Obesity


OBESITY

Definition:
A chronic condition is characterized by excess adipose tissue leading to body weight 20% over expected weight, arising as a consequence of positive caloric balance. Also defined as Body mass Index (BMI) (weight in kilograms divided by height in metres squared) over 30 kgm/square metre values between 25-30 being categorized as overweight.

  • Is considered the world’s oldest metabolic disorder. The W.H.O considers obesity a global pandemic.
  • Causes include genetics, environmental factors, drugs like corticosteroids, a variety of neuroendocrine problems like Cushing’s syndrome, polycystic ovart disease etc.
  • Leads to serious diseases like coronary artery disease, hypertension, diabetes, cerebrovascular disease, mechanical disturbances in lung and joint function., psychosocial disability, hyperlipidemias, gall stones, reflux oesophagitis, and to greater surgical and obstetric risks. Obesity has been named the mother of all the above diseases.
  • Upper body (abdomen and flank) obesity is of greater consequence for ill health than lower body obesity (buttock and thighs).

Prognosis
Long-term weight loss zis extremely difficult to achieve. A great deal would depend upon the patient’s motivation. In women higher levels of adiposity as measured by the body mass index w‘ere associated with increased risk for fatal and nonfatal coronary artery disease. This applies even for modest weight gains after 18 years of age. Excess mortality is associated, with the occurrence of other risk factors like elevated blood pressure alongside.

Maiiagement
General Principles:

No single effective method of treatment available. Only multidisciplinary approach works. a) Diet b) Exercise c) Behaviour therapy d) Drugs e) Surgery.

Sufficient motivated patient is very essential for success of therapy. Drugs in use seem to have short-term effects with weight gain recurring on withdrawal. Drug therapy is to be tried only if supervised diet, behaviour modification and exercise fail to help after 3 months trial. When on drugs, if the weight falls to reduce by less than 5% after 12 weeks, the drug is to be discontinued. Drug therapy indicated if BMI is over 30, on 27 in those with other risk factors.

Pharmacological interventions do not seem to produce sustained long term weight loss.

General Measures

  1. Diet Modification & Calorie control
    • Conventional reducing diet: In the overweight or moderately obese patient a practical approach to effect an energy deficiency of 500 Kcal. day, leading in most patients to a weight loss of 0.5 /kg a week. (800 – 1200 K cal/day) depending on activity, and the patient’s life style. Should contain less calories than the patient’s maintenance requirement, should contain all essential nutrients, and should contain high fibre to give satiation and should be acceptable to the patient.
    • Total starvation: Is too drastic, disturbs body composition, and may lead to sudden death. Not to be attempted by patient.
    • Very low calorie diet : Indicated in the morbidly obese patient with risk to life and under close medical supervision only. VLCD ‘Protein sparing modified fasts’ with 50-80 gms/day high protein diet to prevent negative Nitrogen balance, and 400 K cal/day. Could be tried for short periods of up to 6 weeks, under medical supervision.
  2. Physical Execrcise
    Calls for adequate motivation, and an exercise regimen suited to individual patient with respect to age, fitness, etc. Usually, the effect on body weight is only marginal.
  3. Be Behaviour modification
    Of gr at importance in therapy and is based on study of the patient’s attitude to food and eating, social factors that influence his eating, non-nutritive stimuli for eating etc. Advice given would include eating.

Patient teaching

  • ‘Behaviour Modification (vide supra).
  • Explain hazards of obesity.
  • Education on human nutritional requirements and calorie consumption.
  • Education on the futility of several ‘popular dietary fads’.