Transcript What is Obesity? Should we be concerned?

WHAT IS OBESITY?
WHY SHOULD YOU BE
CONCERNED?
OBESITY
• TOO MUCH adipose or FAT mass
• Increased weight is due to excess fat,
not due to excess LEAN mass or
muscles
2004 NNHeS: 23.4% Filipinos (BMI > 25)
What causes of Obesity?
• It is a complex disorder involving chronic
excess of food intake (INPUT) relative to
the level of energy spent (OUTPUT)
Energy intake
Energy output
Energy Imbalance
Food Intake
Energy Expenditure
Contributors to obesity:
• Genetic/ Familial
• Hormonal abnormalities
• Abnormal chemistry in the
body
• Cultural factors
• Psychosocial factors
Nature of Obesity
• Inheritance may influence body
weight/ mass
• Environment: key role (nurturing
patterns)
– Lifestyle patterns
• Too much energy-dense food (high fat
diet or simple carbohydrate-rich food)
• Decreased opportunities and motivation
for physical activity (escalators,
elevators, etc)
• Unhealthy diet
• Physical inactivity
BODY MEASUREMENTS
• Body Mass Index
– Weight (kg) / Height (m2)
– [Weight (lbs.) / Height (in2)] x 703
• WAIST circumference
• Waist to Hip Ratio
• Skin-fold thickness
• Underwater weighing
• CT scan/ MRI
BODY MEASUREMENTS
Disease Risk*
Classification
BMI kg/m2
WAIST CIRCUMFERENCE
<102 cm (men) >102 cm
<88 cm (women) >88 cm
Underweight
<18.5
Normal range
18.5 – 24.9
Overweight
25.0 – 29.9
Increased
High
Obesity (Class I)
30.0 – 34.9
High
Very high
Obesity (Class II)
35.0 – 39.9
Very high
Very high
Extreme Obesity
(Class III)
>40.0
Extremely
high
Extremely
high
WHY is it bad to
become OBESE?
EFFECTS ON HEALTH
• Obesity has major bad effects on the
body
• Up to twelve-fold increase in death
• Related to increased fat within the
abdomen/ tummy or visceral fat
• Effect of obesity on different parts of the
body can vary from one person to
another
COMPLICATIONS OF OBESITY
• Heart disease
• Type 2 diabetes
mellitus
• Hypertension
• Stroke
• Certain types of
cancer (endometrial,
breast, prostate,
colon)
• Dyslipidemia
• Gallbladder disease
• Sleep apnea and
other respiratory
problems
• Reduced fertility
• Osteoarthritis
• Increase in all-cause
mortality
• Emotional distress
• Discrimination
• Social stigmatization
LUNG DISEASE
• EFFECTS:
– decreased chest wall movement
– difficulty of breathing
• Obstructive Sleep Apnea
“Pickwickian”
REPRODUCTION
• Difficulty in having a baby/ infertility
• Higher risk of cancer
GASTROINTESTINAL SYSTEM
• Gallstones: cholesterol stones
• Higher mortality from CANCER of
the esophagus, colon, rectum,
pancreas, liver, gall bladder, bile
ducts
BONES, JOINT & SKIN
• Increased traumatic
osteoarthritis
• Gout
• Varicose veins
OBESITY & DIABETES
TYPE 2
• High blood sugar due to the effect of
lack of Insulin
• OBESITY is a major risk factor: 80%
of patients who are obese have
diabetes
• Modest weight loss improves insulin
sensitivity and glucose control
HEART DISEASE
• OBESITY can lead to heart disease
• Among Asians, a BMI as low as 23
kg/m2 increases risk for heart disease
and Diabetes
• Abdominal obesity is linked to high fats
in the blood
THE METABOLIC SYNDROME
HIGH BLOOD PRESSURE
DIABETES
HIGH CHOLESTEROL
The metabolic syndrome is a silent
killer
Brought about
by OBESITY
The metabolic syndrome is a silent
killer: patients need effective
treatment
• Affects nearly 1 in 5 men and 1 in 4
women and is increasing1
• Two times as likely to die from HEART
DISEASE2
• Risk of heart attack and stroke is threefold
HEALTH IMPLICATIONS
In children and adolescents:
• Potential adverse psychologic and emotional
consequences
– Social stigmatization
– Precipitation of eating disorders
• Weight loss does not impair linear growth and
normal development
GOALS
• Body weight reduction by 5 to 10%
from baseline over a 6-month period
to achieve a healthy weight
• Weight reduction of 1 to 2 lbs per
week for six months is physiologic
and healthy
DIETARY THERAPY
• Reduction in the total amount of food
intake for overweight and obese patients
is the cornerstone of treatment.
• Fat reduction is a practical way to
reduce calories
• Reducing dietary fat alone without
reducing total amount of food intake is
not sufficient
• There is no scientific evidence in clinical
trials supporting fad diets.
PHYSICAL ACTIVITY
• Exercise contributes modestly to
weight loss
• May decrease abdominal fat
• Increases fitness of the heart
• May help maintain weight loss
EXERCISE & SPORTS
EXERCISE & SPORTS
EXERCISE & SPORTS
PHYSICAL ACTIVITY
• Should be an integral part of weight loss
therapy and weight maintenance
• Encourage moderate levels of activity for
30 to 40 min/day, 3 to 5 days/week
• Set a long term goal
– Accumulate at least 30 minutes of
moderate intensity physical activity on
most, preferably all days of the week
BEHAVIORAL THERAPY
• Useful adjunct to diet and physical
activity
• Behavior strategies to promote diet
and exercise should be used
routinely
• Monitor situations that lead to
excessive eating
MEDICINES
• Lifestyle therapy should be considered
before the use of pills or Weight loss
drugs . But it may be used as part of a
comprehensive weight loss program
• ONLY medicines prescribed by doctors
based on verified evidences should be
taken
MEDICINES
• Avoid use of drugs without
accompanying lifestyle modifications
• Assess drug safety and efficacy
continually
• Discontinue use
– if the drug is ineffective in
weight loss or weight maintenance
– Serious adverse events
SURGERY
• Option in carefully selected patients:
NIH
– Clinically severe obesity
• BMI  40 kg/m2
• BMI  35 kg/m2 with comorbid conditions
–
–
–
–
When less invasive methods have failed
at eligible weight for 3 – 5 years
can tolerate surgery
absence of alcoholism, psychiatric illness,
addiction
– Clearance by a psychiatrist
The Philippine College of Physicians wishes to acknowledge
the following for their invaluable efforts in the preparation
of this module
Aimee Andag-Silva, MD
Rosa Allyn G. Sy, MD
Committee on Advocacy & Public
Relations
Philippine Society of Endocrinology and
Metabolism