CHS 412 Lecture 2

Health Education to prevent and control Obesity and its danger

Dr. Ebtisam Fetohy

Objectives of the lecture

At the lecture the students will be able to:

1-Define Obesity

2-List different methods for measurements of obesity and overweight

3-Classify obesity

4-Identify advantages and disadvantages of BMI to assess health risks

5-List Causes of obesity

6-List diseases associated with obesity

Obesity as a public health problemObesity as a public health problemThe rapid rise in the prevalence of obesity in

both rich and poor countries in recent years has been described as an epidemic.

• At the global level, excess body weight is the sixth most important risk factor for ill health.

• Many adverse health outcomes are strongly associated with obesity.

How is obesity measured?How is obesity measured?It is defined as the excessive accumulation of body fat.

-There are a number of ways to measure body fat: There are a number of ways to measure body fat: Measurements that are simple, cheap and Measurements that are simple, cheap and appropriate for routine use include: appropriate for routine use include:

• Waist circumference

• Hip circumference

• Waist-to-hip circumference ratio

• Indices derived from weight and height, e.g. body mass index

• skin fold thickness using calipers (e.g. triceps, scapular)

How is obesity measured?How is obesity measured?• Measurements of body fat that are Measurements of body fat that are

expensive and require special equipment expensive and require special equipment and highly trained personnel include:and highly trained personnel include:

Underwater weighing Bioelectrical impedanceالمعاوقة Computerized topography

Classification of obesity (1) – Classification of obesity (1) – ‘apples’ and ‘pears‘apples’ and ‘pears’’::

1.1. The apple shape: also called “androidThe apple shape: also called “android”, “abdominal” or “central”“central” obesity

• People with high waist-to-hip ratios are "apples",

• Their body fat is distributed mainly on the upper trunk, the chest and abdomen giving the typical ‘apple shape’

• Individuals are mostly male

• A waist-to-hip ratio >1.0 for men and >0.8 for women indicates an increased risk of cardio-cardio-vascular vascular disease and diabetes mellitusdiabetes mellitus

Classification of obesity (1) – Classification of obesity (1) – ‘apples’ and ‘pears’‘apples’ and ‘pears’::

2.2. The pear shapeThe pear shape: also calledalso called “gynaeoid“gynaeoid” or ““peripheralperipheral” obesity obesity

• People with lower waist to hip ratios are "pears“ – • Their body fat is distributed mainly on the lower trunk,

the hips and thighs giving the typical ‘pear shape’. • Individuals are mostly female. • Associated health risks are minimal if any. Obesity can be

classified into two groups on the basis of body fat distribution and the waist-to-hip circumference ratio.

-This simple classification is easily understood by the public and also predicts the risk of obesity-related health problems.

Classification of obesity (2) – Classification of obesity (2) – body mass index (BMI)body mass index (BMI)::

• Classification of obesity (2) – body mass index (BMI) BMI = = weight in kilograms - kg/m2- square of height in meters

Over weight definition 1Over weight definition 1Note: Although overweight is identified by a BMI Although overweight is identified by a BMI

of ≥ 25.0 kg/m2of ≥ 25.0 kg/m2, the risks of obesity-associated diseases, such as:

• Diabetes, • Hypertension and • Dyslipidaemia, increase from a BMI of about increase from a BMI of about

21.0 kg/m2. 21.0 kg/m2.

