obesity jaber amin

Dr. Jaber Amin Manasia5th year medical student

Presented to Dr. Panayiota Vryonidou Al- Louzi

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Define obesity

Describe health consequences of obesityEvaluation & Management Obesity in adultsObesity in children Obesity in elderly

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An excessive amount of body fat, which increases the risk of medical illness and premature death.

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Worldwide obesity has nearly doubled since 1980.

In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.

35% of adults aged 20 and over were overweight in 2008, and 11% were obese.

65% of the world's population live in countries where overweight and obesity kills more people than underweight.

More than 40 million children under the age of five were overweight in 2011.

Obesity is preventable.Dr. Jaber Manasia 4

In Jordan , 64% of both men and women are overweight.

30% of Jordanians are obese.

WHO website

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WHO Classification BMI Risk of Death

Underweight Below 18.5 Low

Healthy weight 18.5-24.9 Average

Overweight (grade 1 obesity)

25.0-29.9 Mild increase

Obese (grade 2 obesity) 30.0-39.0 Moderate/severe

Morbid/severe obesity(grade 3)

40.0 and above

Very severe

World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, 1997 [3]

• BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.

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Abdominal obesity

•also known as belly fat or clinically as central obesity, is excessive abdominal fat around the stomach and abdomen.

•There is a strong correlation between central obesity and cardiovascular disease.

•Abdominal obesity has been linked to Alzheimer's Disease as well as other metabolic and vascular diseases.

•Visceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes.

Women

>88 cm (80cm) = Increased risk

Men

>102 cm (90cm) = Increased risk

Lean MEJ et al. Lancet; 1998; 351:853-6

cm

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Abdominal obesity, given as waist circumference*†

Men >102 cm (>40 in)

Women >88 cm (>35 in)

Triglycerides≥150 mg/dL

HDL cholesterol

Men <40 mg/dL

Women <50 mg/dL

Blood pressure≥130/≥85 mm Hg

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

an increased intake of energy-dense foods that are high in fat; andan increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.

Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing and education.


Raised BMI is a major risk factor for noncommunicable diseases such as:

cardiovascular diseases (mainly heart disease and stroke), which were the leading cause of death in 2008;diabetes;musculoskeletal disorders (especially osteoarthritis - a highly disabling degenerative disease of the joints);some cancers (endometrial, breast, and colon).


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Common presenting problems include type 2 diabetes mellitus, hypertension, musculoskeletal complaints (particularly back, knee, hip, or foot pain), and breathing difficulties.

It is important to identify the excess weight or obesity as a problem, even if that is not the presenting complaint.

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Physical Examination :To rule out signs of secondary causes of

obesity:o Cushing syndromeo hypothyroidism oro other pituitary abnormalities.Measurement of the waist circumference is

also important as noted above.

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Many treatment modalities are available to foster weight loss.

it is crucial to remember to set goals with the patient.

The best practice is to prevent overweight and obesity from occurring by instilling in patients the healthy habits of good nutrition and avoiding a sedentary lifestyle.

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There are critical periods in life when weight gain is more likely, these include after childbirth and menopause, so if patients can learn to anticipate these changes, it is possible that they can institute appropriate lifestyle changes to prevent weight gain.


The following modalities are used in the treatment of obesity :

Counseling and behavioral interventionsMedication Surgery


The National Heart, Lung, and Blood Institute (NHLBI) practice guideline suggests an initial weight loss of 10% of body weight among 6 months ; however, this may not always be practical or achievable . and even a 10-lb weight loss may ameliorate related conditions, such as hypertension and elevated blood glucose.

Additional goals should include the maintenance of weight loss over time, and prevention of further weight gain.


Modification of other cardiovascular risk factors, such as smoking, hypertension, elevated cholesterol, and physical inactivity, and recognition and treatment of diabetes deserve equal emphasis in the management of overweight or obese patients.

Note that as patients quit smoking, they are likely to gain weight, so anticipatory guidance about this is essential.

Patients should not expect to be able to quit smoking and lose weight at the same time.




