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Obesity & Metabolic syndrome

Obesity is defined as an abnormal growth of the adipose tissue and or enlargement of fat cell size (hypertrophic obesity) or increase in fat cell number (hyperplastic obesity).
Obesity is often expressed in terms of body mass index (BMI)

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Obesity & Metabolic syndrome

  1. 1. OBESIT Y & METABOLIC SYNDROME D R . A N I M E S H G U P TA M D , F D M , F A G E A S S O C I AT E P R O F E S S O R D E P T. O F C O M M U N I T Y M E D I C I N E , N M C H , S A S A R A M
  2. 2. INTRODUCTION • Obesity is defined as an abnormal growth of the adipose tissue an or • enlargement of fat cell size (hypertrophic obesity) • increase in fat cell number (hyperplastic obesity) • Obesity is often expressed in terms of body mass index (BMI) 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 2
  3. 3. OBESITY – CUT OFF VALUE (Z SCORES/ WHO GROWTH REFERENCE) • Children under 5 years of age – Overweight : weight-for-height greater than 2 SD – Obesity : weight-for-height greater than 3 SD • Children aged between 5–19 years – Overweight : BMI-for-age greater than 1 SD – Obesity : BMI-for-age greater than 2 SD 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 3
  4. 4. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 4
  5. 5. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 5
  6. 6. PATHOPHYSIOLOGY OF OBESITY • The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. – Increased intake of energy-dense foods that are high in fat and sugar – Increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 6
  7. 7. EPIDEMIOLOGICAL DETERMINANTS 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 7
  8. 8. EPIDEMIOLOGICAL DETERMINANTS... • Age – Any age group. – Increases with age. – Infants with excessive weight gain have an increased incidence of obesity in late life. – This causes hyperplastic obesity in adults which is extremely difficult to treat with conventional methods 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 8
  9. 9. EPIDEMIOLOGICAL DETERMINANTS... • Sex: – Women have higher rate of obesity than men. – In Framingham, USA study, men found again weight between 29-35 years of age, while women gain mostly between 45-49 years of age. • Genetic factors: – Twin studies have shown close correlation • Physical inactivity • Socioeconomic status: – inverse relationship 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 9
  10. 10. EPIDEMIOLOGICAL DETERMINANTS... • Eating habits – Composition of the diet. – Periodicity. – Amount of energy • Psychosocial factors – Emotional disturbances. – Overeating is a symptom of Depression, anxiety, frustration and loneliness. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 10
  11. 11. EPIDEMIOLOGICAL DETERMINANTS... • Familial tendency – Runs in families. • Endocrine causes – Cushing syndrome, growth hormone deficiency. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 11
  12. 12. EPIDEMIOLOGICAL DETERMINANTS... • Alcohol – Relationship between alcohol consumption and adiposity was generally positive for men and negative for women. • Drugs – Corticosteroid, contraceptives, beta blockers etc 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 12
  13. 13. HEALTH CONSEQUENCES/ HAZARDS • Cardiovascular diseases (mainly heart disease and stroke) • Diabetes • Musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative disease of the joints); • Cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon). 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 13
  14. 14. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 14
  15. 15. FAT DISTRIBUTION 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 15
  16. 16. ASSESSMENT OF OBESITY • Body Weight • SkinfoldThickness • Waist Circumference • Waist : Hip Ratio • Others – Total body water, total body potassium and body density The most widely used criteria for assessment of obesity includes 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 18
  17. 17. BODY WEIGHT • Widely used index but its not an accurate measure of excess fat. • In epidemiological studies, Cut off point for overweight and obesity are +2SD and +3 SD from the median weight for height respectively 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 19
  18. 18. INDICATORS FOR ADULTS SUCH AS • Body Mass Index ( Quetelet’s Index) = Wt.(kg) / Ht.(m)2 • Ponderal Index = Height (cm) / Cube root of bodyweight (kg) • Brocca Index = Height (cm) – (minus) 100 • Corpulence index = Actual weight / Desirable weight 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 20
  19. 19. BMI (KG/M2) VALUES Grade SEAR WHO Underweight <18.5 <18.5 Normal range 18.5-22.9 18.5 – 24.9 Overweight / Pre Obese 23.0 – 24.9 25.0 – 29.9 Obese class I 25-29.9 30.0 – 34.9 Obese class II ≥30 35.0 – 39.9 Obese class II - > 40.0 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 21
  20. 20. SKINFOLD THICKNESS • Rapid and non-invasive method for assessing body fat. • Harpenden skin calliper • Measurement taken at 4 sites – mid-triceps, biceps, subscapular, suprailiac region. • Sum of the measurements should be less than 40 mm in boys and 50 mm in girls. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 22
