An evidence based discussion on obesity and NCD

1. Obesity: The Culprit
Presented by-
Dr. Jheelam Biswas
Department of NCD, BUHS

2. Outlines
• What is obesity
• Causes of Obesity
• Health consequences of obesity
• Obesity and Diabetes
• Obesity and cardiovascular diseases
• Obesity and chronic respiratory diseases

3. Outlines
• Obesity and cancer
• Obesity and Mental illness
• Barriers to prevention
• Recommendations
• Conclusion

4. What is obesity
• Obesity is a medical condition in which excess
body fat accumulates to the extent that it may
have a negative effect on health, leading to
reduced life expectancy and/or increased
health problems

5. Measuring obesity
• For adult-
 BMI ≥ 30 kg/m2
 WC >90cm in male, >80cm in female
 Waist-hip ratio >0.90 (male), >0.85 (female)
 Waist-height ratio (overweight: men, 0.53 to
0.57 and women, 0.49 to 0.53)

6. Measuring obesity (cont..)
• For children <5 years -
Weight to height more than 3 SD than WHO child
growth standard median
• For children of 5 to 19 years-
BMI for age more than 2 SD than WHO growth
reference chart

7. Types of obesity

8. Prevalence of obesity
• According to 2016, WHO updated data 1.9 billion
people are considered as obese who are aged
18 years or above
• According to WHO STEPS survey 2010 in
Bangladesh, the prevalence of overweight and
obesity together constituted 17.6% of the
population, the prevalence was much higher in
women (21.6%) than in men (13%)

9. Causes of obesity
• Several factors are responsible for
obesity-
Behavioral and lifestyle factors
Diseases
Drugs
Genetics

10. Behavioral factors
Unhealthy dietary patterns
Less physical inactivity
Medication use
Easy availability of fast food
Unfavorable physical activity environment
Less education and skills
 Food marketing and promotion

11. Drugs and diseases
• Many diseases like-
 Cushing’s disease
 Polycystic ovary syndrome
 Thyroid and other endocrine disorders
• Many drugs like-
 Steroids
 Antidepressants

12. Mental illness and genetics
• Many mental illnesses like-
Depression
Eating disorders
• Genetics and environmental influences also
play major role (Multifactorial obesity)

13. Health consequences of obesity
• According to CDC obesity affects almost all
organ systems and creates adverse health
effects.
Hypertension
Dyslipidemia
Type 2 diabetes
Coronary heart disease
Stroke

14. Health consequences (cont…)
Gallbladder disease
Osteoarthritis
Sleep apnea, obesity related asthma
Endometrial,breast,colon, liver cancers
Low quality of life
Mental illness
Chronic pain

15. Obesity and Diabetes
• Diabetes mellitus (DM) and obesity have a
complex relationship
• Obesity stands out as a risk factor for Type 2
DM
• Obesity causes insulin resistance and thus it
becomes a precursor for Type 2 DM

16. Type 2 Diabetes
Beta cell failure
Impaired glucose tolerance
Obesity
Genetic predisposition+ Environmental
factors+ sedentary lifestyle

17. Obesity and Diabetes (cont.)
• In the Harvard Alumni Health Study, it was found
that, body weight and high blood sugar level are
directly related and weight gain is a significant
risk factor for development of diabetes mellitus
• Persons with central obesity are more at risk of
developing DM and CVD.

18. Obesity and Diabetes (cont.)
• National health survey, 1995 in US showed that
in white people around 65–75 % of incident
cases of diabetes could be avoided if the whole
population would not exceed a BMI of 25 kg/m2
• Also weight loss of 16% resulted dramatic
reduction in the incidence of type 2 diabetes

19. Obesity and Diabetes (cot.)
• In 2001, NIH Clinical Research Unit, Arizona,
conducted an experimental study to find out
that adults with waist to hip ratio >35.5 in (male)
and >38.5in (female), had impaired glucose
tolerance and hyperinsulenimia
• But having weight reducing diet and physical
excises for 6 months, it became normal

20. Obesity and Diabetes (cont.)
• According to Health Technology Assessment
systematic reviews 2008, for each kilogram of
weight gained annually over a period of
10 years, there is an associated 49% increase
in the risk of developing T2DM in the
subsequent 10 years
• According to WHO reports, 2013, 86% of adults
with T2DM are overweight or obese

21. Obesity and Diabetes (cont.)
• A comparative study conducted by BADAS in
January 2011 to December , found a significant
association between DM and obesity indices
• There women are found more obese than men,
and more prone to developing DM, also younger
people are more at risk than older people

22. Obesity and cardiovascular diseases
• Obesity increases the risk of the development of
cardiovascular events
• Three mechanisms are responsible for obesity
related hypertension and as the consequence
cardiovascular diseases

23. Obesity and cardiovascular diseases
(cont..)
• Activation of the
sympathetic nervous
system
• Activation of the
renin-angiotensin
system
• Sodium retention

24. Obesity and cardiovascular diseases
(cont..)
• The consequence of both obesity and obesity
related hypertension leads are cardiovascular
diseases like Stroke and Myocardial Infraction
• Obesity is related with raised blood lipids, which
in turn causes atherosclerosis, followed by
development of cardiovascular diseases

25. Obesity and cardiovascular diseases
(cont..)
• In Framingham Heart Study, it was found that, a
5% weight gain was associated with a 20–30%
increase in hypertension and ischemic heart
diseases incidence
• Harvard Male Alumni study found a weight gain
of 25 pounds was associated with a 60%
increase in hypertension and cerebrovascular
incidences

26. Obesity and cardiovascular diseases
(cont..)
• DACODA Study 2008 across different ethnic
groups like Chinese, Japanes, Malawi, it was
found that, obese women were at 2 fold risk of
developing CVD in the BMI group of 24.0 - 24.9
kg/m2
• WHO recommends the use of lower BMI cut
points for Asian population

