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OBESITY
Conditions and Interventions
Obesity:
Obesity is an unhealthy accumulation of body fat
...

Adipocytes (fat cells) are not passive deposits of excess fat
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Prevalence of Obesity and Over-weight:
The one-third of U
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In 1980’s,
obesity has developed as an epidemic and throughout the world
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All states had
obesity rates over 20 percent, and 19 exceeded 10 exceeded by 2013
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Although some data suggest that the overall rate of overweight and obesity may be
leveling off, the rates of severe obesity (BMI > 40) are expected to double by 2030 to
10 percent of the population, indicating a shift to higher weight and greater adiposity
...
They are
complex and chronic conditions, stemming from numerous interacting physiological,
individual, environmental, and genetic factors
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Normal Body-weight:
Normally body weight is determined by a neuroendocrine regulatory system that tends
to maintain weight at a relatively stable “set point” through homeostatic feedback
processes
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Insulin resistance:
A condition in which cells “resist” the action of insulin in facilitating the passage of
glucose into cells
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Genetic and environmental influences, including food experiences in infancy and
childhood, are causes
...
It occurs when
an individual’s set point shifts and stabilizes at a higher weight level
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Mechanism behind weight gain:
These mechanisms behind weight gain and obesity distinguish between the metabolic
brain responsible for homeostatic regulation, and the cognitive and emotional brain,
which responds to perceived pleasantness, liking, wanting, and reward
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Phenotypes:
Phenotypes (i
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, observable traits the results from interactions between genetics and
the environment) help explain why some people are obese yet “metabolically healthy”
and some people are normal weight, but laboratory tests indicate they are “metabolically
obese
...
Psychological, socioeconomic, and cultural factors play a role
in shaping attitudes, behaviors, and lifestyle patterns
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Obesogenic Environment:
The prevailing obesogenic environment seems to stack the deck against controlled
eating
...
Technological advances in every dimension of life—work, leisure
time, transportation—have replaced physical activity with sedentary activity and further
contributed to the obesity epidemic
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Obesity has been linked to other diseases
through adipose-related inflammation
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This low-grade inflammation is an independent,
determinant of many chronic diseases, including obesity
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The risks rise as
the degree of excess weight rises
...
Life expectancy is shortened by 6–19 years,
depending on the severity of obesity
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Health Consequences:
People who have obesity, compared to those with a healthy weight, are at increased risk
for many serious diseases and health conditions, including the following:
I
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III
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V
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VII
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IX
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XI
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All-causes of death (mortality)
High blood pressure (hypertension)
High LDL cholesterol, low HDL cholesterol, or high levels of
triglycerides
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Coronary heart disease
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Low quality of life
Mental illness such as clinical depression, anxiety, and other mental
disorders
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Physical Health Impacts:
Some of the co-morbidities related to overweight and obesity include cancers (cancers
of breast, endometrial, ovarian, colorectal, esophageal, kidney, pancreatic, prostate),
Type 2 diabetes, hypertension, stroke, Coronary Artery Disease, Congestive Heart
Failure, asthma, chronic back pain, osteoarthritis, pulmonary embolism, gallbladder
disease, and also an increased risk of disability
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2
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Obesity can also have a profound effect on your mental
health
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3
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This is called sleep apnea
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4
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GERD occurs when stomach acid leaks into the esophagus
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This is when bile builds up and
hardens in the gallbladder
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Fat can also build up around the
liver and lead to liver damage, scar tissues, and even liver failure
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Cardiovascular and endocrine system:
In people with obesity, the heart needs to work harder to pump blood around the body
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High blood pressure is the leading
cause of stroke
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Insulin is a
hormone that carries sugar from your blood to your cells, where it’s used for energy
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Type 2 diabetes is linked to a range of other health issues, including
heart disease, kidney disease, stroke, amputation, and blindness
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Hardened arteries, also
called atherosclerosis, can increase the risk of heart attack and stroke
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6
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It can also increase a
woman’s risk of having serious complications during pregnancy
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Skeletal and muscular systems:
Obesity can cause deteriorating bone density and muscle mass
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Osteosarcopenic obesity can lead to a higher risk of fractures,
physical disability, insulin resistance, and poorer overall health outcomes
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8
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A condition known as acanthosis
nigricans can also occur
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9
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This strain increases your risk
for stroke
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Stroke risk factors include heart
disease, metabolic syndrome, hypertension, lipid abnormalities, type 2 diabetes and
obstructive sleep apnea
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Other Conditions:
a
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b
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All of
these conditions are caused or made worse by obesity
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Suicide: Studies have shown a correlation between severe obesity and
major depressive disorder
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Studies are mixed
on whether obesity is associated with higher suicide rates
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d
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Studies have shown that people affected by
obesity, particularly severe obesity, are at higher risk of septicemia
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Liver Disease: Obesity is the major cause for fatty liver and non-alcoholic
fatty liver disease
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Fatty liver disease can cause scarring of the liver,
resulting in worsened liver function, and this can lead to cirrhosis and liver
failure
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Other conditions resulting in diminished
quality of life: stress urinary incontinence (leakage), polycystic ovarian syndrome,
infertility, and skin fold rashes
...
However,
overweight is a stigma and the obesity discrimination can lead to some mental disorders
...

