Obesity Presentation PDF

Obesity and Diet Therapy Obesity? Obesity An excess accumulation of fatty tissue  How to diagnose ESITY B O ?  Body Mass Index BMI = Weight (kg)...

Obesity and Diet Therapy Obesity? Obesity An excess accumulation of fatty tissue  How to diagnose ESITY B O ?  Body Mass Index BMI = Weight (kg) Height (M)² EX. 150 Kg. (1.72)² = 50 = BMI 1.72 meters http://a666.g.akamaitech.net/7/666/175/2004011512/cache1.jcpenney.com/images/thumbnail/0900631b8089e1f2T.jpg 150 KG 0 centimeter Cases where BMI is not applied: 1- athletes and weightlifters, as their body mass rate is high as a result of increased muscle weight and not fat weight, and therefore the body contents analysis device must be used to question the weight of fat and not body mass. 2- Pregnant & lactating women, children  2-Triceps skin fold thickness ( calliper device) ‫سمك الجلد في منتصف الجزء العلوي الخلفي من الذراع‬ More than 19-18mm Male More than 25-26mm Female 3- Waist circumference More than 102 cm (Male), 88 cm (Female) 4- Total fat can be estimated by: = Waist to Hip Ratio ‫محيط الوسط بالنسبة الي محيط األرداف‬ Less than 0.9 (male) Normal Less than 0.8 (female) Normal More than these percentage ( obesity ) Growth charts are used to determine the obesity among children  Fat Per cent dy ag o B e  A person’s body fat percentage can be indirectly estimated by using the Deurenberg equation, as follows: Body fat percentage = 1.2(BMI) + 0.23(age) - 10.8(sex) - 5.4 With age being in years and sex being designated as 1 for males and 0 for females. This equation has a standard error of 4% and accounts for approximately 80% of the variation in body fat.  Some authorities advocate a definition of obesity based on percentage of body fat, (imbody analysis) as follows: Men: Percentage of body fat greater than 25%, with 21- 25% being borderline Women: Percentage of body fat great than 33%, with 31-33% being borderline Males Females Low Ideal Moderate Obese Low Ideal Moderate Obese 6- 11- 18- > 25% 14- 19- 23-30% > 30% 10% 17% 20% 18% 22%  Some research has indicated that The size of fat varies according to its location. Fat in the abdomen and visceral area is larger, less numerous, and easier to respond when following a diet. In contrast, fat in the hip area is smaller and more numerous, which requires additional effort to respond. Number & size of fatty acids  What are the Factors Influencing Obesity? Energy imbalance ( out & input of calories) Hormonal disturbances (↓T3, T4, TSH↑) (hypothyroidism), Insulin Resistance, leptin ‫الشبع‬ resistance, ghrelin ‫( الجوع‬excess increase feelings of hunger). Genetic factors Physiologic factors (Lack of balance between hunger and satiety Psychologic factors Birth control pills Bad Food habits Increased intake of soft drinks, fried foods and fast food Pregnant & lactation  hunger hormone’ because it stimulates appetite Leptin resistance causes you to feel hungry Obesity Related Health Problems  Short Term Health Problems Dial Blood Pressure Monitor with separate Stethoscope High Blood Pressure High Cholesterol High Triglycerides  Long Term Health Problems (52 kBytes) Arthritis Cardiovascular Disease Diabetes Gallbladder Disease  esity Ob Treatment Before starting any slimming program, take into account: 1- Knowing the height, weight, thickness of the skin layer at the triceps muscle, the circumference of the hip, the waist circumference (to diagnose and determine the type of obesity) 2- The food habits and dietary life style 3- 24h recall and is analyzed using food analysis tables to find out the amount of calories taken in the day 4- Comprehensive examination: - Picture of lipid profile (TC, TG, HDL, LDL) - analysis of thyroid hormones T3, T4, TSH - blood sugar - measurement of kidney function (if using a high-protein diet) - inbody analysis - analysis of metabolism  Treatment Dietary Therapy Physical activity Fasting/intermitting Behaviour modifications Surgery (morbidity) Drugs (diuretics, laxative, anorexigenic agents) 1- hypocaloric diet (- 500 cal/d or 1000/ d) 2- A high protein diet (30-35%) 3- High fiber diet (25g/d)  Dietary Advices: Decrease energy dens food & beverages Decrease food portions Avoid extra