OBESITY

 SAMALA SAI KRISHNA

 SANIKOMMU SUDHEER REDDY
 RAJENDRAN KALA ABILASH
• Obesity may be 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 .
• obese individuals differ not only in the amount
of excess fat that they store, but also in the regional
distribution of the fat within the body.
• The distribution of fat induced by the weight gain affects the
risk associated with obesity, and the kind of disease that
results.
• It is useful therefore, to be able to distinguish between those
at increased risk as a result of "abdominal fat distribution" or
"android obesity" from those with the less serious "gynoid“
fat distribution, in which fat is more evenly and peripherally
distributed around the body.
• Obesity is perhaps the most prevalent form of
malnutrition.
• It is one of the most significant contributors to ill
health.
• It has been suggested that such increase in body
weight have been caused primarily by reduced
levels of physical activity, rather than by changes
in food intake or by other factors.
• Overweight and obesity are the fifth leading risk of global
deaths. Worldwide, obesity has more than doubled since 1980.
In 2008, more than 1.4 billion adults, 20 years and older, were
overweight. Of these over 200 million men and nearly 300
million women were obese .
• At least 3.4 million adults die each year as a result of being
overweight or obese. In addition, 44 per cent of the diabetes
burden, 23 per cent of ischemic heart disease burden and
between 7 to 41 per cent of certain cancer NON-
COMMUNICABLE DISEASES burdens are attributable to
overweight and obesity .
• Overweight and obesity are linked to more deaths worldwide
than underweight.
Epidemiological determinants

• (a) 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
• (b) SEX : Women generally have higher rate of
obesity than men, although men may have
higher rates of overweight. At menopausal age.
It has been claimed that woman's BMI increases
with successive pregnancies.
• (c) GENETIC FACTORS: There is a genetic component in
the aetiology of obesity. Twin studies have shown a close
correlation between the weights of identical twins even
when they are reared in dissimilar environments . The
profile of fat distribution is also characterized by a
significant heritability level of the order of about 50 per
cent of the total human variation.
• (d) PHYSICAL INACTNITY : There is convincing evidence
that regular physical activity is protective against
unhealthy weight gain.
• (e) SOCIO-ECONOMIC STATUS : Within some affluent
countries, however, obesity has been found to be more
prevalent in the lower socio-economic groups.
• (f) EATING HABITS : Eating habits (e.g., eating in between
meals, preference to sweets, refined foods and fats) are
established very early in life. 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 .
• (g) PSYCHOSOCIAL FACTORS : Psychosocial factors (e.g.,
emotional disturbances) are deeply involved in the aetiology
of obesity. Overeating may be a symptom of depressiori,
anxiety, frustration and loneliness in childhood as it is in adult
life.
• (h) FAMILIAL TENDENCY : Obesity frequently runs in families
(obese parents frequently having obese children), but this is
not necessarily explained solely by the influence of genes.
• (i) ENDOCRINE FACTORS : These may be involved in occasional
cases, e.g., Cushing's syndrome, growth hormone deficiency. ·
• (j) ALCOHOL : A recent review of studies concluded that the
relationship between alcohol consumption and adiposity was
generally positive for men and negative for women (6).
• (k) EDUCATION : In most affluent societies, there is an inverse
relationship between educational level and prevalence of
overweight (6).
• (I) SMOKING : Reports that the use of tobacco lowers body
weight began to appear more than 100 years ago, but detailed
studies have been reported only during the past 10 years or
so. In most populations, smokers weigh somewhat less than
ex-smokers; individuals who have never smoked fall
somewhat between the two.
• (m) ETHNICITY : Ethnic groups in many industrialized countries
appear to be especially susceptible to the development of
obesity and its complications. Evidence suggests that this may
be due to a genetic predisposition to obesity that only
become apparent when such groups are exposed to a more
affluent lifestyle (8).
• (n) DRUGS : Use of certain drugs, e.g., cortico-steroids,
contraceptives, insulin, ~-adrenergic blockers, etc. can
promote weight gain
Use of BMI to classify obesity

