Transcript obesity - KSU Faculty Member websites

obesity
Done by:
Nader Al Dajani
Mohannad Al Romaih
Masoud Al otaibi
Definition

Obesity is defined as an excess accumulation of body fat

This excess accumulation is the result of a positive
energy balance where caloric intake exceeds caloric
expenditure

It is the most common nutritional disorder in
industrialized countries and is becoming increasingly
prevalent in developing countries due to changing
lifestyles.
Epidemiology





WHO’s latest projections indicate that globally in 2005:
approximately 1.6 billion adults (age 15+) were
overweight;
at least 400 million adults were obese.
WHO further projects that by 2015, approximately 2.3
billion adults will be overweight and more than 700
million will be obese.
At least 20 million children under the age of 5 years are
overweight globally in 2005.
Cont.

In study done in Saudi Arabia it shows that the
prevalence of overweight among male subjects was 29%
vs. 27% among female subjects & The prevalence of
obesity among female subjects was significantly higher
than for male subjects (24% vs. 16%)

This value is higher than that reported in the UK,
Australian, US and Italian populations
Etiology


Multifactorial disorders
Genetics:

polygenic, each gene having a small contribution in the presence of precipitating
environmental factors
 It has been long known that the tendency to gain weight runs in families.
However, family members share not only genes but also diet and life style habits
that may contribute to obesity.
 morbid obesity has a stronger genetic component than moderate level of excess
overweight


Energy imbalance
Diet



obesity is associated with increased food consumption
Intake of excess dietary fat has been implicated as a major cause of obesity
Exercises

For a decades A strong link exists between physical inactivity and weight gain
Cont.

Diseases
Hypothyroidism, Cushing’s syndrome, pancreatic insulinoma, growth
hormone deficiency, and hypothalamic insufficiency
 A variety of psychosocial factors contribute to the development of
obesity and to difficulty losing weight


Drugs

antipsychotics (phenothiazines, butyrophenones); antidepressants
and antiepileptics, (tricyclic antidepressants, lithium, valproate,
carbamazepine); and insulin and some oral hypoglycemics.
Whereas most of these medications contribute modestly to obesity,
 the large doses of steroids sometimes used to treat autoimmune
diseases can cause true obesity
Health Effects of Obesity

Obesity is associated with more than 30 medical
conditions, and scientific evidence has established a
strong relationship with at least 15 of those conditions

It has been established that obesity is associated with an
increased prevalence of coronary artery disease,
hypertension, diabetes mellitus, and other diseases.

In addition, life expectancy is shown to be reduced in
those who are obese or overweight.
Cont.

Diabetes (Type 2)

As many as 90% of individuals with type 2 diabetes are reported
to be overweight or obese.

Obesity has been found to be the largest environmental
influence on the prevalence of diabetes in a population.

Obesity complicates the management of type 2 diabetes by
increasing insulin resistance and glucose intolerance, which
makes drug treatment for type 2 diabetes less effective.

A weight loss of as little as 5% can reduce high blood sugar.
Cont.

Hypertension

Over 75% of hypertension cases are reported to be directly attributed to
obesity.

Weight or BMI in association with age is the strongest indicator of blood
pressure in humans.

The association between obesity and high blood pressure has been
observed in virtually all societies, ages, ethnic groups, and in both
genders.

The risk of developing hypertension is five to six times greater in obese
adult Americans, age 20 to 45, compared to non-obese individuals of
the same age.
Cont.

Cardiovascular Disease (CVD)






Obesity increases CVD risk due to its effect on blood lipid levels.
Weight loss improves blood lipid levels by lowering triglycerides
and LDL (“bad”) cholesterol and increasing HDL (“good”)
cholesterol.
Weight loss of 5% to 10% can reduce total blood cholesterol.
The effects of obesity on cardiovascular health can begin in
childhood, which increases the risk of developing CVD as an
adult.
Overweight and obesity increase the risk of illness and death
associated with coronary heart disease.
Obesity is a major risk factor for heart attack, and is now
recognized as such by the American Heart Association.
Cont.

Stroke

Elevated BMI is reported to increase the risk of ischemic stroke
independent of other risk factors including age and systolic blood
pressure.

Abdominal obesity appears to predict the risk of stroke in men.

Obesity and weight gain are risk factors for ischemic and total
stroke in women.

Osteoarthritis (OA)

Obesity is associated with the development of OA of the hand,
hip, back and especially the knee.

At a Body Mass Index (BMI) of > 25, the incidence of OA has
been shown to steadily increase.

Modest weight loss of 10 to 15 pounds is likely to relieve
symptoms and delay disease progression of knee OA.

Sleep Apnea

Obesity, particularly upper body obesity, is the most significant
risk factor for obstructive sleep apnea.

There is a 12 to 30-fold higher incidence of obstructive sleep
apnea among morbidly obese patients compared to the general
population.

Among patients with obstructive sleep apnea, at least 60% to
70% are obese.
Cont.

Cancers

Carpal Tunnel Syndrome (CTS)

Chronic Venous Insufficiency (CVI) & Deep Vein Thrombosis (DVT)



Gallbladder Disease
Gout
abdominal hernias
Cont.


