This document discusses obesity and metabolic syndrome. It begins with definitions of obesity and methods of assessing obesity such as body mass index (BMI) and waist circumference. It then covers the pathophysiology, epidemiological determinants including age, sex, genetics and lifestyle factors. Health consequences of obesity like cardiovascular diseases and cancers are mentioned. The document discusses fat distribution and various assessment methods for obesity. It concludes with prevention and treatment methods for obesity including diet, exercise, drugs and surgery, and defines metabolic syndrome and its causes, criteria for diagnosis.

1. OBESIT Y &
METABOLIC
SYNDROME
D R . A N I M E S H G U P TA
M D , F D M , F A G E
A S S O C I AT E P R O F E S S O R
D E P T. O F C O M M U N I T Y M E D I C I N E , N M C H , S A S A R A M

2. INTRODUCTION
• Obesity is defined as an abnormal growth of the adipose
tissue an or
• enlargement of fat cell size (hypertrophic obesity)
• increase in fat cell number (hyperplastic obesity)
• Obesity is often expressed in terms of body mass index (BMI)
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3. OBESITY – CUT OFF VALUE
(Z SCORES/ WHO GROWTH REFERENCE)
• Children under 5 years of age
– Overweight : weight-for-height greater than 2 SD
– Obesity : weight-for-height greater than 3 SD
• Children aged between 5–19 years
– Overweight : BMI-for-age greater than 1 SD
– Obesity : BMI-for-age greater than 2 SD
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6. PATHOPHYSIOLOGY OF OBESITY
• The fundamental cause of obesity and overweight is an energy
imbalance between calories consumed and calories
expended.
– Increased intake of energy-dense foods that are high in fat and
sugar
– Increase in physical inactivity due to the increasingly sedentary
nature of many forms of work, changing modes of transportation,
and increasing urbanization.
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7. EPIDEMIOLOGICAL DETERMINANTS
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8. EPIDEMIOLOGICAL DETERMINANTS...
• Age
– Any age group.
– Increases with age.
– Infants with excessive weight gain have an increased incidence of obesity in
late life.
– This causes hyperplastic obesity in adults which is extremely difficult to
treat with conventional methods
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9. EPIDEMIOLOGICAL DETERMINANTS...
• Sex:
– Women have higher rate of obesity than men.
– In Framingham, USA study, men found again weight between 29-35 years
of age, while women gain mostly between 45-49 years of age.
• Genetic factors:
– Twin studies have shown close correlation
• Physical inactivity
• Socioeconomic status:
– inverse relationship
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10. EPIDEMIOLOGICAL DETERMINANTS...
• Eating habits
– Composition of the diet.
– Periodicity.
– Amount of energy
• Psychosocial factors
– Emotional disturbances.
– Overeating is a symptom of Depression, anxiety, frustration and
loneliness.
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11. EPIDEMIOLOGICAL DETERMINANTS...
• Familial tendency
– Runs in families.
• Endocrine causes
– Cushing syndrome, growth
hormone deficiency.
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12. EPIDEMIOLOGICAL DETERMINANTS...
• Alcohol
– Relationship between alcohol consumption and adiposity was generally
positive for men and negative for women.
• Drugs
– Corticosteroid, contraceptives, beta blockers etc
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13. HEALTH CONSEQUENCES/ HAZARDS
• Cardiovascular diseases (mainly heart disease and stroke)
• Diabetes
• Musculoskeletal disorders (especially osteoarthritis – a highly
disabling degenerative disease of the joints);
• Cancers (including endometrial, breast, ovarian, prostate, liver,
gallbladder, kidney, and colon).
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15. FAT
DISTRIBUTION
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16. ASSESSMENT OF OBESITY
• Body Weight
• SkinfoldThickness
• Waist Circumference
• Waist : Hip Ratio
• Others – Total body water, total body
potassium and body density
The most
widely used
criteria for
assessment
of obesity
includes
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17. BODY WEIGHT
• Widely used index but its not an accurate
measure of excess fat.
• In epidemiological studies, Cut off point for
overweight and obesity are +2SD and +3 SD
from the median weight for height respectively
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18. INDICATORS FOR ADULTS
SUCH AS
• Body Mass Index ( Quetelet’s Index) = Wt.(kg) / Ht.(m)2
• Ponderal Index = Height (cm) / Cube root of bodyweight (kg)
• Brocca Index = Height (cm) – (minus) 100
• Corpulence index = Actual weight / Desirable weight
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19. BMI (KG/M2) VALUES
Grade SEAR WHO
Underweight <18.5 <18.5
Normal range 18.5-22.9 18.5 – 24.9
Overweight / Pre Obese 23.0 – 24.9 25.0 – 29.9
Obese class I 25-29.9 30.0 – 34.9
Obese class II ≥30 35.0 – 39.9
Obese class II - > 40.0
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20. SKINFOLD THICKNESS
• Rapid and non-invasive method for assessing
body fat.
