancakes, cookies, doughnuts, pastries etc.•Candies, chocolates, cream, cheese.•French fries, potato chips, pizza, pasta, burger, snacking food.•Jams, jellies, sugar and syrup.•Ice cream, ice milk, sherbets, soda drinks.

DIET

EARLY YEARS(UNDER 5S)Preschool children should be physically active at least for 180 minutes.All under 5s should minimize the time spend being sedentary for extended periods except for sleeping.

CHILDREN AND ADOLESCENTSAll children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day. -Vigorous intensity activities, including those that strengthen muscle and bone should be incorporated at least thrice a week.-They should minimize the time spend being sedentary for extended periods.

ADULTS AND OLD AGE-Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week. Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous intensity activity. -Adults should also undertake physical activity to improve muscle strength on at least two days a week. -All adults should minimize the amount of time spend being sedentary for long.

PHYSICAL

ACTIVITY

Ammonium carb-Fat patients with weak heart.Women who are tired and weary and takes cold easily.Leads a sedentary lifestyle.Dry coryza-stoppage of nose-at night-can only breathe through mouth-danger of suffocation.Sadness with disposition to weep, timidity, disgust with life, heedlessness, weakness of memory, great absence of mind.Chilly patient < wet stormy weather ; washing> warmth.

Ammonium muriaticum-Body is fat and legs are thin with large buttocks.Full of grief but cannot weep. Irritability and disposition to be angry.Feets get very cold in the evening in bed.

MANAGEMENT

HOMOEOPATHIC

Antium crudum-Children and old people who have a tendency to grow fat with coated white tongue.Belching and great eructations of ingesta.bloating after eating.Cold and callous excrescenses.Patient is aggravated from extremes of temperature.

Calcarea carbonicum-Sweating on the forehead which wets the pillow while sleeping.Fair, fat, flabby are the red lined symptom.Great sensitiveness to cold damp air.

Capsicum-Person who are weak of lax fibre.the digestion is poor and suffer from myalgia.Have burning pains still doesn’t like cold.Old people who have exhausted their vitality.Home-sickness.>from heat Carlsbad-

Action on liver, treatment of obesity and diabetes.Self satisfied, very talkative, good humored. Discouraged and anxious about domestic duties. Absent minded, heedless, forgets names.Sensitive to cold air. sweats more easily.> Motion and open air.

Calotropis gigantea-Helps in reducing the obesity, without reducing the weight i.e. flesh would decrease but the muscle would become more firm.There is great heat in stomach.

Ferrum metallicum-Obesity with anaemia, puffy face with pitting of flesh. Delicate girls, fearfully constipated with low spirits.< cold weather. > warm weather.Great lassitude and weakness.

Graphitis-Obesity in females with delayed menstruation.Fair, fat , chilly constipated people.

Kali carbonicum-Older fat people characterized by sweat, backache and weakness.Dark haired person with lax fiber and inclined to be fat.

Esculentine-Great fat reducer. Can be alternated with phytoline.Should be given in mother tincture.

Fucus vesiculosus-Given when calcarea carb fails.Indigestion, obstinate constipation, flatulence.To be given in tinctures.

Phytolacca berry- One of the best remedies in weight reduction and corpulence reduction

Phytoline-Great fat reducer. Recommended when the patient is having difficulty in walking, sitting, palpitation, dyspnoea on least exertion, nausea, eructations.Given in mother tincture.

Thyroidinum-Excessive obesity. Acts best in pale patients.Is a powerful diuretic and helps in myx-odema and various types of oedema.

COMPILED BY-

Dr Neena Mehan(Head, Deptt. of Medicine)

Dr Pavneet Kaur (Intern 2013-2014 Dr B R Sur Homoeopathic Medical College, Hospital and Research Centre)