Obesity may be defined as “an abnormal growth of the adipose tissue due to an enlargement of the cell size (hypertrophic obesity) or an increase in fat cell number (hyperplasic obesity) or a combination of both.

1. Epidemiology & Control measures for
Obesity
AB RAJAR
ASSOCIATEPROFESSOR
COMMUNITYHEALTHSCIENCES.
MuhammadMedicalCollege

2. INTRODUCTION
• Obesity may be defined as “an abnormal growth of the
adipose tissue due to an enlargement of the cell size
(hypertrophic obesity) or an increase in fat cell number
(hyperplasic obesity) or a combination of both.

3. Key Facts 2016 !!!
• Worldwide obesity has nearly tripled since 1975.
• 1.9 billion adults,(2016) 18 years and older, were overweight. Of
these over 650 million were obese.
• 39% of adults aged 18 years and over were overweight in 2016, and
13% were obese.
• 38 million children under the age of 5 were overweight or obese in
2019.
• Over 340 million children and adolescents aged 5-19 were overweight
or obese in 2016.

4. Childhood Obesity
• Rates of childhood obesity are alarming
• Problem is worldwide
• Estimated in 2010 42 million children under age 5 are considered
overweight
• Tripled in past 30 years
• Age 6-11 6.5% to 19.6%
• Age 12-19 5.0% to 18.1%

5. Classification
• A. Etiopathogenetic.
• Primary
• Secondary.
• B. Pathologic – anatomy.
• Hypertrophic form
• Hypertrophic-hyperplastic form.
• C. According fat distribution
• Android type (Apple shaped)
• Gynoid type (Pear shaped)

6. Classification
• C. ACCORDING FAT DISTRIBUTION
 1. Android type (apple shaped)
– fat localized in trunk and in abdominal cavity
– risk of DM, AMI, brain ischemia, other diseases of CVS
 2. Gynoid type (pear shaped)
– fat localized at gluteal part, at thighs
– risk of joints damage, mainly

7. Android v Gynoid

8. Epidemiological Determinants
• Age:
• Occur at any age
• Sex:
• Increase in female
• Genetic factors:
• Positive relation ship
• Physical inactivity :
• Positive relation ship

9. Epidemiological Determinants
• Eating Habits:
• Eating b/w the meals , preference to sweets refined food and fat.
• Beverages marketing , fashion ,convince
• Psychosocial Factors:
• Anxiety, depression leads to over eating
• Family History:
• Positive relation ship

10. Epidemiological Determinants
• Endocrine factors:
• Cushing Syndrome, Growth Hormone deficiency
• Alcohol:
• Positive relation ship
• Education:
• Inverse relation ship
• Drugs:
• Corticosteroid, Contraceptive, Insulin, Beta blockers

11. Use of BMI to classify the Obesity
• BMI index of weight for height
• BMI used for classify the obesity:
i. Under weight
ii. Overweight
iii. Obesity

12. Classification of Obesity
Classification BMI Risk
Under weight <18.50 Very Low
Normal Range 18.50-24.99 Low
Over weight >25.00 Average
Pre-obese 25.00-29.99 Increase
Obese class 1 30.00-34.99 Moderate
Obese class 11 35.00-39.99 Sever
Obese class 111 >40.00 Very sever

13. INTRA ABDOMINAL (CENTRAL) FAT ACCUMULATION

14. Intra Abdominal (Central) Fat Accumulation
• Compare to S/C adipose tissue, intra abdominal adipose tissue has
more cell per unit mass higher Body Fat, high receptor for
glucocorticoid and greater catecholamine induce lipolysis
• These make highly sensitive
• Intra abdominal adipose tissue located upstream from liver in the
portal circulation lead increase efflux of lipid for liver

15. Assessment of Obesity
• Body weight
• Skin fold thickness
• Waist circumference and waist Hip Ratio
• Others

16. Body Weight
• Not an accurate measure of excess fat
• It is conventional to accept +2 SD from the median weight
• BMI (Qutelets Index) and Brocca Index are widely used index

17. Body Weight
• Other indicator
I. Ponderal Index
II. Lorents formulae
III. Corpulence Index

18. Assessment of Obesity
• BMI (Qutelets Index):
• BMI =
𝑊𝑒𝑖𝑔ℎ𝑡 (𝐾𝐺)
𝐻𝑒𝑖𝑔ℎ𝑡2 (𝑚)
• Ponderal Index:
• Ponderal Index =
𝐻𝑒𝑖𝑔ℎ𝑡 (𝑐𝑚)
𝐶𝑢𝑏𝑒 𝑟𝑜𝑜𝑡 𝑜𝑓 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 (𝑘𝑔)