On the other hand, in some cases, experiencing the obesity discrimination has led to the
development of psychopathology and poor health behavior that through a vicious cycle,
will enhance their overeating, bulimia, or other related problems
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Sexual activity and sexual health outcomes such as sexual satisfaction, unintended
pregnancy, and abortion have been mentioned as relevant issues
...
The overweight stigma
and attributable discrimination is documented in all the key areas of living, including
growth and development, educational process, employment structure, and provision of
health care
...
At times they also suffer from discrimination, ridicule, social bias, rejection,
and humiliation
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• Cancer
• Type 2
Diabetes
• Hypertension

• CVD

Physical
Health

Mental
Health

• Lower well
being
• Eating
Disorders

Spirtual
Health

Social
Health

• Low selfesteem
• Mood
Disorders
• Impaired
Body image
...
Annual nationwide productivity costs of obesity-related
absenteeism range between $3
...
38 billion
($132 per individual with obesity)
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The obese (BMI ≥ 30)
had 36% higher average annual health care costs than the healthy-weight group,
including 105% higher prescription costs and 39% higher primary-care costs
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If a person consumes high amounts
of energy, particularly fat and sugars, but do not burn
off the energy through exercise and physical activity,
much of the surplus energy will be stored by the body
as fat
...
But genetic and
hormonal factors might play a role as well
...
Calories:
The energy value of food is measured in units called
calories
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This number of calories may sound high, but it can be easy to reach if you eat certain
types of food
...
Another problem is that many people
are not physically active, so lots of the calories they consume end up being stored in
their body as fat
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Poor Diet:
Obesity does not happen overnight
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eating large amounts of processed or fast food – that's high in fat and sugar ·
drinking too much alcohol – alcohol contains a lot of calories, and people who
drink heavily are often overweight
B
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eating larger portions than you need – you may be encouraged to eat too much
if your friends or relatives are also eating large portions
D
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comfort eating – if you have low self-esteem or feel depressed, you may eat to
make yourself feel better
Unhealthy eating habits tend to run in families
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Regularly eating high-calorie
foods, such as fast foods, baked goods and vending machine snacks, can cause your
child to gain weight
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3
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Many people
have jobs that involve sitting at a desk for most of the day
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For relaxation, many people tend to watch TV, browse
the internet or play computer games, and rarely take regular exercise
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Too much time spent in sedentary activities, such as watching television or
playing video games, also contributes to the problem
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Genetics:
Genomic are genetic factors inherited in the child parents
...
However, not this factor is wholly
the reason but it can be a cause of obesity
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All in all, genetic factors cause obesity as it is analyzed by various
Researchers and Scientists
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Having even
one obese parent may raise a child’s risk for it
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5
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These
include: An underactive thyroid gland (hypothyroidism) – where your thyroid gland
does not produce enough hormones · Cushing's syndrome – a rare disorder that causes
the over-production of steroid hormones
However, if conditions such as these are properly diagnosed and treated, they should
pose less of a barrier to weight loss
...
Weight gain can sometimes be a side effect of stopping smoking
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Breastfeeding:
After the birth of a child mother stops feeding and is also the main cause of obesity in
children
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Approximately every mother wants to
breastfeed his child but due to certain medical implications mothers stopped feeding as
recommended by a doctor not to feed her child
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Insulin Controlling:
Insulin controls the fat and energy level of the body
...
It is researched that western type diet boosts the insulin prevention
in high weight people
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However, many studies are showing that the increasing level of insulin also
cause obesity and makes the role of insulin for obesity scandalize
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So, in this way one can start losing weight with the
control of insulin level
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8
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These things are increasing the use of food intake
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Similarly, if a person has a lot of food availability in-front of the table and is eating in
the big plates or dishes then he will eat more
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There is a strong tie between economic status and obesity
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In some places, people may have limited access to
affordable healthy foods
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The junk food in shops displays in such a way that it grabs attention and start eating by
forgetting about the obesity condition
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Sometimes it is necessary to eat junk food when an individual has not enough
money to buy a fresh food or meal or there is no availability of other good food except
junk food
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9
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The processed sugar is more encourage fat
in contrast to unprocessed sugar exists in fruits and some vegetables
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Sugar is a
major contributor to the body fat that causes obesity
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The high intake of sugar causes to prevent insulin levels and
reduce the satiety in comparison to glucose intake
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10
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Most of the people eat food too much in the two- or three-times meals, it is
not a good idea try to eat in small portions but 5 to 6 times in small meals in a day
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11
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Some children
overeat to cope with problems or to deal with emotions, such as stress, or to fight
boredom
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Psychological, socioeconomic and cultural factors play important role in shaping
attitudes, behaviors and lifestyle patterns
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Nutrition Assessment
Goals of nutritional assessment is:
1) To identify the presence and type of malnutrition
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3) To devise suitable diets as prophylaxis against disease later in life
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Patient’s nutrition knowledge, food access, food selection, and functional capacity to
prepare food and engage in physical activity are all important for individualized
treatment planning
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Relatively small amounts
of weight loss (5% to 10% of body weight) can reduce or prevent the health risks
associated with obesity
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Comprehensive Weight Management Program:
A comprehensive, multicomponent weight management program is needed for
successful weight loss, including diet, physical activity and behavior therapy
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Men and women have different preferences for type of program, delivery options, and
outcome goals
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In addition to behavioral modification to alter eating and physicalactivity patterns, pharmacotherapy can be used to support weight loss
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Weight loss goals:
Goals of weight management are to
1) Prevent further weight gain,
2) Reduce body weight,
3) Maintain a lower body weight for the long
term
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A moderate rate of weight
loss of ½ to 1 pound per week is recommended
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To lose one pound in a week, one needs to
create a negative balance of 500 calories per day
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Nutrition assessment of adults with overweight or obesity and obesity-related diseases
and conditions:
Anthropometrics
Height, weight, BMI, waist circumference, waist-hip ratio
Food and Nutrition History
Weight history: age of onset, highest/lowest adult weights, patterns of weight
gain and loss, environmental triggers to weight gain, triggers to excessive or
disordered eating
o Dieting experience: number and types of diets, weight-loss medications, success
of previous efforts
o Current eating patterns: meal and snack patterns (skipped meals, largest meal,
snacks/grazing)
o
o
o
o