A healthy eating plan gives your body the nutrients it needs every day. It has enough calories for good health, but not so many that you gain weight.

A healthy eating plan is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar. Following a healthy eating plan will lower your risk for heart disease and other conditions.


Healthy foods include:Fat-free and low-fat dairy products, such as low-fat yogurt, cheese, and milk.Protein foods, such as lean meat, fish, poultry without skin, beans, and peas.Whole-grain foods, such as whole-wheat bread, oatmeal, and brown rice. Other grain foods include pasta, cereal, bagels, bread, tortillas, couscous, and crackers.Fruits, which can be fresh, canned, frozen, or dried.Vegetables, which can be fresh, canned (without salt), frozen, or dried.

Canola and olive oils, and soft margarines made from these oils, are heart healthy. However, you should use them in small amounts because they're high in calories.




Weight-loss medicines approved by the Food and Drug Administration (FDA) might be an option for some people.

If you're not successful at losing 1 pound a week after 6 months of using lifestyle changes, medicines may help. You should only use medicines as part of a program that includes diet, physical activity, and behavioral changes.

Weight-loss medicines might be suitable for adults who are obese (a BMI of 30 or greater). People who have BMIs of 27 or greater, and who are at risk for heart disease and other health conditions, also may benefit from weight-loss medicines.


Sibutramine (Meridia®)As of October 2010, the weight-loss medicine

sibutramine (Meridia®) was taken off the market in the United States. Research showed that the medicine may raise the risk of heart attack and stroke.



Table 18.11 Drugs Commonly Used for Weight Loss

Drug DoseFDA Approval Action Adverse Effects

Sibutramine (Meridia)

5, 10, 15 mg 10 mg orally daily to start, may be increased to 15 mg or decreased to 5 mg

Long-term use (controlled substance C-IV)

Norepinephrine, dopamine, and serotonin reuptake inhibitor

Increase in heart rate and blood pressure; drug interactions with CNS active drugs, including MAOIs and seratonergic medications

Orlistat (Xenical)

120 mg120 mg orally three times daily before fat-containing meals

Long-term use

Inhibits pancreatic lipase, decreases fat absorption

Decrease in absorption of fat-soluble vitamins; soft stools and anal leakage

Phentermine (Adipex-P, Fastin, Oby-trim, Pro-fast, Zantryl)

8, 15, 18.75, 30, 37.5 mg8 mg three times daily 30 minutes before meals, or 15–37.5 mg daily before breakfast

Short-term use (controlled substance C-IV)

Appetite suppressant

Abuse, hypertension, tachycardia, restlessness, insomnia

Dietylpropion (Tenuate, Tenuate Dospan, generic available)

25 mg, 75 mg SR25 mg three times daily, 1 hour before meals, or 75 mg SR once daily in the midmorning

Short-term use (controlled substance C-IV)

Appetite suppressant

Pulmonary hypertension, arrhythmias, psychosis, dry mouth, restlessness

CNS, central nervous system; FDA, US Food and Drug Administration; MAOIs, monoamine oxidase inhibitors.

A recent meta-analysis demonstrated that such medications can lead to a weight loss of about 5 kg after 1 year, with little evidence for long-term sustained weight loss.

A general guideline is that if a patient taking a weight loss medication has not lost at least 2 kg after 4 weeks, the medication should be discontinued


Surgical procedures for weight loss should be reserved for patients in whom medical weight loss treatment has failed, and who are suffering from complications of extreme obesity.

Bariatric surgery can be considered an option for patients with :

• BMI >= 40 kg/m2• BMI >= 35 kg/m2, if cardiovascular risk

factors are present.


Available procedures include : • placing a restrictive band around the stomach

to reduce the capacity (gastric banding). • ligating off part of the stomach (gastroplasty) • bypassing the stomach altogether (gastric

bypass).

Gastric bypass has been shown to be more effective than gastric banding for weight loss and requires fewer surgeries for revision, but has more side effects.



Also known as insulin resistance syndrome or “Syndrome X.”

characterized by abdominal obesity, dyslipidemia, elevated blood pressure, and impaired fasting glucose.

