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| Obesity |
The term obesity implies excess of the fat (adipose tissue)
in the body.
Measurement
Body Mass Index (BMI)
It is defines as person’s weight (kg) divided by the square
of person’s height (meters).
BMI (kg/m2) is classified as the following:-
- Normal: 18.5 – 24.9
- Underweight: < 18.5
- Overweight: 25 – 29.9
- Obesity Class I : 30 – 34.9
- Obesity Class II : 35 – 39.9
- Obesity Class III : >40
Ideal Body Weight for Height
Calculated by multiplying square of height in meters by 22.5
- Underweight: <20% of ideal body weight
- Overweight: >10%of ideal body weight
- Obesity: >20% of ideal body weight
Skin Fold Thickness
Estimated by using special calipers.
Measured over triceps, biceps, subscapular and suprailiac
regions
Normal value in Male – 12.5mm
Normal value in Female – 16.5mm
Waist Circumference
Measured at the narrowest segment between ribcage and iliac
crests
Abdominal Obesity in Male = >102 cm and in Female = >88cm
Waist: Hip Ratio
Hip measurement at the buttock
Abnormal in Male - >0.9 and in Female- >0.8
Causes
Simple Obesity
- Physical inactivity
- Eating habits
- Psychological factors (overeating may be the symptoms of depression, anxiety and frustration)
- Genetic factor
- Alcohol
- Smoking
Secondary Obesity
- Hypothyroidism
- Cushing’s syndrome
- Diabetes mellitus
- Hypothalamic disorders
- Medications – valproic acid, carbamazepine, antidepressant, corticosteroids, antipsychotics, lithium and glipizide
Risks Associated with Obesity
- Coronary artery disease
- Type 2 DM
- Hypertension
- Stroke
- Breast, endometrial and colon cancer
- Varicose vein
- Depression
- Cholelithiasis
- Sleep apnea syndrome
- Deep vein thrombosis
- Osteoarthritis
- Dyslipidaemia
Treatment
Goals
- Attempt initially to reduce weight by approximately 10% from the baseline. Further weight reduction is attempted after initial success.
- Reduce weight at the rate of about ½ to 1 kg/week for 6 months.
Physical Exercise
- It reduces abdominal fat and increase cardiorespiratory fitness
- Moderates exercise should be done for 30 – 45 minutes / day and 3 - 5 days a week.
Dietary Modification
- Encourage low–fat diet with low calorie.
- Use of very low carbohydrate diet but with normal or high saturated fat.
- High protein diet
Behavior Modification
- It is useful adjunct to diet and physical exercise.
- Patient often require motivation to lose weight
Pharmacotherapy
- Drug therapy is usually reserved for patient with high risk of complications from obesity.
- Orlistat – Taken with each of the three main meals of the day and the dose can be adjusted (60 – 120 mg) to minimize side effects (loose stool, oily spotting, fecal frequency and flatus).
- Sibutramine – It is second choice drug and cannot be used in those with hypertension or cardiovascular disease). Its side effects are dry mouth, constipation and insomnia.
- Other drugs – Rimonabant, Lorcaserin, etc.
Bariatric Surgery
- Useful in patient with BMI >40
- It is used to reduce the size of the stomach.
- It is the most effective long – term treatment for obesity and is the only anti – obesity intervention that has been associated with reduces mortality.
Other Options
- Jaw wiring
- Jejunoileal shunt
- Gastroplasty
- Gastric bypass
- Gastric banding
- Liposuction
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