1. OBESITY IN FAMILY PRACTICE MANAGEMENT OF OBESITY IN FAMILY PRACTICE

2. DR. G. C. DHAR. MD., DTM&H FRSTM&H (UK), MCFP (CANADA)

3. IN 1998, THE WORLD HEALTH ORGANIZATION DESIGNATED OBESITY AS A GLOBAL EPIDEMIC

4. WHAT TO DO ? OBESITY EPIDEMIC!

5. SEDENTARY LIFESTYLE & EXCESSIVE EATING

6. L U X U R Y L I F E !

7. ?

10. OBESITY NOW IS NOT A PROBLEM OF HIGH INCOME COUNTRIES IT IS NOW DRAMATICALLY INCREASING IN MIDDLE AND LOW INCOME COUNTRIES

15. WHAT IS BMI? BODY WEIGHT IN KG DIVIDED BY HEIGHT IN METER SQUARE

16. ALTHOUGH WE DEFINE OBESITY BY BMI BMI EXACTLY DOES NOT REFLECT THE ACTUAL ADIPOSITY

19. VISCERAL OR CENTRAL OBESITY IS RISKY MEASURED BY WAIST CIRCUMFERENCE WAIST CIRCUMFERENCE

25. HIGHER WAIST CIRCUMFERENCE IS AN INDEPENDENT RISK FACTOR HIGH CONTENT OF VISCERAL FAT = HIGHER METABOLIC RISK

28. NOT ALL PATEINTS WITH ABDOMINAL OBESITY ARE IN RISK STOP!!!

29. ABDOMINAL FAT SHOULD BE DEFFERENTIATED INTO VISCERAL FAT & SUBCUTANEOUS FAT H O W ?

31. PERIPHERAL FAT e.g. AROUND HIP CONTAINS MORE PUFA AND MORE PHYSIOLOGIC

32. MODERN MARKER OF OBESITY WAIST HIP RATIO (WHR)

35. BODY MASS INDEX(BMI) WAIST CIRCUMFERENCE The two important screening methods of obesity accepted worldwide

47. CHILDHOOD OBESITY FOR CHILDREN FROM 2-20 YEARS, BMI MEASUREMENT IS DIFFERENT FROM THOSE OF ADULTS

48. CHILDHOOD OBESITY

49. HOW TO MEASURE CHILD HOOD OBESITY?

50. BMI FOR CHILDREN AGE AND GENDER SPECIFIC

51. OBTAIN ACCURATE WEIGHT & HEIGHT MEASUREMENT

52. CALCULATE BMI IN THE SAME WAY AS ADULT

53. BMI NUMBER IS PLOTTED ON THE BMI-FOR-AGE GROWTH CHART TO OBTAIN PERCENTILE RANKING. DIFFERENT CHART FOR BOYS AND GIRLS

59. KEY PATHOPHYSIOLOGICAL MECHANISMS FOR THE DEVELOPEMENT OF OBESITY RELATED DISEASES

60. ENDOTHELIAL DYSFUNCTION ATHEROSCLEROSIS INFLAMMATION

66. TNF-ALPHA Generally together with IL1 & IL6, increases the synthesis of C Reactive Protein

67. INTERLUKIN-6 (IL-6) Increases C reactive Protein

69. C-Reactive Protein (CRP) Number one inflammatory marker

72. RESISTIN Plays both in inflammation and insulin resistance

74. WHY INFLAMMATION IS SO IMPORTANT?

80. HOW TO MANAGE?

89. DIETARY CHANGE

91. TARGET: LOW CALORIE DIET CAUTION! Must not be less than 800kcal/day

92. WHAT HAPPENS WHEN CALORIES REDUCED BELOW MAINTENANCE?

93. RECENT INSTITUTE OF MEDICINE (IOM) GUIDELINES ACCEPTABLE MACRONUTRIENT DISTRIBUTION RANGE (MDR)

94. WHAT IS MDR?

98. E G G I N O B E S I T Y

103. PHYSICAL ACTIVITY SHOULD BE STARTED GRADUALLY. walking 10min/day-3days in a week, increase gradually up to 45min/day-7days/week

104. ACSM's Guidelines for Exercise Testing and Prescription -- Sixth Edition, page 26 Virtually all sedentary individuals can begin a moderate exercise program safely.

107. Non-pharmacological treatment should be continued together with pharmacological agents

108. TWO DRUGS CURRENTLY APPROVED BY FDA SIBUTRAMINE ORLISTAT

111. THESE ARE FOR LONG TERM USE If weight reduction is not achieved 2kg in 4 weeks, drug should be discontinued

112. NEWER PHARMACOLOGICAL AGENT Endocannabinoid (ECS) receptor blocker

124. DOCTORS! WHERE WE STAND? WITH OBESITY?

126. NO!!

127. NO!!

128. NO!!

129. NO!

130. N O !

131. Y E S !

132. YES!!

133. YES!!

134. YES!!

135. YES!

136. BE ACTIVE KEEP HEALTHY

138. T H A N K Y O U!