obesity Flashcards
What’s the recommended maximum daily sugar intake? (in grams)
Adults 30g
children (7-10) 24g
children (4-6) 19g
What’s the recommended maximum daily sugar intake? (in cubes)
Adults 7 cubes children (7-10) 6 cubes
children (4-6) 5 cubes
what is the recommended weekly amount of physical activity for adults
150 mins mod intensity or 75 vigorous intensity
minimise sedentary time
strength and improve balance 2 days a week
what is the definition of obesity
Obesity is a disorder in which excess body fat has accumulated to an extent that health may be adversely affected.
mostly assessed by BMI
how is obesity classified by BMI
Healthy 18.5-24.9
Overweight 25-29.9
obesity 30 (inc by 5 to II and III)
Kids - age, gender, weight chart (85th gentile overweight and 95th obese)
Nuances in classification by BMI
Children - use age & gender specific standards
Athletes - particularly those with high muscle mass
People at the extremes of the height distribution
Non-Caucasian populations
(BMI >27.5 in Asian comparable morbidities in Caucasian BMI >30)
Patterns of obesity
General obesity – fat is distributed over the whole body
Central abdominal obesity – fat is distributed mainly in the chest and abdomen.
what are the risks with central abdominal obesity
associated with higher risks of diabetes, raised blood lipids, and greater cardiovascular morbidity and mortality compared to general obesity
Definition of central obesity
Waist circ. >= 94cm /37 inches in men
Waist circ. >= 80cm/31.5 inches in women
Definition of metabolic syndrome
A cluster of conditions (body fat, blood lipids, BP, blood sugar associated with increased risk of stroke, heart disease and diabetes)
need inc waist circulation and at least 2 of raised blood TG, red HDLC, raised BP and raised fasting glucose
what are cultural perspectives on obesity
Many contemporary cultures still value fatness, but thinness more valued in post industrial societies
Acculturation - migrants to industrialized societies often gain weight due (diet and reduced activity) – e.g. USA Mexicans
Individual social factors associated with weight - unmodifiable
Gender – stigmatization more common for women
Age – life stages, gain weight in adulthood, lose it in old age (reflects physiology, calorie intake, activity levels)
Ethnicity – inc by ethnicity, may reflect calorie intake and physical activity as much as genetics
Employment – (higher income – better diet, activity, structure). Unemployed women more likely to be overweight and unemployed men underweight.
Parenthood – increases with each child. Childbearing weight (physiological), while childrearing (reduced activity and changes to dietary patterns)
Individual social factors associated with weight - modifiable
Income – Low income consume less fruit and veg but more calories
Education – More knowledge about nutrition. Energy expenditure is inversely associated with education
Marriage – obese people marry later, and more likely to marry obese partners. Married men weigh more than single men.
Household size – elderly live alone are more likely to be underweight
Residential density but rural residents slightly heavier
Is obesity at epidemic levels?
worldwide increased prevalence
dramatic acceleration in last decade
predicted to overtake smoking in preventable cause of death
how does the UK compare to other countries
UK does not compare well with more countries
Dramatic accelerations and dire predictions
Linked to gender, ethnicity, deprivation and parental obesity
Many children already with problems at reception
Picture can change in individual children
health impact of obesity - circulatory system
Increased risk of hypertension – co-factor for stroke and coronary heart disease, deep venous thrombosis, pulmonary embolism
health impact of obesity - musculoskeletal
weight on the joints – especially the knees with cartilage degeneration. Low back pain.
health impact of obesity - metabolic and endocrine systems
Type 2 DM, dyslipidaemias (high cholesterol and triglycerides) with atherosclerosis (fat in lining of arteries), gout
health impact of obesity - cancer
Increased risk of breast, colon and endometrial cancers
health impact of obesity - reproductive and urological
Stress incontinence in women, menstrual abnormalities, polycystic ovarian syndrome, infertility, childbirth risks, erectile dysfunction
health impact of obesity - respiratory system
Sleep apnoea and asthma
health impact of obesity - liver disease
fatty liver = non-alcoholic fatty liver disease (NAFLD) (steatosis = fat infiltration of liver cells). NAFLD prevalence rising, may require liver transplant at later stages
health impact of obesity - gastrointestinal
gastro-oesophageal reflux, gall stones, pancreatitis
health impact of obesity - psychological and social
– Low self esteem, stress, social disadvantage, depression, reduced libido
effect of obesity on children
Type 2 DM inc
Asthma
Sleep apnoea
CVD (damage in childhood, inc risk of hypertension in adult)
Musculoskeletal - Tibia vara (bow legs), slipped femoral epiphysis, knee pain, ankle foot pain / problems
Mental health – Low self esteem, emotional and behavioural problems
Internal drivers- Energy intake
Gut hormones- satiety (anorexigenic) and hunger (orexigenic)
CNS - hormones and hypothalamus via vagus
Adipose - Leptin (red adiposity in rats)
Internal drivers
Stress hormones: adrenaline/ cortisol
Circadian rhythm – sleep deprivation
Genetics
Microbiome
Genetics and obesity
Appetite is genetically determined with a growing number of genetic mutations associated with small increases in appetite and higher prevalence of obesity
Twin studies of identical and non identical pairs confirms high heritability of weight.
Microbiome and obesity
less variety and quantity of microbes in gut
External drivers- Energy intake
Environment Economic Social Cultural Education
issues with weight loss
hard to maintain easier to gain than lose cycle of starvation-binge behaviour change harder by stigma
Slowing of Weight Loss
metabolism slows
feedback regulation to resist weight loss
appetite increase
Important considerations when Advising on Dietary Approaches for Weight Loss
nutritional adequacy cultural acceptance economic affordability safety efficacy eg exercise, self monitoring, diet quality, support
what diets could be used for weight loss
no single diet can claim superiority and one size doesn’t fit all, all have considerations
eg mediterranean, low-carb, low-fat, intermittent fasting
what drugs can be used for weight loss in primary care
limited use appetite suppressants - safety concerns bulking agents, diuretics, thyroxine avoid Type 2 DM drugs - not proven newer drugs for use around
what intervention is used when others fail
bariatric surgery Laparoscopic adjustable band
Sleeve gastrectomy
Roux-en- Y /laparoscopic
gastric bypass
bariatric surgery outcomes
surgical complications improves: Type 2 DM hypertension dyslipidaemia sleep apnoea
Interventions to prevent or treat obesity
A whole city environment to support ‘healthy weight’
National Policy
Local policy to address obesogenic environments
Education and communication
Individual and environmental