27. Obesity and cardiovascular diseases
(cont..)
• According to WHO STEPS survey,
Bangladesh, 2010, the prevalence of
hypertension is 17.9% in general, 18.5% in men
and 17.3% in women
• A health survey at the year 2015 on 665
students of Rajshahi University aged 22-25 yrs,
reported that a major portion of obese

28. Obesity and cardiovascular diseases
(cont..)
students (52.46%) were pre-hypertensive and
34.43% obese students were stage I
hypertensive patient.
• A meta analysis on CVD risk factors among
Bangladeshi population has found a strong
relationship with increased waist hip ratio and
CVD incidence

29. Obesity and chronic respiratory
diseases
• Obesity is associated with chronic inflammatory
state, and adipose tissue also releases some
inflammatory mediators and causes many
respiratory diseases like-
• Obstructive sleep apnea
• Obesity Hyperventilation Syndrome,
• COPD
• Obesity related asthma

30. Obesity and chronic respiratory
diseases (cont..)

31. Obesity and chronic respiratory
diseases (cont..)
• One of the first reports identifying an association
between symptoms of asthma and overweight
was published in 1984
• In this retrospective study held among British
population the relationship between overweight
and seven respiratory symptoms was found

32. Obesity and chronic respiratory
diseases (cont..)
• A longitudinal study conducted in Tucson
Epidemiologic Study of Airways Obstructive
Diseases in 1999, reported that obesity in
chronic bronchitis is probably because of
sedentary lifestyle and vice versa
• Burden of Obstructive Lung Disease (BOLD)
Initiative, 2008, reported that 54% of the
patients with COPD had a BMI >30 kg/m2

33. Obesity and chronic respiratory
diseases (cont..)
• A cross sectional study in Santos University
Hospital, Brazil, it was reported adolescents
with BMI >30kg/m2, have significant decrease
in lung volume and total lung capacity
• The prevalence of lung disease in obese
people found to be high in the different other
studies, obstructive lung diseases having
predominated

34. Obesity and cancer
• Obese people often have chronic low-
level inflammation, which can, over time, cause
DNA damage that leads to cancer
• A study in 2013, Australia, among post
menopausal women, obese and overweight
women were found to be in two to about four
times risk than normal-weight women to develop
endometrial cancer

35. Obesity and cancer (cont..)
• World cancer research foundation report 2015
reported that, obese people are slightly (about
30%) more likely to develop colorectal cancer
than normal-weight people
• This study also reported that postmenopausal
women, with higher BMI are in modest increase
in risk of breast cancer

36. Obesity and Mental illness
• Obesity and mental illness are interlinked
• Due to psychiatric illness, depression, there is
lack of physical work , poor body image, binge
eating, and anti psychotic medications causes
obesity, again the social situations created by
obesity may also lead to mental illness

37. Obesity and Mental illness (cont.)
• In a longitudinal study in 1997, among US
adolescents, increased BMI was positively
found to be related to depression
• In US healthy survey 2011, it was found that,
15% of the obese men were taking
antidepressants, about the same amount had
some type of sleeping problem

38. Obesity and Mental illness (cont.)
• In 2014, four different national studies across
Europe and Australia, shows that 46%- 79% of
seriously mentally ill individuals have BMI ≥ 30
kg/m2
• In 2013, researchers from Monash University
reported that obese children show signs of
emotional disturbance (23.4%) than non obese
children (14.3%)

39. Barriers to prevention
• For adults-
 Some people may not choose to change their
lifestyle or agree to treatment
 Lack of knowledge about buying and cooking
food, and how diet and exercise affect health
 The cost and availability of healthy foods and
opportunities for exercise

40. Barriers to prevention (Cont.)
 Safety concerns, for example about cycling
 Lack of time
 Personal tastes
 The views of family and community members
 Low levels of fitness, or disabilities
 Low self-esteem and lack of assertiveness.

41. Barriers to prevention (Cont.)
• For children and young adults
• Availability of junk foods near school
• Lack of time
• Lack of confidence and low self esteem
• Scarcity of playground in school and residential
areas

42. Prevention strategies
• Two types of prevention approach can be taken
to prevent and control obesity-
 Population based approach
 Individual based approach

43. population-based prevention

44. Individual-based approach
• Providing information and lifestyle modification
• This part includes providing information about
healthy diet and physical activities
• Aware the person about the consequences of
excessive weight gain

45. Dietary advice
 Adjust portion sizes to age, gender, weight, and
activity level
 Encourage children to eat regular meals
including breakfast
 Encourage intake of low salt foods and limit the
intake of energy-dense foods and fast foods .
 Encourage intake of daily 5 rations of fruits

46. Physical activity
• Children:
 Encourage children gradually to perform at least
60 minutes of moderate to vigorous exercise
daily
 Discourage sedentary behavior of more than
2 hour for children particularly of screen time
 Encourage family approach to physical exercise

47. Physical activity (cont..)
• Encourage adults to do at least 30 minutes of
moderate-intensity physical activity on 5 or more
days a week
• This should be built up over time; start by
walking 10 minutes a day on a few days during
the first couple of weeks then add more time
and days gradually

48. Managing obesity
• This part is appropriate for those who are
already suffering from obesity.
• It includes-
 Taking history and identifying risk factors
 Taking appropriate measurements
 Giving proper dietary advice
 Advising proper physical activities
 Psychological assessments

49. Conclusion
• In conclusion, obesity epidemic a new challenge
to public health professionals as it is one of the
main risk factor for most of the non-
communicable disease
• National and community level as well as
individual level approaches are needed to take
to face this challenge