8. Waist-to-hip ratio Ratio = WAIST HIPS TO FIND RATIO Waist: Measure at narrowest point with stomach relaxed Hips: Measure at fullest point Desired Ratio Women : < 0.8 Men : < 1.0 Risk increases if waist circumference is >94 cm in men and >80 cm in women
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10. Obesity – An imbalance in energy intake and energy expenditure Proteins (20%) BMR (60-65%) ENERGY INTAKE ENERGY EXPENDITURE Carbohydrates (55%) Physical activity (25-30%) Fats (25%) Thermic effect of food (10%)
11. Role of hypothalamus in mediation of hunger and satiety Thalamus Paraventricular HO conserv Oxytocin rel. 2 Anterior hypothalamic Body temp Optic tract Arcuate Neuroendocrine Fornix Rage, Hunger Supraoptic Vasopresin rel. Dorsomedial GI stimuli Periventricular Neuroendocrine Ventromedial Satiety Lateral hypothalamic Hunger, thirst
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18. Approaches to obesity management Diet Activity Drugs VLCD Surgery BMI 23-25 No risk factors DM/CHD/HT/HL - BMI 25 – 30 No risk factors DM/CHD/HT/HL (consider) BMI > 30 No risk factors DM/CHD/HT/HL ( in severe ) ( conside r in severe )
25. STORM Study : Proportion of patients maintaining at least 5% and 10% weight loss 100 20 40 60 80 0 6 12 18 24 6 12 18 24 5% responders 10% responders Sibutramine Placebo Lancet 2000; 356:2119-2125 Proportion of patients (%)
26. STORM Study: Effect on Waist Circumference and Waist/Hip Ratio Decrease in waist circumference (cm) Change (a) Waist Circumference (b) Waist/Hip Ratio
27. STORM Study : Effects on lipids 5 0 -5 -10 -15 -20 -25 Placebo Sibutramine Triglycerides % c h a n g e 0 0 24 18 12 6 5 0 -5 -10 -15 -20 -25 Placebo Sibutramine VLDL cholesterol 18 0 24 12 6 % c h a n g e Lancet 2000; 356:2119-2125
28. STORM Study : Effects on lipids (Contd.) 18 0 24 12 6 25 20 15 10 5 0 HDL cholesterol % c h a n g e Sibutramine Placebo Month of assessment Weight loss Weight maintenance Lancet 2000; 356:2119-2125 30
29. STORM Study : Effect on Insulin and HbA 1c Month of Assessment Placebo Sibutramine Lancet 2000; 356:2119-2125 % Change HbA 1c . Month of Assessment Placebo Sibutramine % Change Insulin