NIH: A weight and height chart is a useful clinical tool to determine a person’s BMI

Advantages of using BMI to classify obesityAdvantages of using BMI to classify obesity• It is low-coslow-cost and • EasyEasy to use for health professionals for assessing

individuals, it is commonly used to determine desirable body weights and

• It allows people to compare their own weight statuscompare their own weight status to that of the general population

• It correlates well with the amount of body fatcorrelates well with the amount of body fat as measured by more complex techniques

• It predicts dangers associated with obesitypredicts dangers associated with obesity; as BMI increases the risk for diseases increases

• It is a useful screening tooluseful screening tool to use at the population level and,

• Because it is universally accepted, BMI reference data is available for many different populations

Disadvantages of BMIDisadvantages of BMI

BMI: Which of these men is at risk of ill health and why? (a) (b) These men have the same height, weight and BMI, but have different percent body fat BMI calculated as follows: BMI = 28.4 kg/ m2. Although BMI is equally high in both men, it is not known:it is not known:

(a) It is due to lean body mass or(b) It is due to body fat. -This shows that, used alone, a high BMI is not diagnostic of

obesity. BMI also varies with age and sex in those <18 years. These are some of the disadvantages of using BMI to assess health risks.

QuestionsQuestions

Put “true” or “false”:• Obesity is the excessive accumulation of body

fat• Body mass index (BMI) is the most universally

accepted index of obesity • A woman with a BMI of 46.0 is overweight • To calculate the BMI of an individual, we need

the weight, height and body fat distribution • A man with weight 76 kg and height 1.55 m is

obese.

Question 2:Question 2:

A 25 year old male athlete weighs 87.3kg and has a height of 1.75m:

A. Calculate his BMI How would you classify his BMI ?

B. Is the classification of obesity based on BMI reliable for this man and, if not, why?

The global burden of obesityThe global burden of obesity• The USA has the highest obesity rate in the world. • IN American adults, 50m are obese (BMI >30.0) and • 6m have class III obesity (BMI >40.0). • Obesity in adolescents has increased from 5% in 1966 -

1970 to 14% in 1999.

Obesity in adults on the increase - worldwideObesity in adults on the increase - worldwide

• Dramatic increases in obesity in recent years is not confined to the USA.

• Obesity in children living in poorer countries: Obesity in children living in poorer countries Africa & Middle East: 4 year olds

• Latin America and Caribbean: 4-10 year olds • Prevalence of overweight in 10-year old

children in selected countries

The burden of obesity – costly, deadly…The burden of obesity – costly, deadly…::• The financial burden of obesity: WHO data show

that obesity accounts for 5-10% of the total health care budget in several developed countries

• This is probably a low estimate as not all of the cost of management of obesity and its related problems can be calculated

• In 2000, the U.S. spent $117 billion on obesity (9% of the national total health budget)

The burden of obesity – costly, deadly…The burden of obesity – costly, deadly…::• The morbidity and mortality burden of obesity:The morbidity and mortality burden of obesity: Overall,

about 2.5 millions deaths are attributed to overweight/obesity worldwide In the UK, about 30,000 deaths are attributable to obesity.

• Ten times this figure occurs in the USTen times this figure occurs in the US where obesity is the second second greatest preventable cause of death following smoking smoking

• Nearly 70% of cases of cardiovascular disease70% of cases of cardiovascular disease are associated with obesity

• Obesity predisposes to an overall reduction of quality of overall reduction of quality of life andlife and premature death from diet related, chronic non-premature death from diet related, chronic non-communicable diseasescommunicable diseases

People who are obese or overweight also have a People who are obese or overweight also have a lower life expectancylower life expectancy

• A 40-year-old nonsmoking male who is overweight will A 40-year-old nonsmoking male who is overweight will lose 3.1 years of life expectancy; one who is obese will lose lose 3.1 years of life expectancy; one who is obese will lose 5.8 years. 5.8 years.

• A 40-year-old overweight nonsmoking female will lose 3.3 A 40-year-old overweight nonsmoking female will lose 3.3 years of life expectancy; one who is obese will lose 7.1 years of life expectancy; one who is obese will lose 7.1 years. years.

Questions 3:Questions 3:Write “T” or “F”Write “T” or “F”: :

1.1. Obesity is a worldwide public health problem Obesity is a worldwide public health problem

2.2. Obesity is not a major public health problem in Obesity is not a major public health problem in developing nations developing nations

3.3. The highest rate of obesity is found in the U.S.A The highest rate of obesity is found in the U.S.A

4.4. Obesity related problems account for less than Obesity related problems account for less than 5% of healthcare budget in developed countries 5% of healthcare budget in developed countries

5.5. Obesity leads to premature death from diet related Obesity leads to premature death from diet related chronic communicable diseases.chronic communicable diseases.

