Chronic Diseases

1. EPIDEMIOLOGY OF
OBESITY

2. Background
■ One of the most commonest expression of unhealthy diet often combined with lack
physical activity.
■ Indeed we are amidst an epidemic of obesity.
■ Over the past few decades there has been dramatic rise in the prevalence of obesity
throughout the world including India.
■ It is estimated byWHO that globally over 1 billion (16%) adult are overweight and 300
million (5%) are obese.
■ In india prevalence of obesity among women is 12.6% & 9.3% in men. In other words
more than 100 million individuals are obese in India.

3. The human phenotype is changing rapidly
Increased body size and fatter body composition
Response to environments that make low demands on
energy expenditure, together with greater energy-
density diets
This change is occurring within one to three generations,
around the world
Not entirely an urban phenomenon, but more pronounced in
big cities

4. India : Double Burden of Disease
Under nutrition due to Poverty 30 % below BPL
Over nutrition and Obesity 5-7% MIG and HIG Urban area
This is most productive workforce
of the country Academics/Planners/
Administrators/ Professionals
SHOULD BE GIVEN PRIORITY
Current scenario: Global & India

5. Author Year
of
Study
Country/
State
Criteria
used
Prevalence
of over-
weight
(M/F)
Prevalence
of obesity
(M/F)
Gopinath et.al 1994 Delhi BMI>25 21.3% (M)
33.4% (F)
INA
Singhal et al 1998 Jaipur BMI>25 14.6% (M)
6.6% (F)
INA
Asthana et al 1997 Varanasi BMI>25 30.2% (F) INA
Chadha et al 1997 Delhi BMI>25 20.7 (M)
32.6% (F)
INA
ObesityTrends in India : Recent studies:Adults

6. Author Year
of
Study
Country/
State
Criteria
used
Prevalence
of over-
weight
(M/F)
Prevalence
of obesity
(M/F)
Singh et.al 1999 5 Cities BMI>23
BMI>25
BMI>27
50.9% (F)
Vasanthanani 2000 Coimbatore BMI>30 36.0% (M)
Mohan et al 2000 Chennai BMI>25 38.0% (M)
33.1% (F)
Easwaran et al 2001 Coimbatore BMI>25
BMI>24
65.0% (M)
65.0% (F)
Gupta et al 2002 Jaipur BMI>27 24.5% (M)
30.2% (F)
NFHS-II 1998-
99
India BMI>25 8.6% MIG
27.2 HIG
ObesityTrends in India : Recent studies

7. Survey Normal (%)
BMI 18.5-25
Obese (%)
BMI>25
NNMB (75-79) 48.8 3.4
NNMB (88-90) 46.6 4.1
NNMB (94) 46.3 6.6
NNMB Slum (93-94) 51.7 11.6
Trends in Body Mass Index of Adult Women
Body Mass Indix (BMI) is defined as weight (kg)/height² (m)

8. ObesityTrends in India : Recent studies
Children
S.No Author Name State/
country
Prevalence of
obesity
1.* Umesh Kapil
etal, 2001
Delhi
(India)
8% boys
6% girls
2.** Vedavati S etal,
1998
Chennai,
India
6% obese
1.* Indian Pediatrics, 2002 May, 17: 449-452
2.** Indian Pediatrics, 2003 Aug, 40: 775-779.

9. Obesity Trends* Among U.S. Adults
BRFSS, 1990
*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person
No Data <10% 10%–14%
http://www.cdc.gov/nccdphp/dnpa/obesity/

10. Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

11. Obesity Trends* Among U.S. Adults
BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

13. What are the determinants of obesity?
■ Obesogenic environment:
– Affluent lifestyle, sedentary home environment, vanishing old family tradition and
cultures, energy rich food, lack of exercise & out door activities.
■ Age:
– Incidence increasing with age till age of 60 due to hormonal and other biological
changes in a body.
■ Gender:
– Females are more likely to prone as compare to male due inherent physiological
factors.
■ Ethinicity:
– Unexplained variation are prevalent in different ethnic groups.

14. ■ Educational level:
– In India it is seen that educated people are more likely to be obese compared to less
educated, as they are more likely to be affluent but in western countries it is revers
as educated people are more likely to be aware and concern about health problems.
■ Income:
– Directly proportional of income in India.
■ Marital status:
– Obesity is more among married people.
■ Parity:
– Women with more parity are likely to be obese.
■ Diet:
– Diet rich in fat, sugar & refined food is responsible for obesity.
What are the determinants of obesity?

15. ■ Smoking:
– Smoking per se reduces obesity by virtue of Nicotine being an anorexic agent.
■ Alcohol:
– Alcohol provides 7Kcal/gm double than the carbohydrate and more over snacks
consumed along with alcohol provide additional calories.
■ Physical inactivity:
– High physical activity is a vital component to keep high fat & obesity under check.
What are the determinants of obesity?

16. ■ Increased energy intake
■ Passive over eating: Physiological hunger & psychological hunger.
■ Binge eating
■ Decreased energy expenditure
■ Metabolic factors: Cushing’s syndrome, hypothyroidism etc.
■ Genetic factors
■ Fetal programming: Barker’s hypothesis
What are the causes of obesity?

