epidemiology of obesity

1. OBESITY
presented by
Bijay kumar mahato
BPH 3rd semester
PSPH

2. definition
Obesity is a state of excessive accumulation and stored of body fats,
Usually caused by consumption of more calories than body can use.
Also called as corpulence or fatness.
 Obesity may be defined as an abnormal growth of the adipose
tissue due to an enlargement I fat cell size (hypertrophic obesity) or
an increase the number of fat cells(hyperplastic obesity) or a
combination of both.

3. Measurement of obesity
WHO classification BMI [ KG/M2]
Underweight < 18.5
Normal weight 18.5-24.99
overweight 25-29.99
Obesity class I 30-34.99
Obesity class II 35-39.99
Obesity class III >40

6. Epidemiological Factors :
• 1. Age :
• Obesity can occur at any age & generally increases with age. • Infants with
excessive weight gain have an Increased incidence of obesity in later life.
• 2. Sex :
• Women generally have rate of obesity than men.
• 3. Genetic Factors :
• Amount abdominal fat was influenced by a genetic compare accounting for 50 -
60% of the individual difference.
• 4. Physical Inactivity :
• Regular physical activity is protective against unhealthy weight gain. Sedentary
life style promotes obesity. In some individuals a major reduction in activity
without the compensatory decrease in habitual energy intake may be the major
cause of increased obesity Eg : In athletics when they retire and in young people
who sustain injuries.

7. Cont..
• Socio-Economic Status :
There is inverse relationship between socio-economic status & obesity.
Eating Habits :
The composition of the diet, the periodicity with which it is eaten & the amount of energy
derived from it are all relevant to the aetiology of obesity.
A diet containing more energy than needed may lead to prolonged poste prandial
hyperlipidemia & to deposition of triglycerides in the adipose tissue resulting in obesity.
Psychosocial Factors :
Psychosocial factors (Eg : Emotional disturbances) are deeply involved in aetiology of obesity.
Overeating may be a symptom of depression, anxiety, frustration & loneliness.
Excessive obese individuals are usually withdrawn self-conscious, lonely secret eaters.

8. Cont…
• Familial Tendency :
• Obesity frequently runs in families.
• Endocrine Factors : These may be involved in occasional cases, Eg :
Cushing’s syndrome, growth hormone deficiency. 0.
• Alcohol :
• Relationship between alcohol consumption & adiposity was generally
positive for men & negative for women.
• Drugs :
• Use of certain drugs, Eg : Corticosteroids, OCPS, insulin, B-adrenergic
blockers can promote weight gain.

9. Assessment of Obesity
• : The most widely used criteria for assessment of obesity are
1. Body Weight :
• Body weight it is not an accurate measure of excess fat, though it is a
widely used Index. • In epidemiological studies it is conventional to accept
+2 SD (standard deviations) from the median weight for height as a cut-off
point for obesity.
• 2. Skinfold Thickness :
• It is a rapid & non invasive method for assessing body fat Several varieties
of callipers (Eg : Harpenden skin callipers) are available for measuring
skinfold thickness. The measurement may be taken at all four sites – mid
triceps, biceps, subscapular, & supra iliac regions The sum of the
measurements should be less than 40 mm in boys & 50 mm in girls.
•

10. 3. Waist Circumference and Waist :
Hip ratio (WHR) Waist circumference is measured at the midpoint between
the lower border of the ribcage & iliac c rest. It is a convenient & simple
measurement
It is unrelated to height & correlates closely with BMI & WHR.
It is an approximate index of intra - abdominal fat mass & total body fat.
Changes in waist circumference reflect changes in risk factors for
cardiovascular disease & other forms of chronic disease.
There is an increased risk of metabolic complications for men with a waist
circumference > 102 cm & women with a waist circumference > 88 cm.
WHR: > 1.0 in men & > 0:85 in women indicates abdominal fat accumulation.

11. • 4. Others :
• (a) Measurement of total body water.
• (b) Measurement of total body potassium.
• (c) Measurement of total body density.
• The techniques involved are relatively complex & can't be used for
routine clinical purposes.