Calories in and calories out – the imbalanceCalories in and calories out – the imbalance• The energy value of food can be expressed in calories.

Obesity occurs when a person consumes more calories Obesity occurs when a person consumes more calories than his/her body needs.than his/her body needs.

• Excess calories are stored as fat and lead to weight increase. For e.g., consuming 3,500 calories3,500 calories more than the body needs results in a gain of 0.45kg of fat0.45kg of fat.

• The factorsfactors which affect the balance between calories in balance between calories in and calories out differ from one person to anotherand calories out differ from one person to another.

• Obesity is believed to result from a complex interplay of Obesity is believed to result from a complex interplay of the following factors: the following factors:

1. Genetic factors 2. Socio-economic (lifestyle and diet) 3. Cultural factors 4. Psychological and medical factors

Genetic factorsGenetic factors::• We know that obesity tends to run in families,

suggesting a genetic cause. • Although, families also share dietdiet and lifestylelifestyle, both of

which contribute to obesity, research has shown that genetic factors account for as much 80%80% of the link between heredity and obesity.

• Studies in adoptees Studies in adoptees المتبنونالمتبنونand twins strongly and twins strongly support this link:support this link: Adults who were adopted as children have weights closer to their biological parents than to their adoptive parents

• Monozygotic (identical) twinsMonozygotic (identical) twins show a much stronger correlation in body weight than dizygotic (non-than dizygotic (non-identical) twins.identical) twins.

Socio-economic factors and lifestyleSocio-economic factors and lifestyleDiet Apart from our genes, environmental factors

also contribute to the recent surge مفاجئة in زيادةobesity. The following changes in diets across the The following changes in diets across the world play a major role:world play a major role:

• Increase in consumption of energy dense foods – containing animal fats

• Decrease consumption of complex carbohydrates and fibre - coarse grains, fruits

• Increase intake of saltsalt and alcohol

Socio-economic factors and lifestyleSocio-economic factors and lifestyleIn recent years, societies of the western world have enjoyed In recent years, societies of the western world have enjoyed

an over abundance of food – an over abundance of food – • So people feast تمتعon larger portions at low prices. • As this “affluence” اليسرcreeps into the urban centres

of the developing world, we are beginning to see a rise in obesity.

• The growth of the fast food industry has made an abundance of high fat, inexpensive meals widely available, resulting in a shift in stable المستقرة foods from low quality staples (corn) to high quality refined staples (processed rice, wheat).

Cultural factors (1)Cultural factors (1)::• The cultural practice of placing young women in ‘fattening

rooms’ for months before marriage or after childbirth. In fattening تسمين rooms, the daily routine was to:

1.1. Sleep , Sleep ,

2.2. Eat and Eat and

3.3. Grow fatGrow fat. The women spent their time resting like beached whales and gorging التهام on a high-fat, high-calorie diets. This practice has greatly reduced in recent years in south-eastern parts of Nigeria.

• In certain cultures of the world ‘big is beautiful’. Obesity was a sign of wealth and well-being in the past and still is in many parts of Africa.

Cultural factors(2)Cultural factors(2)::• In contrast to many Western cultures where thin is, in

many culture-conscious people in these parts hailed as a sign of good تكور a woman's rotundity ,رحبتhealth, prosperity ازدهار and allure اغراء.

• The Japanese sumo wrestlers The Japanese sumo wrestlers مصارعونمصارعون are well known are well known obese individuals. They achieve their big size from:obese individuals. They achieve their big size from:

• An elaborateمتقن rice- based diet, • Fat-rich stew حساءand • Lots of sleep.