  21. 21. WAIST CIRCUMFERENCE & WAIST:HIP RATIO • Waist circumference is measured at the midpoint between the lower border of the rib cage and iliac crest. • Convenient and simple measurement. • Waist circumference = 90 cm (men) & 80 cm (women) – Indians/ SEAR [Globally 102/88] • WHR = < 0.9 (men) & < 0.8 (women) 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 23
  22. 22. RELATIVE RISK OF HEALTH PROBLEM ASSOCIATED WITH OBESITY Greatly increased Moderately increased Slightly increased Type 2 diabetes CHD Cancer (breast cancer in post- menopausal women, endometrial cancer, colon cancer) Gall bladder disease Hypertension Polycystic ovary syndrome Dyslipidaemia Osteoarthritis (knees) Impaired fertility Insulin resistance Hyperuricaemia and gout Low back pain due to obesity Breathlessness Increased risk of anesthesia complications. Sleep apnea Fetal defects associated with maternal obesity. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 24
  23. 23. PREVENTION & CONTROL Weight control • Dietary Changes – Proportion of energy dense foods such as simple carbohydrates and fats should be reduced. – Fibre content in the diet should be increased through the consumption of common un-refined foods. – Adequate levels of essential nutrients in the low energy diets should be ensured. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 25
  24. 24. PREVENTION & CONTROL… • Increased physical activity – Regular physical exercise • Drug – ORLISTAT – currently licenced for long-term use. – Sibutramine(increased cardiovascular events) and rimonabant (psychiatric side-effects) in recent years - STOPPED 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 26
  25. 25. ORLISTAT • Primary function is preventing the absorption of fats from the human diet, thereby reducing caloric intake. • It inhibits pancreatic and gastric lipases (an enzyme that breaks down triglycerides in the intestine) and thereby decreases the hydrolysis of ingested triglycerides, reducing the dietary fat absorption by approximately 30%. • The adverse effects include loose stools, oily spotting, faecal urgency, flatus and the potential for malabsorption of fat soluble vitamins. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 27
  26. 26. SURGERY • Bariatric Surgery – The most effective long term treatment for obesity and is only anti-obesity intervention that has been associated with reduced mortality. – It is usually reserved for those with severe obesity (BMI >40kg/m2) or those with BMI >35kg/m 2 and significant complications such as type2 diabetes or obstructive sleep apnoea. 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 28
  27. 27. METABOLIC SYNDROME • It is a cluster of metabolic disorders that occur together, increasing the risk of heart disease, stroke and type 2 diabetes. • It is a multifactorial disease with multiple risk factors that arises from insulin resistance accompanying abnormal adipose deposition and function. • It is also known as syndrome X or insulin resistance syndrome. • Conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol and triglyceride levels 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 29
  28. 28. CAUSES OF METABOLIC SYNDROME • Insulin resistance – It occurs when cells in the body (liver, skeletal muscle and adipose/fat tissue) become less sensitive and eventually resistant to insulin. – Glucose can no longer be absorbed by the cells but remains in the blood, triggering the need for more and more insulin (hyperinsulinaemia) to be produced in an attempt to process the glucose. – The production of ever-increasing amounts of insulin weakens and may eventually wear out the beta cells. • Central obesity – Associated with insulin resistance and the metabolic syndrome – Contributes to HTN, high serum cholesterol, low HDL-c and hyperglycemia 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 30
  29. 29. CRITERIA 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 31
  30. 30. DIAGNOSIS – MINIMUM 3 CRITERIA • Elevated triglyceride levels or drug treatment of these elevated levels (≥ 150 mg/dL) • Reduced HDL cholesterol levels or drug treatment of these reduced levels (< 40 mg/dL in men; < 50 mg/dL in women) • Elevated blood pressure or treatment of hypertension (systolic 130 mm Hg and/or diastolic ≥ 85 mm Hg) • Elevated fasting glucose levels or treatment with antihyperglycemic medications (≥ 100 mg/dL) • ElevatedWC (population and country-specific definitions) 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 32
  31. 31. THANK YOU… 8/27/2020 Obesity & Metabolic Syndrome Dr.Animesh Gupta 33
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Obesity is defined as an abnormal growth of the adipose tissue and or enlargement of fat cell size (hypertrophic obesity) or increase in fat cell number (hyperplastic obesity). Obesity is often expressed in terms of body mass index (BMI)

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