ABSTRACT
Obesity is becoming the plague of 21st century. Obesity is a key risk factor in natural History of other chronic & noncommunicable diseases. Obesity & lack of physical activity have the second largest public health impact after smoking.
KEY-WORDS
Adipose tissue, Body weight, physical inactivity, Heredity, BMI, Increased morbidity & mortality, Exercise.
INTRODUCTION-
Obesity is a chronic & increasingly common disease characterised by excess body fat. It develops gradually & often persists throughout life. Obesity is an important emerging health porblem in India.
DEFINITION-
Obesity may be defined as an abnormal growth of adipose tissue due to an enlargement of fat cell size(Hypertrophic obesity) or increase in fat cell number(Hyperplastic obesity) or combination of both.
TYPES OF OBESITY
- Android obesity : Collection of fat mostly in the abdomen (above waist, i.e, apple shaped bodies) also called as central Obesity.
- Gynoid obesity- Collection of fat on the hips & buttocks (below the waist, i.e, pear shaped bodies)
EPIDEMIOLOGICAL FACTORS/ CAUSES OF OBESITY
Age- Obesity can occur at any age, & it increases with age. Infants with excessive weight gain have an increased incidence of obesity in later life.
Sex- Women have higher rate of Obesity than men.Men gain weight between the ages of 29 & 35.Women gain weight between 45 & 49 years of age.
Genetic factors- There is a genetic component in the aetiology of obesity.
Physical inactivity- Reduction in activity without the compensatory decrease in habitual energy intake may be the major cause of obesity. Physical inactivity may cause obesity which in turn restricts activity. This again leads to increase in weight. It is a viscious cycle.
Socio-economic status- there is a clear inverse relationship between socio-economic status & obesity. i.e, obesity has been found to be more prevalent in lower socio-economic group.
Eating habits- like, eating in between meals, preferance to sweets, refined foods & fats, are responsible. A diet containing more energy than need may develop prolonged post prandial hyperlipidemia hyperlipidaemia & deposition of triglycerides in adipose tissue resulting in obesity.
Psychosocial factors- eg- emotional disturbances are deeply involved in the aetiology of obesity. Overeating may be a symptom of depression, anxiety, frustration & loneliness in childhood. Excessively obese individuals are usually are usually withdrawn, self conscious, lonely & secret eaters.
Familial tendency- obesity frequently runs in families.
Endocrinal factors- MAY BE INVOLVED IN OCCASIONAL CASES. eg- in cushings syndrome, growth hormone deficiency etc.
- Alcohol- in men especially.
- Education- inverse relationship between educational level & prevalence of obesity.
- Drugs- corticosteroids,contraceptives, insulin, b adrenergic blocks etc can promote weight gain.
ASSESSMENT OF OBESITY
Depends upon-
- Body weight
- Skinfold thickness
- Others.
A- Body Weight-
1.Body mass index- ( Quetlet’s Index)
= Weight (Kg)
-----------------
Height2 (m)
2. Ponderal index- Height (cm)
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cube root of body weight (Kg)
3. Broca’s index = Height (cm)- 100.
Eg- if a person’s height is 160 cm, his ideal weight is (160-100)= 60 Kg.
4. Lorentz’s formula- Ht (cm)- 150
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2(women) or 4 (men)
5.Corpulence index- = Actual weight
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Desirable weight.
This should not exceed 1.2.
The body mass index & broca’s index are widely used.
B. Skinfold thickness-
A large proportion of total body fat is located just under the skin. So, the method mostly used is the measurement of skinfold thickness. Several varieties of calipers, eg, Harpenden’s skin calipers are available for these purpose.The measurements can be taken at all the four sites – Midtriceps, Biceps, Subscapular & Suprailiac region. The sum of measurements should be less than 40mm in boys & 50 mm in girls.
C. Waist circumference-
It is measured at the midpoint between the lower border of the rib cage & the iliac crest. There is an increase riskof metabolic complications for men with a waist circumference equal to more than 102cm & women with a waist circumference equal to or more than 88cm.
D. Others-
Measurement of total body water,
Measurement of total body potassium.
Measurement of total body density.
These are some additional methods for measurement of obesity. But as these techniques are relatively complex, they cannot be used for routine clinical purposes.
HAZARDS OF OBESITY
Increased Morbidity-
Obesity is a positive risk factor in the development of Hypertension, Diabetes Mellitus, Gall Bladder disease & Coronary heart disease, Cancers, PCOD. Also, Varicose veins, Abdominal Hernia, Osteoarthritis of knees, hips, & lumbar spine, flat feet, Depression, Sleep apnea & Psychological stress etc. Also, Obesity may lead to lowered fertility.
Increased mortality-
Increased mortality is brought about by increased incidence of Hypertension, Coronary Heart disease, Renal diseases. Obesity lowers life expectancy.
PREVENTION & CONTROL
Prevention should begin in early childhood as obesity is harder to treat in adults than in children. Here, the goal is to maintain weight within the normal range of BMI. it should also include prevention of weight gain. This can be achieved by dietary changes, increased physical activity & a combination of both.
Dietary factors-
The proportion of energy dense foods such as simple carbohydrates & fats should be reduced. The fibre content in the diet should be increased through consumption of common unrefined foods. Emphasis should be given on greater intake of fruits, vegetables & foods in high fibre.Here the basic consideration is that the food energy intake should not be greater than what is necessary for energy expenditure.
Increased physical activity-
This is a very important part of weight reducing program. Regular physical exercise is the key to an increased energy expenditure.
Others-
Appetite suppressing drugs have been tried in control of obesity. Surgical treatment like gastric bypass, gastroplasty, jaw wiring etc are used with limited success. ALSO, Bariatric surgery is used nowadays to redce weight.
Health education –
Has an important role to play in teaching people how to reduce weight & prevent obesity.
Homoeopathic indicated Remedies for Obesity-
- Phytolaca Decandra
- Calcarea Carb
- Thyroidinum
- Antim crud
- Focus vesiculosus
- Graphites
- Ammonium mur. Etc.
REFERENCES-
- Textbook of P.S.M by Dr K.Park
- API Textbook of Medicine
- Bailey & Love’s Short practice of Surgery. By- Norman Williams, P Raonan O’Connell, Andrew W Mccaskie.
- Practical P.S.M by- Dr Shastri,Dr Patel, Dr Rathod.
- Select your Remedies by- Rai Bahdur Bishambar Das