Psychological and medical factorsPsychological and medical factors:/1:/11.1. Psychological factorsPsychological factors are known to influence

eating habits. Many people eat in response to negative emotions, such as anger, sadness or boredom .

2.2. Metabolic and organic factorsMetabolic and organic factors including drug drug therapiestherapies have been associated with obesity as metabolic rate slows down, the tendency to gain weight increases. Slow metabolic rateSlow metabolic rate is found with reduced physical activityreduced physical activity, advancing age, and in females females compared to males

Psychological and medical factorsPsychological and medical factors:/:/ 22

3.3. Certain medical conditionsCertain medical conditions are associated with are associated with obesityobesity: depressiondepression, hypothyroidism, pituitary tumors, cerebral diseasescerebral diseases including infectionsinfections, hydrocephalus, as well as certain chromosomal chromosomal anomaliesanomalies – Down syndrome.

4.4. Drugs that can cause weight gain includeDrugs that can cause weight gain include: corticosteroids, anti-depressant drugsanti-depressant drugs, antipsychotics, oral contraceptiveoral contraceptive and progestagenic compounds, hypoglycemic hypoglycemic agentsagents, insulin, antihistaminesantihistamines,

Question 5:Question 5:

Which of the following factors will increase the risk of obesity in an individual? Write “T” or “F”.:

A. Physical inactivity

B. Consumption of fast foods

C. Psychological depression

D. Normal sized parents

E. Hyperthyroidism

Question 6:Question 6:

• Several factors play a role in the pathogenesis of obesity. What risk factors match the following pictures?: a)? c)? b)?.

Obesity is a disease. /2Obesity is a disease. /2ndnd part part• Associations with obesity are proteanمتقلبة . Medical associations of obesity:Medical associations of obesity:

1. Hypertension and 2. Type II diabetes 3. Coronary artery disease, and 4. Stroke, 5. Cancers and 6. Reproductive abnormalities 7. Psychological complications including eating disorders,8. Respiratory and other complications.

Effects of obesity Effects of obesity

Obesity - a known risk factor for several life-Obesity - a known risk factor for several life-threatening medical conditionsthreatening medical conditions (1) (1) Diabetes Mellitus (DM) ::

• The relation between obesity and type II diabetes (non-insulin dependent diabetes) has been established since the 1970s excess. Fat deposits in Fat deposits in obesity is associated with:obesity is associated with:

1. Insulin resistance,

2. Glucose intolerance and

3. Premature type II diabetes.

(1) (1) Diabetes Mellitus (DM):/2:/2• 90% of patients with type II diabetes have BMI

higher than 2323kg/m2 • The risk of type II DM is greatly increased where The risk of type II DM is greatly increased where

there is:there is: A.A history of early weight gain (childhood

obesity), B.Android obesity (The apple shape)The apple shape), C.Positive family history of DM, and D.Maternal history of gestational DM.

Obesity - a known risk factor for several life-Obesity - a known risk factor for several life-threatening medical conditionsthreatening medical conditions

(2) Coronary artery disease and stroke(2) Coronary artery disease and stroke:• The effect of obesity on cardiac function is thought The effect of obesity on cardiac function is thought

to be due to a combination of:to be due to a combination of:

1. Hypertension,

2. Diabetes mellitus,

3. Dyslipidaemia and

4. Increased fat mass

• The risk increases as BMI values exceed 2121.0 kg/m2. Studies show that heart failure in 14% women and 11% men is due to obesity

(3)Cancers:(3)Cancers:• The risk for cancers is more among the obese

than the non-obese population estimates non-obese population estimates indicate that overweight and inactivity account indicate that overweight and inactivity account for a quarter to a third of cancers of thefor a quarter to a third of cancers of the:

1. Breast,

2. Colon,

3. Endometrium,

4. Kidney and

5. Esophagus

(4)Psychological features of obesity:• In US women obesity increases the risk of being In US women obesity increases the risk of being

diagnosed with:diagnosed with: 1. Major depression by 37% 2. Low self esteem, 3. Anxiety,قلق 4. Depression and 5. Obsessive االستحواذيbehaviors are common among

obese individuals especially women

Obesity and depression are linked closely with two Obesity and depression are linked closely with two eating disorderseating disorders:

A. Night eating syndrome and B. Bingeافراط eating disorder (including bulimiaالنهم

nervosa). These need early recognition and early psychotherapy

Other effects of obesity (2): 1.1. Obesity has serious deleterious effects on quality Obesity has serious deleterious effects on quality

of life.of life.2. There is the social stigma associated with obesity, 20% of obese

people are less likely to marry than their thinner counterparts 3. The annual household income of obese people is nearly $7,000 less

than that of thinner people 4. An obese person is 10% more likely to live a life of poverty

5.5. With obesity there is:With obesity there is: Restricted activity, Exercise intolerance, Pain, Worry, Low self esteem, and Depression

Question 7Question 7

Which of the following are recognized Which of the following are recognized associations of obesity. Write “T” or “F”associations of obesity. Write “T” or “F”: :

a) Hypertension

b) Type 1 diabetes

c) Osteoarthritis

d) Ovarian cancers

e) Coronary heart disease

What is childhood obesity ?What is childhood obesity ?/1/1

Defining childhood obesity : Obesity in childhood has reached epidemic levels.

• In the US, it is the most common nutritional disorder in children.

• Developing countries are also affected as the prevalence rises among children of urban dwellers who emulate يحاكيthe ‘affluent western lifestyle’

What is childhood obesity ?What is childhood obesity ?/2/2As in adults, the WHO uses the body mass index (BMI) as As in adults, the WHO uses the body mass index (BMI) as

the standard definition of obesity in children.the standard definition of obesity in children. BMI is calculated with the same formula for children

and adults, but the results are interpreted differently:but the results are interpreted differently: BMI for children, also referred to as BMI-for-age, is

gender and age specific BMI changes dramatically with age in children as body

fat changes with growth, and between girls and boys with maturity

BMI-for-age, gender specific growth charts used for children and teens 2 – 20 years of age.

Defining childhood obesity:Defining childhood obesity:• BMI-for-Age is used for children and teens because

of their rate of growth and development.• It is a useful tool because:It is a useful tool because:

A. BMI-for-age in children and adolescents compares well to laboratory measures of body fat

B. BMI-for-age can be used to track تعقيبbody size throughout life

In children, obesity is defined asIn children, obesity is defined as a BMI greater than the 95th95th percentile for age

o while overweight overweight is a BMI greater than the 85th85th percentile for age till the 95th95th percentile for age

Risk factors for childhood obesity/1Risk factors for childhood obesity/1::

1. Obesity in one or both parents

2. Infants of diabetic mothers

3. Children from single parent families

4. Families with fewer children and

5. Higher birth weight

Risk factors for childhood obesity/2Risk factors for childhood obesity/2::

6. Rapid growth during infancy are associated with an increased prevalence of obesity

7. Formula feeding during infancy

(Breast feeding in women who didn't smoke (Breast feeding in women who didn't smoke during pregnancy [during pregnancy [but not in women who but not in women who smoked during pregnancy]smoked during pregnancy] was significantly was significantly associated with a reduced risk of obesity)associated with a reduced risk of obesity)

Risk factors for childhood obesityRisk factors for childhood obesity• Sedentary lifestyleSedentary lifestyle – increase TV viewing,

computer gamescomputer games, car rides, including a reduction in reduction in number of mandatory physical education classesnumber of mandatory physical education classes in schools especially in the US

• Increase consumptionIncrease consumption of sugar sweetened drinks, sodasoda, snacks, energy dense fast foodenergy dense fast food in large portions.

