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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.
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