OBESITY – LIFESTYLE
MODIFICATION AND
COMPLICATION
AADITHYA SHAJI
AANAND AJAY
WHAT IS OBESITY?
• OBESITY IS DEFINED AS AN EXCESS OF ADIPOSE TISSUE THAT IMPARTS
HEALTH RISK ;A BODY WEIGHT OF 20% EXCESS OVER IDEAL WEIGHT FOR
AGE,SEX AND HEIGHT IS CONSIDERED A HEALTH RISK .
• A BMI OVER 25 IS CONSIDERED OVERWEIGHT AND OVER 30 IS OBESE (WHO)
CAUSES OF OBESITY
● ACCUMULATION OF FAT RESULTS FROM
THE IMBALANCE BETWEEN ENERGY
CONSUMPTION AND ENERGY EXPENDITURE
THAT IS TOO LARGE TO BE DEFENDED BY
THE HYPOTHALAMIC REGULATION OF BMR
● A CONTINUOUS SMALL DAILY INTAKE
POSITIVE ENERGY BALANCE OF 50-200 kcal
WOULD LEAD TO WEIGHT GAIN OF 2-20 kg
OVER A PERIOD OF 4-10 YEARS
ETIOLOGY
● OBESITY RESULTS WHEN CALORIC INTAKE EXCEEDS UTILISATION .
THE IMBALANCE OF THESE TWO COMPONENTS CAN OCCUR IN THE
FOLLOWING SITUATIONS
● IN ADEQUATE PUSHING OF ONSELF AWAY FROM THE DINING TABLE
CAUSING OVEREATING.
● INACTIVITY AND SEDENTARY LIFESTYLE
● GENETIC PREDISPOSITION
● DIET LARGELY DERIVED FROM CARBOHYDRATES AND FATS THAN
PROTEIN RICH DIET
● SECONDARY OBESITY- HYPOTHYROIDISM , CUSHINGS DISEASE,
HYPOTHALAMIC DISORDERS, INSULINOMA
MANAGEMENT OF OBESITY
LIFESTYLE
● DIET- CHANGES IN EATING HABIT MUST BE PERMANENT IF WEIGHT
LOSS IS TO BE MAINTAINED.
● REDUCING THE ENERGY DENSITY OF THE [BY REDUCING THE
DIETARY FAT] CAN ALLOW PARTIENTS TO FEEL SATIATED WHILE
CONSUMING FEWER CALORIES
● INCREASING THE CONSUMPTION OF FOODS HIGH IN WATER AND
FIBRE[ FRUITS, LEGUMES, VEGETABLES, SOUPS]
● AVOID EXCESS INTAKE OF BEVERAGES CONTAINING SUBSTANTIAL
CALORIES WITH LITTLE OR NO SATIETY
● A REGULAR PATTERN OF DIET SHOULD BE ENCOURAGED.
EXERCISE
● HAS AN IMPORTANT ROLE IN MAINTENANCE OF WEIGHT LOSS
● 2008 PHYSICAL ACTIVITY FOR AMERICANS RECOMMEND THAT ADULTS
SHOULD ENGAGE IN 150MIN OF MODERATE INTENSITY OR 75MIN A WEEK
OF VIGOROUS INTENSITY AEROBIC PHYSICAL ACTIVITY PER WEEK.
● FOCUSSING ON SIMPLE WAYS TO ADD PHYSICAL ACTIVITY INTO NORMAL
DAILY ROUTINE THROUGH LEISURE ACTIVITIES, TRAVEL AND DOMESTIC
WORK SHOULD BE SUGGESTED
● ASK THE PATIENT TO WEAR PEDOMETER OR ACCELEROMETER TO
MONITOR KCAL EXPENDED AS A PART OF ACTIVITIES
● A HIGH LEVEL OF PHYSICAL ACTIVITY[ >300MIN OF MODERATE ACTIVITY
PER WEEK] IS OFTEN NEEDED TO LOSE WEIGHT AND SUSTAIN WEIGHT
LOSS
BEHAVIORAL MODIFICATIONS
• COGNITIVE BEHAVIORAL THERAPY IS USED TO HELP CHANGE AND REINFORCE
NEW DIETARY AND PHYSICAL BEHAVIOURS
• STRATEGIES INCLUDE : SELF MONITORING TECHNIQUES , STRESS
MANGEMENT; STIMULUS CONTROL , SOCIAL SUPPORT,PROBLEM SOLVING AND
COGNITIVE RESTRUCTURING TO HELP PATIENTS DEVELOP MORE POSITIVE
AND REALISTIC THOUGHTS ABOUT THEM
BEHAVIOURAL MODIFICATION TO AVOID SOME OF THE EFFECTS OF THE ‘OBESOGENIC’
ENVIRONMENT IS THE CORNERSTONE OF LONG-TERM CONTROL OF WEIGHT.
ADOPTING REGULAR EATING PATTERNS AND MAXIMISING PHYSICAL ACTIVITY ARE
ADVISED.