and unhealthy snacks Don’t skim[ breakfast and avoid eating at night Manage emotional eating Energy restriction should be individualized according to nutritional habits, level of physical activity, comorbidities, and previous dieting attempts Healthy Meal Planning Don’t forget when putting a meal plan that our aim is maintaining health and prevention or treatment of obesity related diseases. Key principles: Adequacy Balance Variety Carb. 45 to 55% Protein: 20 to 25% Fat : not exceed 25% of total calories Side effects of severe caloric restriction (800 calories/ day): hypotension Decrease in Muscle mass Easy fatigability Cold intolerance Dry skin Hair loss Menstrual irregularity Cholecystitis  High Fiber / Low Carb Diets & Mediterranean Diets A low-carb diet limits carbohydrates — such as those found in grains, starchy vegetables and fruit — and emphasizes foods high in protein and fat. Many types of low-carb diets exist. Each diet has varying restrictions on the types and amounts of carbohydrates that can be eaten. A low-carb diet is generally used for weight loss. Some low-carb diets may have health benefits beyond weight loss, such as reducing risk of type 2 diabetes and metabolic syndrome.  High Fiber / Low Carb Diets & Mediterranean Diets Fats Protein CHO 35 % 15 % 50 % Should be from healthy Avoiding Including fruits, sources (PUFA, MUFA) processed and vegetables and including Nuts, olive oil fatty meats whole grains. and oily fish  Ketogenic Diet The ketogenic diet is a very low carb, high fat diet. It involves drastically reducing carbohydrate intake and replacing it with fat. This reduction in carbs puts body into a metabolic state called ketosis. When this happens, the body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain. Ketogenic diets can cause significant reductions in blood sugar and insulin levels. This, along with the increased ketones, has some health benefits.  Ketogenic Diet Fats Protein CHO 55-60 % 30-35 % 5-10 % As a Nutritionist, you have to be careful when providing your patient this large amount of fats. Although it’s not easy, but fats should be healthy ones to avoid Hyperlipidemia.  Remember Use Various Treatment Components Together  Behavior Modification Four Distinct Phases Describing the behavior to be modified Replace established behavior with new Develop technique to control behaviors Using rewards for success  Modifying Eating Behaviors ❖ Change where and why patient eat ❖ Know the body’s triggers that cause binge eating ‫اسباب‬ ‫شراهىة االكل‬ ❖ Reduce fried foods ❖ Reduce plate size ❖ Remember all calories count!!!! New Plate Old Plate Modifying Exercise Behaviors a-Aerobic conditioning b-Flexibility exercises c-strength/resistance training ❖Fats are broken down and their end products are CO2 & H2O, which means you need to breath a lot and sweat a lot (Aerobic cardio exercises such as running, jumping).  Surgery Obesity surgery is used to modify the stomach or intestines to decrease the amount of food eaten or by liposuction ‫شفط الدهون‬ procedure. (Some procedures such as Gastric sleeve, Bypass, Ring, Balloon..etc) Mainly used for people – Who have a BMI>40 – Who have a serious medical condition – Liposuction can be considered the best intervention for those subjects with localized fat deposites and diet resistant body areas. Gastric Sleeve ‫تكميم‬ ‫تحويل مسار المعدة ‪Gastric Bypass‬‬ Gastric Balloon  ‫الميزوثرابي‬ ‫شــــــفط الدهون‬ ‫‪Mesotherapy‬‬ ‫‪Liposuction‬‬ ‫عملية جراحيه ومخاطر التخدير وخز باألبر الدقيقة بدون تخدير‪،‬‬ ‫قد يحتاج البعض لدهن مرهم‬ ‫الكلى‬ ‫مخدر موضعى‬ ‫يذيب الدهون التي في داخل‬ ‫يزيل الخاليا الدهنية‬ ‫الخلية‬ ‫ال يحتاج (يعاود المريض نشاطه‬ ‫يحتاج فترة نقاهة اسبوعين‬ ‫)في نفس اليوم‬ ‫يجب لبس مشد طبي حول الجسم ال يحتاج بل ينصح بأرتداء‬ ‫المالبس الواسعة‬ ‫لعدة أسابيع‬ ‫كدمات طفيفة‬ ‫اّالم وكدمات ما بعد العمليه‬ How avoid obesity  Drink a lot of water daily. Eat 5-6 small meals / every 3-4 hours. Eat food with high fiber contents (vegetables, fruits, whole grains). Drink healthy drinks ( green tea, coffee, lemon,….) and avoid soda. Don’t take more than 3 tsp sugar/d & 3 Tsp oil/d. Reduce salt intake. Avoid preserved & processed food. Walk 30 min daily Thank You