dr Bhoomi shah

1. OBESITY
BY :DR BHOOMI P SHAH (MPT CARDIO )
AASISTANT PROFESSOR
VINAYAKA INSTITUTE OF PHYSIOTHERAPY
ANAND

2. CONTENTS
•Introduction
•Etiology and causes
•Tool to measure the obesity
•Pathophysiology
•Total energy expenditure
•Health problems
•Types
•General treatment

3. OBJECTIVE
•What is obesity? and its causes.
•How to measure the obesity?
•What is pathophysiology?
•What is total energy expenditure? And its detail.
•Which are the health related problem occur during
obesity?
•What are the types of obesity?
•What are the treatment techniques?

4. Definition
The condition of having an excessive amount of body
fat, BMI more than 30 kg per meter square.
Obesity is implicated in a wide variety of health
problems such as impaired sense of wellbeing and
impaired quality of life, numerous complications, high
frequency of sick leave and early retirement, and
increased mortality.
The health-related complications are due to the
increased proportion of body fat and associated
disturbances of endocrine/metabolic function and due
to increased mechanical load.

5. Borderline obese- men with relative fat value of 20 to
25% body fat
women with values of 30 to 35% body fat
Obese- men with more than 25% body fat
women with more than 35% body fat

6. Etiology
Obesity is of complex origin and specific causes
undoubtedly differ from one person to the next.
Causes- (which are directly or indirectly related to the
onset of obesity.)
•Gluttony
•Genetic
•Hormonal imbalances
•Physiological and psychological trauma
•Emotional trauma
•Alterations in basic homeostatic mechanisms
•Environmental factor- cultural habits, inadequate
physical activity and improper diets

7. Tool to measure the obesity
Relative weight
It is used to express the percentage by which an
individual is either overweight or underweight.
It is determined by dividing a person’s weight by the
mean weight for the medium frame category, based on
height.
The result is then expressed as a percentage.
E.g. Man who weight 104kg at a height of 183 cm.
And 73kg is the mean value for the medium frame
category.
Relative weight- 104/73=142%

8. BMI (body mass index)
Frequently used standard to estimate obesity.
Dividing body weight in kilograms by the square of
body height in meters.
BMI- weight(kg) / height(meter square)
E.g.- man who weights 104kg and is height 183cm.
BMI- 104/(183)square
BMI- 31 kg/m2

9. World health organization 1998
Disease risk – type 2 diabetes, hypertension, cardiovascular disease.
Increased waist circumference also can be a marker for increased risk
even in persons of normal weight.

10. •For children-
Less than 5 percentile – underweight
5-85 percentile- normal
85- 95 percentile- overweight
More than 95 percentile - obese

11. Advantages of BMI
Low cost and easy to use for health professionals for
assessing individuals.
It predicts dangers associated with obesity; as BMI
increases risk of diseases .
It is a useful screening tool to use at the population
level and because it is universally accepted

12. Limitations of BMI
BMI and percentage body fat remains independent of
age, gender, ethnicity and race.
BMI has significant limitations in assessment of the
individual as it does not take into account the
distribution of body fat.
BMI does not provide information regarding where
body fat is stored

13. Weight- hip girth ratio
That exceed 0.80 for women and 0.95 for men
increase risk of death even after adjusting for BMI.
Measurement:-
1. Waist at navel while standing relaxed, not pulling in
stomach
2. Over the buttocks where girth is largest
3. Divide waist girth by hip girth measure

15. •Waist circumference values possess greater relative
risk for cardiovascular disease, type 2 diabetes, cancer,
dementia and cataracts (leading cause of
blindness)than individuals with small waist
circumference or peripheral obesity.
•Excess weight distribution in the abdominal area also
increase colorectal cancer risk.
•A waist girth exceeds 91cm (36 in.) in men and 82
cm(32 in) in women nearly doubles the risk of cancer

16. Pathophysiology
Two genes that control body weight.
Gene that synthesizes leptin, a crucial hormonal body
weight regulating substance, produced by fat and
released in the bloodstream that acts on the
hypothalamus.
Congenital absence of leptin produced continual
hunger and marked obesity in the children.
Defect in Leptin’s signal