The relationship between childhood and adult The relationship between childhood and adult obesityobesity

• Born in the 60’s with a birth weight of 2.7kg (normal weight), she quickly became plump plump in infancy. Neither parent was overweight (father 72.6kg and1.72m; mother 50.8kg and 1.52m) From the age of 7, she was significantly From the age of 7, she was significantly heavier than her peersheavier than her peers. In her early teens, she “weighed 88.9kg” and was advised by her pediatrician to join a slimming club. The weight gain persisted till adulthoodThe weight gain persisted till adulthood. She is currently on nine different medications for obesity related problems

• bridesmaid وصفat wedding-Married at age 40 weight - 178 kg, Height - 1.65m, BMIBMI = 66 kg/m2

The relationship between childhood and adult The relationship between childhood and adult obesityobesity

• Now that you have read this story, list 5 obesity-associated problems that may occur in this woman. Mrs. S. actually actually developed: developed:

1. hypertension 2. type II diabetes 3. hypothyroidism 4. menorrhagia

5. recurrent cellulitis Other Other possible problems include possible problems include :

6. osteoarthritis7. stroke 8. metabolic syndrome 9. coronary heart disease10.menstrual disorders 11.psychological disorders 12.cancers – ovarianovarian, endometrial,

breast, cervical, prostateprostate

Question 8:Question 8:• The following are statements about childhood obesity.

Write “T” or “F”.: a) Obesity is not a problem in children b) BMI-for-age is used for children and teens because of

their rate of growth and development c) The use of BMI to define obesity doesn’t depend on

genderd) BMI-for-age in children and adolescents compares well to

laboratory measures of body fat e) The longer a child remains obese beyond age 3 years, the

more likely that the obesity will persist into adulthood

Management of obesity/1Management of obesity/1::Effective management of obesity requires long-term Effective management of obesity requires long-term

strategies and an integrated, multi-disciplinary approach strategies and an integrated, multi-disciplinary approach that includes:that includes:

1. Community-based support for behavioral modification including: diediet and exercise.exercise.

2. Research over the last decade indicates that a 5-10% 5-10% reduction in body weightreduction in body weight is sufficient to significantly improve medical conditions associated with obesity, improve medical conditions associated with obesity, such as: such as:

HypertensionHypertension, Diabetes mellitus, and Elevated cholesterol levels.

Management of obesity/2Management of obesity/2::

Currently there is lack of evidence of effective Currently there is lack of evidence of effective programmes for integrated management of programmes for integrated management of obesity. But the following management options obesity. But the following management options for the management of obesity exist:for the management of obesity exist:

A. Dietary modification

B. Behavioral modification

C. Physical activity

D. Pharmacotherapy

E. Surgery

Management of obesity/3Management of obesity/3::

As always, “prevention is better than cure”.As always, “prevention is better than cure”. 1. Recently the UK government has set a target

to halt يوقف the rise in obesity in children aged ≤11 by 2020.

2. Strategies for the prevention of childhood and adult obesity may need to address factors during or before infancy that are related to infant growth.

Management options (1):• Dietary modification the most common and Dietary modification the most common and

conservative treatment for obesity utilizes:conservative treatment for obesity utilizes:

1. A nutritionally balanced diet,

2. Low calorie diet,

3. Diet mustmust include more fruitsfruits and vegetablesvegetables, nutsnuts, whole grains and excludeexclude fattyfatty and sugarysugary foods

4. Weight-loss programs recommend diets consisting of 1,200 to 1,500 calories per day, calories per day,

The calories usually in the following proportions:The calories usually in the following proportions: A. 60 % carbohydrate,

B. 30 % fat, and

C. 10 % protein. Individuals must be carefully screened and medically medically

supervisedsupervised while on the diet (the degree of weight loss being dependent on individuals ability to adhere to dietary recommendations)

Studies have shown that meal replacements Studies have shown that meal replacements بدائلبدائل are often more effective than very low calories diets, resulting in an increase in the amount of initial weight loss and enabling dieters to maintain their weight loss

Management options (2) Management options (2) PharmacotherapyPharmacotherapy:• It is recommended that anti-obesity drugs be It is recommended that anti-obesity drugs be

used only used only in:

1. Individuals aged 18-75yrs with a BMI of 30kg/m2 or more.

2. Individuals with a BMI of ≥27kg/m2 with existing risk factors such as diabetes, cardiac disease, obstructive sleep apnea or hypertension.