o Eating location and environment: meals eaten out (cafeteria, fast food,
restaurant, carry lunch), family meals, television • on at mealtime
o Types and amounts of food typically eaten: 24-hour recall or food frequency,
food preferences, ethnic foods, cultural practices
o Nutritional intake: assessment of reported intake for energy and adequacy of
key nutrients
o Total caloric intake
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Physical Activity:
a
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b
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c
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Reasons to lose weight at this time,
weight-loss goals
e
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Support system
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He or she will help you set new nutrition goals
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He or she will track the progress at each visit
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Most people should aim to lose about 1 to 1
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A balanced vitamin/ mineral supplement may be recommended
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Very-low-energy diets (800 kcal/day) can produce rapid weight loss
but should only be used under close medical supervision
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Cognitive Behavioral Therapy for Weight Management:
Successful programs developed for
weight
management,
diabetes
education, and other lifestyle changes
utilize cognitive behavioral therapy
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Key features are
helping the client recognize and
replace automatic and irrational
thoughts and beliefs (cognitive restructuring) and increasing awareness and control of cues associated with eating
(stimulus control)
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Realistic goals: Identify a healthy weight goal and a feasible rate of loss (0
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0
lb/week), and provide the ability to self-monitor progress
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Caloric deficit: Develop an individualized meal plan with intake adjusted to lose
weight gradually
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Meal plan: Build meal plans around a variety of foods that fit with the patient’s
lifestyle and budget, can be readily obtained, and can be enjoyed by the entire
household
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Skill development: Provide tools and skills training, including teaching, practicing
within sessions, home-work, review, and feedback
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Problem-solving techniques: Assist with development of strategies to anticipate and
solve potential weight- management problems
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Self-monitoring and self-management: Provide tools for keeping food and activity
records and builds confidence in ability to monitor and adjust
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Cognitive restructuring: Help client examine thought processes and recognize
dysfunctional thinking
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Stress management: Teach strategies other than eating to deal with stressful
situations
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Support system: Encourage having someone to check in with and receive support
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Regular exercise: Advice initiation and gradual increase of physical activity,
tailored to the patient’s ability, aiming for 30–60 minutes most days of the week and
including aerobic and muscle-strengthening activities
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Maintenance: Make available support for weight loss and for maintenance of the
loss
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Long-term effectiveness: The weight-management plan is built around learning
and practicing behaviors that can be maintained for a lifetime
Physical Activity for Weight Management
Added physical activity contributes to the
energy deficit required for weight loss
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For obese individuals,
exercise should be initiated slowly and the
intensity increased gradually
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Depending on
body size, fitness level, and exercise intensity, 30 minutes of moderate physical activity
five days a week would burn approximately 1000 calories
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Physical activity is crucial to the
prevention of weight regain
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Pharmacotherapy for Weight Loss
For some, comorbidities and risk factors warrant addition of weight-loss drugs to the
comprehensive intervention plan
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Mechanisms for drug action include appetite suppression and inhibiting
fat absorption from the gut
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Bariatric Surgery
Bariatric surgery is reserved for patients with clinically severe obesity who meet criteria
(BMI ≥40 or ≥35 with high risk for obesity-related morbidity or mortality, and generally
after other therapy has been tried for six or more months without success)
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Bariatric surgery
impacts the mechanisms of metabolic and hedonistic obesity and has been shown to
result in improvement or resolution of obesity-related comorbidities (e
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, lower blood
glucose, better lipid profile, lower blood pressure, reduced cardiovascular disease risks,
and increased mobility)
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Patients considered for gastric surgery must be highly
motivated to adhere to aftercare guidelines to prevent the onset of post-operative
complications (nausea, vomiting, dehydration, and dumping syndrome) and prevent
long-term nutritional deficiencies
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