18. Total energy expenditure
Total amount of energy expended each day can be
expressed as the sum of 3 components.
1. Resting metabolic rate(RMR)
2. The thermic effect of a meal(TEM)
3. The thermic effect of activity(TEA)
Resting metabolic rate
Metabolic rate early in the morning following an
overnight fast and 8 hrs. of sleep
Represents minimal amount of energy required to
support basic physiologic processes
Accounts 60-75% of total energy expenditure/day

19. Thermic effect of a meal(TEM)
Increase in metabolic rate that is associated with
digestion, absorption, transport, metabolism, storage of
food.
Accounts for 10% of total energy expenditure/day
This value also includes some energy waste, because
the body can increase its metabolic rate above that
necessary for food processing and storage.
Thermic effect of activity(TEA)
Energy expended above RMR to accomplish activity.
Accounts for 15-30% of total energy expenditure/day

21. Health problems associated with obesity
Obesity are associated with an increased overall rate
of death.
A major increase in risk occurs when the BMI exceeds
30 kg/m2 , although BMI values between 25 and 30
are associated with increased risk for many diseases.
Major diseases: heart disease
hypertension
diabetes
certain type of cancer.

22. •Obesity has been directly related to
changes in normal body function
Increased risk for certain diseases
Adverse psychological response.

23. Types of obesity
1. Upper body obesity / android / apple shaped
2. Lower body obesity / gynoid / pear shaped
Upper body obesity as risk factor for following
condition:
Coronary artery disease
Hypertension
Stroke
Elevated blood lipids
Diabetes
 Atherosclerosis

25. General treatment
The energy consumed by the body in the form of food
must equal to total energy expended, which is the sum
of the RMR, TEM, TEA.
The energy – balance equation:
energy intake – energy excreted= RMR+TEM+TEA
The body normally maintains a balance between
caloric intake and caloric expenditure, but when this
balance is upset, weight will be lost or gained.
Both weight looses and weight gains appear to depend
largely on just 2 factors: dietary intake and physical
activity.

26. The effects of diet alone, exercise alone and
combination of both on weight loss has been assessed,
which shows diet and exercise both too gather in
weight loss and its maintain of it.
Weight loss generally should not exceed 0.45 to 0.9
kg per week. ( 23.4 kg in year)
Very low caloric diet which includes about 350 to 500
kcal of food per day with maintaining certain amount
of protein and carbohydrates to minimize the loss of
fat free body mass, especially reducing intake of fat
and simple sugars.
effective regular physical activity for weight loss is
related to degree of excess body fat.

27. •Aerobic exercises and resistance training also help in
weight loss along with diet, as they stimulate fat
catabolism, maintain blood pressure and promotes
cardiovascular fitness.
•Moderate to high caloric cost such as circuit resistance
training, walking, running, rope skipping, stair
stepping, cycling and swimming.
•Many recreational sports and games also are effective
in weight control.
•Resistance training – continuous exercise using low
resistance and high repetitions.
•Consequently this exercise mode burns calories during
a typical 30-60 minute workout.

29. •Hormones and drugs also have been used to assist
patients in weight loss by decreasing their appetite or
increasing their RMR.
•Surgery- intestinal bypass and gastric bypass are less
used because of risk of complications.
•Gastric stapling –safer and more effective
partition off stomach and insertion of gastric balloons
to reduce the capacity of the stomach.

30. •Behaviour modification- one of the most effective
techniques for helping people with weight gain.
•Major weight losses have been achieved by change in
behaviour pattern associated with eating.
•People have to make a normal daily routine and follow
that and result in weight loss.

31. References
Exercise physiology (7th edition)
William McArdle, frank katch , victor katch.
ACSM’s resource manual for guidelines for exercise testing and
prescription.(7th edition)
Wolters kluwer/ lippincott williams & wilkins
Physiology of sport and exercise(3rd edition)
Jack wilmore, david costill

32. Thank you