WHAT IS OBESITY? WHY SHOULD YOU BE CONCERNED?

1. WHAT IS OBESITY? WHY SHOULD YOU BE CONCERNED?

2. OBESITY • TOO MUCH adipose or FAT mass • Increased weight is due to excess fat, not due to excess LEAN mass or muscles 2004 NNHeS: 23.4% Filipinos (BMI > 25)

3. What causes of Obesity? • It is a complex disorder involving chronic excessof food intake (INPUT) relative to the level of energy spent (OUTPUT) Energy intake Energy output

4. Energy Imbalance Food Intake Energy Expenditure

8. Contributors to obesity: • Genetic/ Familial • Hormonal abnormalities • Abnormal chemistry in the • body • Cultural factors • Psychosocial factors

9. Nature of Obesity • Inheritance may influence body weight/ mass • Environment: key role (nurturing patterns) • Lifestyle patterns • Too much energy-dense food (high fat diet or simple carbohydrate-rich food) • Decreased opportunities and motivation for physical activity (escalators, elevators, etc) • Unhealthy diet • Physical inactivity

11. BODY MEASUREMENTS • Body Mass Index • Weight (kg) / Height (m2) • [Weight (lbs.) / Height (in2)] x 703 • WAIST circumference • Waist to Hip Ratio • Skin-fold thickness • Underwater weighing • CT scan/ MRI

12. BODY MEASUREMENTS

13. WHY is it bad to become OBESE?

14. EFFECTS ON HEALTH • Obesity has major bad effects on the body • Up to twelve-fold increase in death • Related to increased fat within the abdomen/ tummy or visceral fat • Effect of obesity on different parts of the body can vary from one person to another

15. Heart disease Type 2 diabetes mellitus Hypertension Stroke Certain types of cancer (endometrial, breast, prostate, colon) Dyslipidemia Gallbladder disease Sleep apnea and other respiratory problems Reduced fertility Osteoarthritis Increase in all-cause mortality Emotional distress Discrimination Social stigmatization COMPLICATIONS OF OBESITY

16. LUNG DISEASE • EFFECTS: • decreased chest wall movement • difficulty of breathing • Obstructive Sleep Apnea “Pickwickian”

17. REPRODUCTION • Difficulty in having a baby/ infertility • Higher risk of cancer

18. GASTROINTESTINAL SYSTEM • Gallstones: cholesterol stones • Higher mortality from CANCER of the esophagus, colon, rectum, pancreas, liver, gall bladder, bile ducts

19. BONES, JOINT & SKIN • Increased traumatic osteoarthritis • Gout • Varicose veins

20. OBESITY & DIABETES TYPE 2 • High blood sugar due to the effect of lack of Insulin • OBESITY is a major risk factor: 80% of patients who are obese have diabetes • Modest weight loss improves insulin sensitivity and glucose control

21. HEART DISEASE • OBESITY can lead to heart disease • Among Asians, a BMI as low as 23 kg/m2 increases risk for heart disease and Diabetes • Abdominal obesity is linked to high fats in the blood

22. THE METABOLIC SYNDROME HIGH BLOOD PRESSURE DIABETES HIGH CHOLESTEROL The metabolic syndrome is a silent killer Brought about by OBESITY

23. The metabolic syndrome is a silent killer: patients need effective treatment • Affects nearly 1 in 5 men and 1 in 4 womenand is increasing1 • Two times as likely to die from HEART DISEASE2 • Risk of heart attack and stroke is threefold

24. HEALTH IMPLICATIONS In children and adolescents: • Potential adverse psychologic and emotional consequences • Social stigmatization • Precipitation of eating disorders • Weight loss does not impair linear growth and normal development

25. GOALS • Body weight reduction by 5 to 10% from baseline over a 6-month period to achieve a healthy weight • Weight reduction of 1 to 2 lbs per week for six months is physiologic and healthy

27. DIETARY THERAPY • Reduction in the total amount of food intake for overweight and obese patients is the cornerstone of treatment. • Fat reduction is a practical way to reduce calories • Reducing dietary fat alone without reducing total amount of food intake is not sufficient • There is no scientific evidence in clinical trials supporting fad diets.

29. PHYSICAL ACTIVITY • Exercise contributes modestly to weight loss • May decrease abdominal fat • Increases fitness of the heart • May help maintain weight loss

30. EXERCISE & SPORTS

31. EXERCISE & SPORTS

32. EXERCISE & SPORTS

33. PHYSICAL ACTIVITY • Should be an integral part of weight loss therapy and weight maintenance • Encourage moderate levels of activity for 30 to 40 min/day, 3 to 5 days/week • Set a long term goal • Accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all days of the week

34. BEHAVIORAL THERAPY • Useful adjunct to diet and physical activity • Behavior strategies to promote diet and exercise should be used routinely • Monitor situations that lead to excessive eating

35. MEDICINES • Lifestyle therapy should be considered before the use of pills or Weight loss drugs . But it may be used as part of a comprehensive weight loss program • ONLY medicines prescribed by doctors based on verified evidences should be taken

36. MEDICINES • Avoid use of drugs without accompanying lifestyle modifications • Assess drug safety and efficacy continually • Discontinue use • if the drug is ineffective in weight loss or weight maintenance • Serious adverse events

37. SURGERY • Option in carefully selected patients: NIH • Clinically severe obesity • BMI  40 kg/m2 • BMI  35 kg/m2 with comorbid conditions • When less invasive methods have failed • at eligible weight for 3 – 5 years • can tolerate surgery • absence of alcoholism, psychiatric illness, addiction • Clearance by a psychiatrist

38. The Philippine College of Physicians wishes to acknowledge the following for their invaluable efforts in the preparation of this module Aimee Andag-Silva, MD Rosa Allyn G. Sy, MD Committee on Advocacy & Public Relations Philippine Society of Endocrinology and Metabolism