19. Assessment of Obesity
•Lorents formulae:
• Lorents Formulae =
𝐻𝑒𝑖𝑔ℎ𝑡 𝑐𝑚 −100 −𝐻𝑒𝑖𝑔ℎ𝑡 𝑐𝑚 −150
2 𝑤𝑜𝑚𝑒𝑛 𝑜𝑟 4 𝑚𝑒𝑛
•Corpulence Index:
• Corpulence Index =
𝐴𝑐𝑡𝑢𝑎𝑙 𝑊𝑒𝑖𝑔ℎ𝑡
𝐷𝑒𝑠𝑖𝑟𝑎𝑏𝑙𝑒 𝑤𝑒𝑖𝑔ℎ𝑡
• This should not exceed 1.2

20. Brocca Index
• Brocca Index
• Brocca Index= Height (cm) minus 100
• For example if a person height is 160 cm
• His ideal weight 160-100=60kg

21. Assessment of Obesity
• SKIN FOLD THICKNESS:-
• It is rapid and non invasive
• Large proportion of fat store in just under the skin
• The measurement are taken at all four sites
• Mid Triceps, Bicep, suprascapular, supra illac region
• Less then 40mm in boys and 50 mm in girls

22. Assessment of Obesity
• WAIST CIRCUMFERENCE AND WAIST HIP RATIO:-
• Waist circumference measure at mid point b/w the lower boarder of
the rib cage and the illac crest
• Approximate indicator of abdominal fat and total fat
• Increase Waist circumference , increase CV risk and other form of
chronic diseases

23. Assessment of Obesity
• OTHERS TECHNIQUES:-
• COMPLEX, NOT USED FOR CLINICAL AND EPIDEMIOLOGICAL
PURPOSE
I. Measurement of total body water
II. Measurement of total body potassium
III. Measurement of body density

24. Hazard of Obesity
• INCREASE MORBIDITY :-
• Obesity is a positive risk factor in the development of HTN. Diabetes,
gall bladder diseases ,coronary heart diseases and other from of
cancer
• Risk factor of varicose vein, abdominal hernia, Osteoarthritis of knee
and hip
• Increase risk in surgery
• Lower fertility

25. Hazard of Obesity
• INCREASE MORTALITY :-
• Due to Hypertension, Coronary Heart Diseases
• Causes lower life expectancy

26. PREVENTION AND CONTROL

27. Nutrition
• NUTRITION COUNTS!
• Nutrition is everything! Healthy foods, fruits, vegetables,
legumes…a colorful diet is best!
• Low sugar, low fat
• Play an hour a day!

28. Fruits and Vegetables
• WHO states:
• Fruits and vegetables need to be part of the daily diet to
prevent disease such as obesity and non communicable
disease
• The statistics are startling
• Lack of enough fruits and vegetables cause
• 19% of GI deaths
• 31% of Ischemic heart disease
• 11% of stroke

29. How much fruit is enough?
• WHO recommends at least 400 gms of fruit and
vegetables each day…
• This will prevent chronic disease related to
overweight and obesity
• Heart disease
• Diabetes
• Cancers

30. Prevention and Control
• WEIGHT CONTROL:-
• Weight control is widely defined as approach to marinating weight
with in the healthy range of BMI 18.5 to 24.9 kg /m2
• Prevention of weight control should begin in early childhood
• Obesity is harder to tear in adults
• Control can by dietary change, increase physical activity, and
combination of both

31. Prevention and Control
• DIETARY CHANGE
• Proportion of energy dense food should be reduce
• Increase fiber diet
• Intake is not great then demand
• Modification of human behavior

32. Prevention and Control
• Increase physical activity
• Appetite suppression drug
• Health education

33. Essential Understandings
• It is well known that obesity is preventable. It is caused by
eating more than we need…so how can we prevent obesity?
• Each of us can…according to WHO
• Have a balance of energy and healthy weight
• Limit how much fat we eat…we need to eat some. But not too much.
• Increase fruits and vegetables
• Limit sugars
• Increase exercise to at least 30-60 minutes per day on most days!

34. FINAL DECISION