CHANGES IN EATING BEHAVIOR
● FOOD SELECTION
● PORTION SIZE CONTROL
● AVOIDANCE OF SNACKING
● REGULAR MEALS TO ENCOURAGE SATIETY
● SUBSTITUTION OF SUGAR WITH ARTIFICIAL SWEETNERS
RECOMMENDING A REDUCTION OF DAILY TOTAL ENERGY INTAKE OF −2.5 MJ (600 KCAL)
FROM THE PATIENT’S NORMAL CONSUMPTION.
DRUGS
1. ORTISTAT- INHIBIT PANCREATIC AND GASTRIC LIPASES
• DOSE- 120MG TAKEN WITH EACH OF THE 3 MAIN MEALS REDUCES DIETARY FAT
ABSORPTION BY ABOUT 30%
• ADVERSE EFFECTS- LOOSE STOOLS,FACEAL URGENCY,FLATUS
2. LOW DOSE PHENIERMINE AND TOPIRAMALE- GREATER SIDE EFFECTS
3.NALTREXONE (OPOID ANTAGOINST) AND NORADRENALINE
4. GLP-1 RECEPTOR AGONIST- LINGLUTIDE, SEMAGLUTIDE
SURGERY
• BARIATIVE SURGERY- MORE EFFECTIVE TREATMENT
• IT SHOULD BE CONTEMPLATED IN MOTIVATED PATIENT WHO HAVE VERY
HIGH RISKS , COMPLICATION OF OBESITY, AND DRUG THERAPY HAS BEEN
INSUFFICENTLY EFFECTIVE
• BARIATIVE SURGICAL PROCEDURE-
• 1. LAPROSCOPIC BANDING
• 2. SLEEVE GASTRECTOMY
• 3. ROUX –EN-Y GASTRIC BYPASS
COMPLICATONS IN OBESITY
• OBESITY AFFECTS BOTH MORTALITY AND
MORBIDITY.
• A BMI ABOVE 35 KG/M2 AT AGE 40 YEARS
REDUCES LIFE EXPECTANCY BY UP TO 7 YEARS
FOR NON SMOKERS AND BY 13 YEARS FOR
SMOKERS .
• AND IF TYPE 2 DIABETES MELLITUS DEVELOPS
ALMOST ALWAYS WITH MODERATE
OVERWEIGHT LIFE EXPECTANCY IS REDUCED
BY 7 YEARS AT ANY BMI
CORONARY HEART DISEASE IS THE MAJOR CAUSE OF DEATH
CANCER RATES ARE ALSO INCREASED IN THE OVERWEIGHT
• COLORECTAL CANCER IN MALES
• CANCER OF GALLBLADDER ,BILIARY TRACT ,BREAST ,ENDOMETRIUM AND
CERVIX IN FEMALES.
RISE IN OBESITY HAS BEEN ACCOMPANIED BY EPIDEMIC OF
• TTYPE 2 DIABETES MELLITUS
• OSTEOARTHRITIS, PARTICULARLY OF THE KNEE [Increased body size → greater
bone density → increased mechanical stress ]
OBESITY MAY HAVE PROFOUND PSYCHOLOGICAL CONSEQUENCES COMPOUNDED
BY STIGMATIZATION OF OBESE IN MANY SOCIETIES
INCREASED INTRA-ABDOMINAL FAT CAUSES CENTRAL (abdominal, visceral,
android and apple shaped) OBESITY
IT IS MOST COMMON AND IS ASSOCIATED WITH TYPE 2 DM, METABOLIC
SYNDROME AND CARDIOVASCULAR DISEASES
INCREASED SUBCUTANEOUS FAT ACCUMULATION CAUSES GENERALISED
(gynoid/pear shaped) OBESITY
PSYCHOSOCIAL NEUROLOGICAL
• EATING DISORDERS. PSEUDOTUMOUR CEREBRI
• BODY IMAGE DISORDER
• SOCIAL ISOLATION AND
STIGMATISATION
• POOR SELF ESTEEM
PULMONARY GASTROINTESTINAL
• EXERCISE INTOLERANCE – • GALL STONES
limited ability to do physical activities • GASTRO ESOPHAGEAL REFLUX
• NON ALCHOLIC FATTY LIVER
• OBSTRUCTIVE SLEEP APNOEA- • COLON CANCER
a serious sleep disorder in
which breathing repeatedly stops and starts.
• ASTHMA
ENDOCRINE CARDIOVASCULAR
• INSULIN RESISTANCE • HYPERTENSION
• GLUCOSE INTOLERANCE • DYSLIPIDEMIA
• TYPE 2 DM • COAGULOPATHY
• PRECOCIOUS PUBERTY • CHRONIC INFLAMMATION
• MENSTRUAL IRREGULARITIES
• POLYCYSTIC OVARY SYNDROME
RENAL MUSCULOSKELETAL
• GLOMERULOSCLEROSIS • ANKLE SPRAINS
• RENAL CANCER • FLAT FEET
• TIBIA VARA
• OSTEOARTHRITIS
• BACKPAIN
REFERENCE
● DAVIDSON ,24TH
● HARRISON
● GOLDEN
● HARSH MOHAN - PATHOLOGY
THANK YOU!