• Harpenden skin calliper
• Measurement taken at 4 sites – mid-triceps,
biceps, subscapular, suprailiac region.
• Sum of the measurements should be less
than 40 mm in boys and 50 mm in girls.
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21. WAIST CIRCUMFERENCE
& WAIST:HIP RATIO
• Waist circumference is measured at the
midpoint between the lower border of the
rib cage and iliac crest.
• Convenient and simple measurement.
• Waist circumference = 90 cm (men) & 80 cm
(women) – Indians/ SEAR [Globally 102/88]
• WHR = < 0.9 (men) & < 0.8 (women)
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22. RELATIVE RISK OF HEALTH PROBLEM
ASSOCIATED WITH OBESITY
Greatly increased Moderately increased Slightly increased
Type 2 diabetes CHD Cancer (breast cancer in post-
menopausal women, endometrial
cancer, colon cancer)
Gall bladder disease Hypertension Polycystic ovary syndrome
Dyslipidaemia Osteoarthritis (knees) Impaired fertility
Insulin resistance Hyperuricaemia and gout Low back pain due to obesity
Breathlessness Increased risk of anesthesia
complications.
Sleep apnea Fetal defects associated with
maternal obesity.
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23. PREVENTION & CONTROL
Weight control
• Dietary Changes
– Proportion of energy dense foods such as simple carbohydrates and
fats should be reduced.
– Fibre content in the diet should be increased through the
consumption of common un-refined foods.
– Adequate levels of essential nutrients in the low energy diets should
be ensured.
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24. PREVENTION & CONTROL…
• Increased physical activity
– Regular physical exercise
• Drug
– ORLISTAT – currently licenced for long-term use.
– Sibutramine(increased cardiovascular events) and rimonabant
(psychiatric side-effects) in recent years - STOPPED
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25. ORLISTAT
• Primary function is preventing the absorption of fats from the human
diet, thereby reducing caloric intake.
• It inhibits pancreatic and gastric lipases (an enzyme that breaks down
triglycerides in the intestine) and thereby decreases the hydrolysis of
ingested triglycerides, reducing the dietary fat absorption by
approximately 30%.
• The adverse effects include loose stools, oily spotting, faecal urgency,
flatus and the potential for malabsorption of fat soluble vitamins.
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26. SURGERY
• Bariatric Surgery
– The most effective long term treatment for obesity and is only anti-obesity
intervention that has been associated with reduced mortality.
– It is usually reserved for those with severe obesity (BMI >40kg/m2) or
those with BMI >35kg/m 2 and significant complications such as type2
diabetes or obstructive sleep apnoea.
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27. METABOLIC SYNDROME
• It is a cluster of metabolic disorders that occur together, increasing the
risk of heart disease, stroke and type 2 diabetes.
• It is a multifactorial disease with multiple risk factors that arises from
insulin resistance accompanying abnormal adipose deposition and
function.
• It is also known as syndrome X or insulin resistance syndrome.
• Conditions include increased blood pressure, high blood sugar, excess
body fat around the waist, and abnormal cholesterol and triglyceride levels
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28. CAUSES OF METABOLIC SYNDROME
• Insulin resistance
– It occurs when cells in the body (liver, skeletal muscle and adipose/fat tissue)
become less sensitive and eventually resistant to insulin.
– Glucose can no longer be absorbed by the cells but remains in the blood,
triggering the need for more and more insulin (hyperinsulinaemia) to be
produced in an attempt to process the glucose.
– The production of ever-increasing amounts of insulin weakens and may
eventually wear out the beta cells.
• Central obesity
– Associated with insulin resistance and the metabolic syndrome
– Contributes to HTN, high serum cholesterol, low HDL-c and hyperglycemia
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29. CRITERIA
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30. DIAGNOSIS – MINIMUM 3 CRITERIA
• Elevated triglyceride levels or drug treatment of these elevated levels (≥
150 mg/dL)
• Reduced HDL cholesterol levels or drug treatment of these reduced
levels (< 40 mg/dL in men; < 50 mg/dL in women)
• Elevated blood pressure or treatment of hypertension (systolic 130 mm
Hg and/or diastolic ≥ 85 mm Hg)
• Elevated fasting glucose levels or treatment with antihyperglycemic
medications (≥ 100 mg/dL)
• ElevatedWC (population and country-specific definitions)
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31. THANK YOU…
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