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Obesity

Obesity. “PERSONS WHO ARE NATURALLY FAT ARE APT TO DIE EARLIER THAN THOSE WHO ARE SLENDER”. Hippocrates Father of Medicine (460 - 377 BC). Classifications. A few statistics. NOTE: Incidence of obesity was 7% in 1980. And it is still on a rise!!. Obesity as a public health issue.

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Obesity

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  1. Obesity

  2. “PERSONS WHO ARE NATURALLY FAT ARE APT TO DIE EARLIER THAN THOSE WHO ARE SLENDER” Hippocrates Father of Medicine (460 - 377 BC)

  3. Classifications

  4. A few statistics NOTE: Incidence of obesity was 7% in 1980 And it is still on a rise!!

  5. Obesity as a public health issue • Total financial cost in 2005 was $3.767 billion • Direct financial cost to Aus health system (23%) • Costs associated with: • Productivity loss (45%) • Carers (21%) • Deadweight loss from transfers egwelfare payments (10%) • Over 60% of these costs are borne by governments and society • Burden of disease – measured in DALYs • Dollar value calculated at $17.1 billion

  6. Contributing Factors Genetics Other • Genetic influences account for 70% of difference in BMI in later life (twin studies) • Ob gene (chromosome 7) • Produces leptin (peripheral appetite suppressant) • Rare genetic condition where no leptin is produced • Thrifty gene hypothesis?? • Feast and famine cycles • Socioeconomic • Clear link with lower socioeconomic groups • Behavioural • Clear link with high levels of TV watching • Cultural • Environmental • Psychological • Issue with obese patients eating more than they admit to eating • Metabolic

  7. Medical Causes • Hypothyroidism • Cushing’s Syndrome • Insulinoma • Hypothalamic Injury • Head injury • Surgery • Infections • But these are relatively uncommon!

  8. Physical Consequences of Obesity

  9. Management of weight - Individuals • Dietary control – reduction in calorie intake • Common diets allow approx 1000kcal (4200kJ) • Very low calorie diets only ever advocated for short periods eg to lose weight for surgery • Needs to be permanent change in eating habits to maintain low weight • Success rate in moderate obesity less than 10% • Exercise • Should accompany diet control • Alone, it provides little long term benefit

  10. Management - Individuals • Behavioural Modification • Encourages patient to take responsibility for changing lifestyle • Time consuming and expensive • Drug Therapy • Multiple hormones/neurotransmitters involved – therefore redundancy – only modest effect • Weight gain when stopped • Eg. Orlistat (pancreatic and gastric lipase inhibitor) • Eg.Sibutramine (acts on serotoninergic and noradrenergic pathways)

  11. Management - Individuals • Surgery • Only used in cases of morbid obesity • Number of different options including gastric banding and gastric bypass (depends on size of pt) • Standard Criteria • BMI 40 – 70 (less than 250kg) • BMI > 35 plus significant comorbidities, DM, sleep apnoea (but not too sick) • Age 18-60 yrs • Previous attempts to lose weight over 5 years

  12. Management - Population • Educational Campaigns • BUT have been found to be not very effective (egMinnesota heart health program) • Too many negative messages – junk food ads!! • Exercise Campaigns • BUT amount of in school exercise does not have impact on total exercise in children • Biggest aim – is to change attitudes young! • No form of primary prevention has been very successful yet

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