12. Type and cause

13. Global burden
• Worldwide obesity has nearly tripled since 1975.
• In 2016, more than 1.9 billion adults, 18 years and older, were overweight.
Of these over 650 million were obese.
• 39% of adults aged 18 years and over were overweight in 2016, and 13%
were obese.
• Most of the world's population live in countries where overweight and
obesity kills more people than underweight.
• 41 million children under the age of 5 were overweight or obese in 2016.
• Over 340 million children and adolescents aged 5-19 were overweight or
obese in 2016.
• Obesity is preventable.
• source: WHO

14. Causes of obesity
Physical inactivity
Overeating and food addiction
Genetics
A diet in high simple carbohydrate
Frequency of eating
Medication- antidepressant
Psychological factors
Diseases
Pregnancy
Processed food intaking
Hormonal issue – insulin increased leptin resistant
More sugary drinking
Lack of knowledge

15. Medical causes
• Cushing’s syndrome
• Hypothyroidism
• Insulinoma
• Craniopharyngioma and other disorders involving the hypothalamus
• Drug induced

16. health Consequence of obesity
• Nervous system problem
• Being overweight or having obesity greatly increases the risk of stroke, where
blood stops flowing to your brain. Obesity can also have a profound effect on
your mental health. This includes a higher risk of depression, poor self-esteem,
and issues with body image.
• Respiratory system problem
• Fat stored around the neck can make the airway too small, which can make
breathing difficult at night. This is called sleep apnea. Breathing may actually stop
for short periods of time in people with sleep apnea.
• Digestive system problem
• Obesity has been associated with a higher risk of gastroesophageal reflux disease
(GERD). GERD occurs when stomach acid leaks into the esophagus.
• in addition, obesity increases the risk of developing gallstones. This is when bile builds up
and hardens in the gallbladder. This may require surgery.
Fat can also build up around the liver and lead to liver damage, scar tissues, and even liver
failure.

17. Cont…
• Cardiovascular system problem
.
In people with obesity, the heart needs to work harder to pump blood around the body.
This leads to high blood pressure, or hypertension. High blood pressure is the leading
cause of stroke..
endocrine system problem
obesity can also make the body’s cells resistant to insulin. Insulin is a hormone that
carries sugar from your blood to your cells, where it’s used for energy. If you’re
resistant to insulin, the sugar can’t be taken up by the cells, resulting in high blood
sugar.
This increases a person’s risk of having type 2 diabetes, a condition where your
blood sugar is too high. Type 2 diabetes is linked to a range of other health issues,
including heart disease, kidney disease, strokoe, amputation, and blindness.

18. health Consequence of obesity

19. Effects of morbid obesity

20. Cancers associated with obesity

21. Complications with obesity

22. WHO strategy
• WHO strategy for preventing overweight and obesity
• Adopted by world health assembly in 2004 and WHO global strategy
on diet, physical activity and health.
• 4 objectives
1. Reduce risk factor of chronic diseases
2. Increase awareness and understanding
3. Implement global, regional, national policies action plan
4. Monitor science and promote research.

23. Prevalence of Overweight, Obesity, and Abdominal Obesity. Results are shown across
selected demographic parameters. Data given as percentages and adapted from a
2005 population-based study of 1,000 urban males of the Eastern Nepalese town of
Dharan.
Overweight (25–29.99 kg/m
2
) (%) Obese (≥ 30 kg/m
2
) (%) Increased Waist Hip Ratio (>0.90)
(%)
Ethnicity
Terai 8.7 8.7 47.8
Major hill 27.8 7.2 52.4
Hill native 41.3 8.2 49.3
Hill occupational 26.3 1.3 55.3
Age (years)
35–49 32.2 9.1 48.0
50–64 35.4 5.5 56.9
≥ 65 30.5 5.5 49.5
Socioeconomic status
Low 21.9 3.8 40.0
Middle 41.5 9.1 60.9
High 43.9 14.6 57.3
Occupation
Labour 69.1 4.7 38.6
Agriculture 67.9 2.5 47.5
Ex-army men 36.4 6.8 55.3
Technical/business 53.4 11.4 58.9

24. Relationship of social components in obesity
aetiology

25. Management of obesity

26. Diet and nutrition
 food to avoid
Junk and processed foods: pizza, burger, potato chips, french fries, candy
bars pastries, cookies and cake etc….
Oily products
Sugary drinks
White bread
Most fruit juice
Some types of alcohol. Specially beer
Ice creams
High calorie coffee drink
Foods high added sugars

27. Good food for obesity
• Leafy greens veg.
• fruits
• Whole eggs
• Salmon
• Cruciferous vegetables
• Lean beef and chicken breast
• Tuna
• Beans and legumes
• Soups
• cottage cheese avocados
• Apple cider vinegar

28. Physical activities
• Fast walking
• Jogging swimming
• Sports and game playing
• Gym workout
• Stair climbing

29. Life style modification
Behavior modification
• Self monitoring of weight
• Stress management
• Social support
• Control on food habit

30. pharmacotherapy
• Medication for obesity have traditionally fallen into two major
categories
Appetite suppression
Gastrointestinal fat blockers

31. Surgery

33. Reference
• Park’s text book of psm
• Falcon’s quick review of psm
• www.who.org
• www.healthline.in