17. Critical period of obesity
■ Age range of 12 to 18 months
■ Age range of 12 to 16 years
■ During pregnancy
Quantification of Obesity:
■ BMI: weight (Kg)/Height (m)2
■ Waist circumference: 90 cm for men & 80 cm for women
■ Waist-Hip ratio: <0.9 for men & <0.8 for women
Types of Obesity
■ Gynoid / pear shaped: Fat evenly distributed
■ Androd / apple shaped: Fat is deposit centrally or on abdominal region.

18. Risk factor for Non Communicable Diseases
 Cardiovascular diseases
CAD, CHF, Stroke
 Insulin Resistance and
Type-2 Diabetes Mellitus
 Reproductive disorders
 Pulmonary diseases
 Gall stone disease
 Cancer- Colon, Rectum, Prostate-Male
 Gall stone–bile duct, breast, endometrium
cervix, ovary- Female
 Bone: Joint and skin diseases
 Oesteoprosis
 Mental Health
 Psychological
well being
 Accidents
 Muscloskeletal
injuries
Obesity
Hazards of obesity

20. Diabetes
Gall bladder disease
Hypertension
Dyslipidaemia
Insulin resistance
Breathlessness
Sleep apnoea
Greatly increased
(relative risk >>3)
Coronary heart disease
Osteoarthritis (knees)
Hyperuricaemia and
gout
Moderately increased
(relative risk
ca 2-3)
Cancer (breast cancer in
postmenopausal women,
endometrial cancer, colon
cancer)
Reproductive hormone
abnormalities
Polycystic ovary syndrome
Impaired fertility
Low back pain
Increased anaesthetic risk
Foetal defects arising from
maternal obesity
Slightly increased
(relative risk
ca 1-2)
Relative risk of health problems associated with
obesity in developed countries.

21. High Prevalence of Metabolic Syndrome
(Syndrome X)
Hypertension
Increased Insulin Resistance
Central Obesity
Dyslipidemia

22. Obesity and Mortality
Morbidly obese individuals (more than 200% ideal
body weight) have as much as a twelve fold
increase in mortality

23. Source: Bray GA. 1992. AJCN; 55; 488S-94S

24. Obesity and Diabetes
As many as 80% of patients with type-2 diabetes
mellitus are obese

26. 4% 4-6% 6% n/a
Source: Mokdad et al., Diabetes Care 2000;23:1278-83
Prevalence of Diabetes among U.S.
Adults, BRFSS, 1993-94

27. Prevalence of Diabetes among U.S.
Adults, BRFSS, 1997-98
4% 4-6% 6% n/a
Source: Mokdad et al., Diabetes Care 2000;23:1278-83

28. Obesity and Diabetes
Mild obesity Two fold risk of Diabetes
Moderate obesity Five fold risk of Diabetes
Severe obesity Ten fold risk of Diabetes

29. Indian Scenario : Diabetes
Between 1988 and 2000, there was a 70%
increase in the prevalence of Diabetes
in the city of Chennai
The recent study document a prevalence of
13% in adults

30. Possible Reasons:
Average per capita energy ( Kcals ) intake as per expenditure
classes , India
Expenditure
Classes
Urban
(1972-73)
Urban
(1993-94)
Lower 30% 1579 1682
Middle 40% 2154 2111
Top 30% 2572 2405
Source: NSSO, 1997

31. Average daily per capita dietary intake of Fats in India
Year Fat (g)
Rural
Fat(g)
Urban
1972-73 24 36
1983 27 37
1993-94 31.4 42
1999-2000 36.1 49.6
Source: NSSO 2001

32. Life style changes between 1972-2000
Increase in Sedentary Life style
Decrease Physical activities
Intake of calories remaining same
Increase in Fat intake
Most manual jobs have been replaced by mechanized
jobs
Transportation to school /work place universally by
use of motor car/Bus/Bicycles
Increase in hours for activities :TV viewing/ Computer

33. Role of Physical Activity
According to WHO at least 30 minutes of cumulative moderate
exercise (equivalent to walking briskly) for all ages plus for children ,
an additional 20 minutes of vigorous exercise ( equivalent to running)
three times a week .
(These recommendations are basically for prevention of CHD).
The prevention of obesity may require combination of both :
more Physical Activity and Dietary interventions.

34. Body Mass Index
RelativeRisk
Women
Willett, Dietz & Colditz, N.E.J.M. 1999. 341, 426-434
BMI in relation to morbidity over 18 yearsBMI in relation to morbidity over 18 years
Aged 30-55 at start.
1
2
3
4
5
6
0
<21 22 23 24 25 26 27 28 29 30
Type 2 diabetes
Cholelithiasis
Coronary Heart Disease
Hypertension

35. How to prevent?
■ “Most obese people won’t enter treatment, most who do
won’t lose weight and most who lose weight regain it”.
- Stukard

36. Prevention
■ Universal prevention:
– Targeted towards all the individual in the community irrespective of their weight.
– Measures like health diet, physical activity, shunning sedentary life style forms as
strategy. Nutrition education also plays vital role.
■ Selective prevention:
– High risk individuals are targeted. Adolescent, pregnant, middle aged and those
with sedentary life style consuming high energy food under psychological stress.
■ Indicated prevention:
– Secondary prevention for those with existing problems of overweight & obesity.

37. How to reduce weight?

39. Likely questions
■ LAQ:
– Describe epidemiology of obesity. How would you advice a middle aged man of 90
kg and 170 cm tall to reduce wt.?
– Discuss principles of a healthy diet in context of lifestyle diseases.
■ SAQ
– Fad diet
– Food pyramid
– BMI
– Benefits of wt. loss