• Body mass index (BMI) is a simple index of weight-forheight

that is commonly used to classify underweight, overweight
and obesity in adults. It is defined as the weight in kilograms
divided by the square of the height in metres (kg/m2).
INTRA-ABDOMINAL (CENTRAL) FAT
ACCUMULATION AND INCREASED RISK
• Compared with subcutaneous adipose tissue, intra abdominal
adipose tissue has more cells per unit mass, higher blood flow, more
glucocorticoid (cortisol) receptors, probably more androgen
(testosterone) receptors, and greater catecholamine-induced
lipolysis. These differences make intra-abdominal adipose tissue
more susceptible to both normal stimulation and changes in lipid
accumulation and metabolism. Furthermore, intra-abdominal
adipocytes are located upstream from liver in the portal circulation.
This means that there is a marked increase in the flux of non -
esterified fatty acid to the liver via the portal blood in patients with
abdominal obesity. There is good evidence that abdominal obesity is
important in the development of insulin resistance, and in the
metabolic syndrome (hyperinsulinaemia, dyslipidaemia, glucose
intolerance, and hypertension) that link obesity with CHO .
Premenopausal women have quantitatively more lipoprotein lipase
(LPL) and higher LPL activity in the gluteal and femoral
subcutaneous regions, which contain fat cells larger than those in
men, but these differences disappear after menopause.
Assessment of obesity

• Before we consider assessment of obesity, it will be

useful to first look at body composition as under;
a. the active mass (muscle, liver, heart etc.)
b. the fatty mass (fat)
c. the extracellular fluid (blood, lymph, etc.)
d. the connective tissue (skin, bones, connective tissue)
Structurally speaking, the state of obesity is characterized
by an increase in the fatty mass at the expense of the other
parts of the body.
• The water content of the body is never increased in case
of obesity.
• The assessment is done in different ways .They are
 1. BODY WEIGHT:

THE BODY MASS INDEX (BMI) AND THE BROCCA

INDEX ARE WIDELY USED.
2. SKINFOLD THICKNESS
• Large proportions of fat is found below the skin
so it is more accessible,rapid and non invasive.
Harpenden skin callipers is used for
measurement. The measurements are done in
mid-triceps, biceps, subscapular and suprailiac
regions. The sum of the measurements should
be less than 40 mm in boys and 50 mm in girls.
• In extreme obesity, measurements may be
impossible. The main drawback of skinfold
measurements is their poor repeatability.
3. WAIST CIRCUMFERENCE AND
WAIST: HIP RATIO (WHR)
• Waist circumference is measured at the mid point between the
lower border of the rib cage and the iliac crest.
• There is an increased risk of metabolic
• complications for men with a waist circumference 102 cm, and
women with a waist circumference 88 cm
OTHERS
In addition to the above, three well-established and more
accurate measurements are used for the estimation of body fat.
• They are measurement of total body water, of total body
potassium and of body density. They are more complex to
perform so they are not used for routine clinical purposes.
PREVENTION AND CONTROL
• Prevention of obesity should begin in early childhood.
• Obesity is harder to treat in adults than it is in children.
• The control of obesity centres around weight reduction.
• This can be achieved by dietary changes, increased physical activity
and a combination of both.

(a) DIETARY CHANGES: The proportion of energy-dense foods such

as
• simple carbohydrates and fats should be reduced; the fibre content
in the diet should be increased.
• (b) INCREASED PHYSICAL ACTIVITY: This is an important part of
weight reducing programme. Regular physical exercise is the key to
an increased energy expenditure.
• (c) OTHERS:
• Appetite suppressing drugs have been tried in the control of
obesity.
• They are generally inadequate to produce massive weight in
severely obese patients. Surgical treatment (e.g; gastric bypass,
gastroplasty, jaw-wiring, to eliminate the eating of solid food have
all been tried with limited success