3. Individuals with a BMI of >30kg/m2, in whom at least 3 months of managed care (supervised supervised dietdiet, exerciseexercise, and behavior modificationbehavior modification) fails to lead to significant reduction in weight.

Two drugs have been licensed for use in the Two drugs have been licensed for use in the treatment of obesity:treatment of obesity:

• Orlistat Orlistat - prevents fat digestion and absorption by binding to gastrointestinal lipases; useful for those with a high intake of fat.

• SibutramineSibutramine - reduces appetite and increases thermogenesis; recommended for those who cannot control their appetite.

These drugs should not be used as sole therapy These drugs should not be used as sole therapy for obesity. for obesity.

Their use requires strict regular monitoring and Their use requires strict regular monitoring and must be discontinued if must be discontinued if

A.A. weight loss isweight loss is <5% after 12 weeks of use or

B. weight gain recurs while on the drugs

• Anti-obesity drug treatment should not be used beyond a yeara year and

• Never beyond two yearstwo years as few studies have examined the consequences of their long-term use

• Gradual reversal of weight loss is known to occur on stopping pharmacotherapy

Question 9:Question 9:Mark the following statements as either True or False:A. Obesity management requires an integrated multi-

disciplinary approach B. Regular exercise is the single best predictor for achieving

long-term weight control C. Diet must exclude more fruit and vegetables, nuts, whole

grains and include fatty and sugary foods D. The criteria for use of pharmacotherapy is a BMI > 20

kg/m2 with persistent co-morbidity E. A 5-10% reduction in body weight is sufficient to

significantly improve medical conditions associated with obesity

What Have I Learnt about Obesity? (1)What Have I Learnt about Obesity? (1)::• Obesity is the excessive accumulation of body fat, best

defined by the Body Mass Index (or Quetelet's Index). • BMI is the universal and convenient measure of obesity. • It is calculated as weight divided by height squared (kg/m2). • The BMI-for-age is used to assess obesity in children. • In adults (age 18years and > 30 kg/m2,), obesity is

defined by a BMI, while of overweight by a BMI between 25 and 29.9 kg/m2.

• A child with a BMI-for-age >95th percentile is obese while one with a BMI-for-age >85th percentile is overweight.

• The longer a child remains obese beyond age 3 yearsage 3 years, the more likely that the obesity will persist into adulthoodpersist into adulthood. 30%30% of obese childrenobese children are also obese as adults. 70% obese70% obese adolescentsadolescents end up as obese adultsobese adults.

• Obesity is believed to result from a complex interplay of several factors; geneticgenetic, environmental (lifestylelifestyle and dietarydietary), cultural, socio-economicsocio-economic, psychological and medicalmedical conditions.

• Obesity is a known risk factor for several life-threatening, chronic medical and metabolic conditions: hypertensionhypertension, coronary artery disease, strokestroke, type II diabetes, cancerscancers.

• A 5 - 10% reduction5 - 10% reduction in body weight has been shown to significantly improve medical conditionsmedical conditions associated with obesity.

What Have I Learnt about Obesity? (2)What Have I Learnt about Obesity? (2)::• Obesity has reached epidemic proportions in several

developed countries of the world and is also creeping up in urban cities of the underdeveloped world.

• Globally, there are more than 1.1 billion overweight adults, and at least 312 million of them are clinically obese.

• 10% of all children worldwide are either overweight or obese, while 17.6 million children under the <5y are estimated to be overweight.

• Rapid urbanization and economic development have led to changing lifestyles and diets across the world which promote excessive weight gain.

• An increasing incidence of obesity is also being seen in the poor, developing countries of the world

• Increase body weight is now the sixthsixth most important risk factor contributing to the overall burden of disease worldwide