harj

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Weight Problems
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Overweight Adults UK
Erens Primatesta 1999
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Obese Adults UK
Erens Primatesta 1999
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Rise in Childhood Obesity - UK
Bundred et al, BMJ Feb 2001
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WHO classification of obesityBMI
weight(kg)/height(m)2
WHO Classification BMI Risk of Death
Underweight Below 18.5 Low
Healthy weight 18.5-24.9 Average
Overweight (grade 1 obesity) 25.0-29.9 Mild increase
Obese (grade 2 obesity) 30.0-39.0 Moderate/severe
Morbid/severe obesity(grade 3) 40.0 and above Very severe
World Health Organisation. Obesity Preventing
and Managing the Global Epidemic. Geneva WHO,
1997 3
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Three people have the following heights 1.65m
1.73 m 1.85m

• They each have a BMI of 30.
• Calculate their body masses.

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1.65m 81.7 kg1.73m 89.8 kg1.83m 100.5 kg
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Body fat distributionApple shaped obesity
Women
Men
gt88 cm (80cm) Increased risk
gt102 cm (90cm) Increased risk
Lean MEJ et al. Lancet 1998 351853-6
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Waist Measurement or BMI?
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Causes of Obesity
Energy Expenditure
Energy Intake

• nutritional, activity levels, endocrine,
• genetic, drugs

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The Costs of Obesity

• 4.6 billion pa, UK (2007)
• Direct
• Death, health service expend, drug prescription
  charges, hospital costs,
• Indirect
• Disability, unemployment, early retirement
• 18 million sick days, 40 000 lost years working
  life, obese die 9 years earlier
• Intangible
• Loss self esteem, relationships, pain

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Physical Effects of Obesity
Stroke
Respiratory disease
Cardiovascular
Diabetes
Gall bladder disease
Osteoarthritis
Hormonal abnormalities
Cancer
gout
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Benefits of 10 Weight Loss
Mortality gt20 fall in total mortality gt30 fall in diabetes related deaths gt40 fall in obesity related deaths
Blood pressure fall of 10mmHg systolic and diastolic pressure
Diabetes 50 fall in fasting glucose
Lipids 10 dec. total cholesterol 15 dec. in LDL 30 dec. in triglycerides 8 inc. in HDL
Jung 1997
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Obesity in practice

• GP average has 2000 patients
• 800 overweight adults BMI gt 25
• 320 obese adults BMI gt 30
• 16 morbidly obese adults BMI gt 40
• 30 increase appointments and prescriptions in
  last 10 years
• 95 will see GP in 5 years
• 130 will die of the disease each year

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Men and their trousers

• 50 of men wear their trousers too tight
• only 10 admit to it
• 45 of men thought they were overweight
• 30 hated their stomach most of all
• Prof Steven Gray, NTU, 1999

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Men and weight loss

• Men are reluctant to seek medical advice to lose
  weight, until after they have developed a medical
  problem
• Less than one fifth GP or hospital obesity clinic
  patients are male
• Women are the driving force behind mens health

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Is this man too big for his trousers?
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What about this man..?
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Or this one..?
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The perfect male..?
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and the perfect female??
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WHO April 2001

• Obesity cannot be prevented or managed solely
  by governments (or health professionals). The
  food industry, the media, communities and
  individuals need to work together so that the
  environment is less conducive to weight gain

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Copy this table, and make a list of practical
things each group could do to tackle obesity
Government Food Industry Media Individual




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LDL and HDL formation
Identify stages 1-5
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Atherosclerosis
Collagen fibre
Platelet
Plaque
Red cells
Cholesterol
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Risk of CHD increases if

• Blood cholesterol gt 5 mmol dm-3
• Blood LDLs gt 3 mmol dm-3
• Blood HDL lt 1 mmol dm-3
• Ratio of HDLLDL should be 41 or better

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Worked examples
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What is meant by the prevalence of a disease?
(1)

• Prevalence means
• The number of people in a population with that
  disease.

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Q. What is the prevalence of obesity in England
in 2007 (2)

• (answer from data in table or graph)
• In England in 2007, 17 of men and 21 of women
  were estimated as being obese (BMI gt 30)

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Q. What are the main risk factors for CHD?
(4)

• Diet rich in saturated fatty acids
• Lack of exercise (low PAL)
• BMI gt 30 ( obese)
• Heredity
• Hypertension ( high BP)

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Q. How does a high salt diet lead to
hypertension? (4)

• Salt in the blood lowers water potential
• Water is drawn into blood from tissues by osmosis
• Blood volume increases
• Heart needs to work harder to pressurise this
  volume of blood

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What happens when Energy Intake is lower than
expenditure?
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Anorexic or fashion victim?
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True Starvation a disease called
MARASMUS. What symptoms can you see?
Very thin (skeletal) Papery skin Weak and
Miserable
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Still world-wide malnutritionWHY?
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Kwashiorkor
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Give three recognisable signs of kwashiorkor.
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Prep A4 essay for next week

• Explain the term malnutrition
• You must include the 4 PEM diseases
• Anorexia, Obesity, Marasmus, Kwashiorkor