Obesity Public Health Overview

Obesity

• Obesity is a global epidemic, and a significant public health concern.
• It's more than just a cosmetic issue; it leads to malnutrition and significant morbidity and mortality.
• Body Mass Index (BMI) is a measure used to assess obesity. BMI is calculated by dividing weight in kilograms by height in meters squared.
• Weight categories based on BMI:
  • Normal: BMI 18.5-24.9
  • Overweight: BMI 25-29.9
  • Obese: BMI 30-34.9
  • Severely Obese: BMI 35-39.9
  • Morbidly Obese: BMI ≥40

Causes of Obesity

• Overconsumption of low-nutrient, high-calorie foods.
• Inadequate intake of nutrient-dense foods (vegetables, dairy, legumes, whole grains, fish, nuts).
• High-fat diets with low vitamin C and folate.
• Insufficient sun exposure resulting in low vitamin D levels.
• Low-grade chronic inflammation.
• Type-II diabetes can increase renal hyperfiltration, resulting in micronutrient loss.

Complications of Obesity

• Numerous health complications arise from obesity due to heightened risk for various illnesses.

Treatment Options

• Lifestyle modification (diet and exercise)
• Nutritional interventions
• Drug therapy
• Metabolic surgery

Lifestyle Modifications

• Healthy eating habits (fruits, vegetables, whole grains)
• Increased physical activity (walking, biking, etc)

Physical Activity

• 10,000 steps per day is recommended.
• 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity weekly.
• Pre-exercise evaluation is vital for some high-risk individuals.

Dietary Approaches

• Low-fat, low-calorie diet
• High-protein diet
• Low glycemic index diet
• Combined high-protein/low glycemic index approach
• Moderate fat diets (Mediterranean diet)
• Newer dietary approaches

Medications

• Orlistat (Xenical)
• Liraglutide (Saxenda)

Management Options

• Dietary and behavioral modification

• Exercise

• Pharmacotherapy

• Pharmacotherapy (drugs) generally has poor long-term results, especially in morbid obesity.

Metabolic Surgery

• Roux-en-Y gastric bypass (RYGB)
• Vertical sleeve gastrectomy (VSG)

Obesity Paradox

• Understanding the nuances of obesity and its association with contradictory health outcomes.

Eating Disorders

• Eating disorders encompass a range of mental health conditions associated with extreme or compulsive behaviors relating to eating.
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder

Anorexia Nervosa

• A condition characterized by self-induced starvation resulting in significant weight loss.
• Three main criteria:
  • Self-induced starvation
  • Intense fear of weight gain
  • Distorted body image
• Physical symptoms may include:
  • Weight loss of 15% below ideal weight
  • Amenorrhea
  • Cachexia
  • Sunken eyes
  • Dry skin

Binge Eating Disorder

• Recurrent episodes of eating unusually large amounts of food over a short period with a lack of control.
• Physical symptoms: weight gain, bloating , fullness, lethargy, salivary gland enlargement.
• Mental health symptoms: guilt, depression, anxiety

Bulimia Nervosa

• Binge eating followed by compensatory behaviors (purging) to prevent weight gain or control body image.
• Physical effects:
  • Dehydration
  • Enlarged salivary glands
  • Electrolyte imbalance
  • Inflammation of the esophagus
  • Constipation

Eating Disorder Treatment

• Addresses these areas:
  • Medical and health problems
  • Self-esteem and self-confidence
  • Psychological effects
  • Nutritional needs
  • Interpersonal relationships