Impaired Respiratory Function
Infertility

Liver Disease

Low Back Pain

Surgical Complications

Daytime Sleepiness
HISTORY
History :
You must take full Hx
 with out forgetting to ask about obesity
cause(s) … ( Etiology )

•
•
•
•
-Energy imbalance
-familial
-Diseases
-Medications
And ask about diseases which arising from
obesity like:
 DM II
 HTN
 CVD
 OA
 Sleep apnea….
& Other diseases


All of the systems that make the body
function are affected by morbid obesity










Cardiovascular System
Digestive System
Endocrine System
Musculoskeletal System
Nervous System
Reproductive System
Respiratory System
Urinary System
Dermatology System (Skin)
Immune System

There are many different presentations of
obese patients…
Some of them are Healthy
 But the others may already have many
complications from obesity.

Examination
Examination:


1st impressions.
Vital signs:








PR
RR
BP
and Temperature
General examination.
Size of thyroid
size of abdominal organs e.g. liver…
Heart and lung sounds.
Evaluation :

Also you must evaluate the patient obesity by
calculating BMI.
BMI =
weight (kg) / [ height (m) ]²
BMI Range
Weight
Classification
Risk of Illness
Less than 18.5 Underweight
Increased
18.5 – 24.9
Ideal weight
Normal
25 – 29.9
Overweight
Increased
30 – 39.9
Obese
High
40 – 50
Morbid obese
Very high
50 Or greater
Super obese
Extremely high
Investigations

Laboratory Data:
Parameter
Normal Range
Blood glucose
Cholesterol
Triglycerides
HDL
LDL
Hemoglobin
Hematocrit
TSH
Cortisole
Serum iron
Uric acid
Hemoglobin A1c*
80-120 mg/dl
< 200 mg/dl
< 150 mg/dl
40 - 60 mg/dl
< 100 mg/dl
13-16 mg/dl
36-44%
0.35-5.50
5-25 am 3-16 pm µg/dl
40-140 mg/dl
(3.5-7.8)
4.8-6.3%
Additional Tests :
 ECG
 x-ray
 U.S

Treatment of obesity
Treatment of obesity comes into
three categories:
1-behavior modification .
{diet and exercise}
2-pharmacotherapy
3-surgical intervention .
National institutes of health guidelines for
treatment of overweight and obesity:
BMI
range
25-26.9
27-29.9
30-34.9
35-39.9
40 or
more
Behavior pharmac Endoscp
mod.
otherapy ic
balloon
Yes*
No
No
Yes*
Yes*
No
Yes
Yes
Yes
Yes
Yes
Yes
yes
Yes
Yes*
* comorbidities present
surgery
No
No
No
No
Yes
Behavior modification:
A multibillion dollar commercial industry
Tow forms of modification :
1- diet
2- exercise
Dietary modification is an effective means of
inducing weight loss.
Dietary modification tow forms:
Low calorie diet (LCD)
Aims for an energy deficit ranging from 500 to
1000 kcal/day
LCD is a low fat diet
LCD Helps losing 0.5 kg/week
That lead to a 10% weight loss over 6 months
Very low calorie diet (VLCD)
VLCD is high protein diet with less fat &no
carbohydrate
Limits energy intake to fewer than 800kcal/day
VLCD helps losing 1-1.5 kg/week
Cont…..
Short term weight loss with VLCD is dramatic
with some people losing up to 20kg in 3 months.
But long term doesn’t differ from LCD
VLCD require physician supervision
Increasing energy expenditure:
exercise is very effective in preventing long
term weight regain.
At least ,doing exercise 3 times /week for
45 minute
Or doing 20 minute exercise each day
Pharmacotherapy:
Currently tow drugs are used
1- sibutramine
2- orlistat

Sibutramine






Appetite suppressant
Mechanism of action is serotonin &
norepinephrine uptake inhibitor
10 mg/day
Side effect :tachycardia, hypertension,
headache, and insomnia
Long term 5%to 10% weight loss
Weight regain happens after stopping the drug
Orlistat






Potent inhibitor of lipase activity
Binds fats
Efficacy of the drug &its side effect increase with
higher fat content in the food
Side effect: fecal leakage , bloating ,and
increase flatulance.
Long term 10% weight loss
120 mg/day 3 times a day
Surgical intervention:
Must be psychologically stable and wiling to
follow postoperative diet instruction
 No endocrine cause for obesity
 Surgical intervention work by decreasing energy
intake
 Most common types
1- gastric banding
2-roux-en-y gastric bypass procedure

Adjustable gastric banding:
Work by restrictive operations
 Creation of a proximal gastric pouch by
inflatable band and placement of an
access port
 45% to 55% EBW over the first two years

Advantages of AGB
Easy applied
 Day surgery
 Done Laparoscopically
 no complications

Disadvantage of AGB:
Esophageal dilatation
 Gastric prolapse
 Band erosion

Roux-en-y gastric bypass
procedure:




Combine restrictive and malabsorptive operation
Most common operative intervention in USA
Work by creation of a small proximal gastric
pouch with roux-en-y gastrojejunostomy
75% to 85% EBW within a couple years
Disadvantage of RNYGB
Anastomotic leak 20%
 Stricture 10%
 Nutritional disturbances
Especially, vitamine B12,iron &calcium
 cholelithiasis