Represents a compilation of traits associated with insulin resistance and an ↑ risk of type 2 DM.


Guidelines from the 2001 National Cholesterol Education Program (Adult Treatment Panel [ATP] III) suggest that the clinical identification of the metabolic syndrome should be based upon the presence of any three of the following traits:

Abdominal obesity (waist circumference > 102 cm in men, > 88 cm in women).

TG ≥ 150 mg/dL.HDL < 40 mg/dL in men and < 50 mg/dL in

women.BP ≥ 130/85.Fasting glucose ≥ 110 mg/dL.


TREATMENT :Directed toward preventing the development

of type 2 DM and coronary vascular disease. Includes lifestyle modifications (diet, weight loss, exercise) and even treatment of insulin resistance with medications.


Through the last decades, the average weights of children have increased.

In 2011, more than 40 million children under the age of five were overweight.

According to NHANES 2009–2010, about 1 in 6 American children ages 2–19 are obese. The survey also suggests that overweight and obesity are having a greater effect on minority groups, including Blacks and Hispanics.


The definition of overweight and obesity in children is based on comparison to children of the same age and sex as follows:


BMI-for-Age Percentile Less than 5th percentile Underweight5th percentile to less than the 85th percentile Healthy weight85th percentile to less than the 95th percentile

Overweight

95th percentile or greater Obese



The United States Preventive Services Task Force (USPSTF) recommends that clinicians screen children age 6–18 years for overweight and obesity and offer them comprehensive behavioral intervention to improve weight status.


Appropiate, weight specific questions include those about diet, activity level, and hours of television viewing, breast versus formula feeding as an infant, as well as presence of family history of obesity, and conditions frequently comorbid with obesity, such as type 2 diabetes, hypertension, and lipid disorders.


There is a long-standing body of evidence supporting the theory that consumption of sweet drinks (fruit juices and soft drinks) is associated with overweight in children. However, a recent publication on the study called Project Eating Among Teens (Project EAT) did not show any association between sugar-sweetened beverages, juice consumption, and weight gain among teenagers over a 5-year period.


measurement of waist circumference is not helpful in screening or diagnosis.

look for secondary causes of obesity (for example, purple striae may suggest hypercortisolism)

Fasting lipid\glucose profiles in presence of family hx.

In a child with normal growth in stature, it is unlikely that overweight or obesity is caused by an underlying metabolic or genetic form of overweight .


Overweight children with the highest risk for adverse health outcome include those with current weight related comorbidities, high risk of developing weight-related comorbidities in the future, or significant negative psychosocial ramifications of their overweight status.



It is important to note that when older adults lose weight, a relatively high percentage

of the weight lost is lean body mass.The BMR decreases with age, and this may

lead to weight gain despite consistency in diet and exercise patterns. In spite of this, the trend is for weight to decrease in older age.

Peak weights for men occur on average at 55 years of age and for women at 65 years.


Generally, its similar to adult guidelines,which consider water intake, increased calcium, and selected vitamin supplements.

The study also recommended weight loss, the improved dietary content and physical activity seemed as important as caloric reduction.


Should not compromise nutritional status, meet nutritional requirements, and contribute to a healthy, sustained declined in weight

Should result in small changes and focus on reduction in fat intake Increase HDL, decrease cholesterol, and

triglycerides Better functioning in patients with OA Decrease glucose intolerance

Should not be a low carbohydrate diet, protein liquid diet, or a high fat diet

Weight loss programs for older adults should focus on maintaining adequate intake of essential nutrients, while reducing caloric intake by controlling dietary fat intake

The DASH (Dietary Approaches to Stop Hypertension) diet is an option for older adults Rich in fruits/vegetables High in lean meats, poultry, and fish Low fat diary products Whole-grain breads and cereals At least six 8-oz glasses of fluid

Older adults are encouraged to seek help of nutrition professionals such as registered dietitians for advice on how to modify their diets

http://www.nhlbi.nih.govhttp://www.ncbi.nlm.nih.govhttp://www.who.int

Essential of Family Medicine 2012

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Health & Medicine

obesity jaber amin