Obesity-

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Obesity EMPOWERED TEAMS

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► Obesity is a disorder of body weight regulatory systems characterized by an ► The prevalence of obesity increases with age . ► A larming now about childhood obesity , which has shown a three-fold increase in prevalence over the last two decades.

Health Problems of Obesity:

Health Problems of Obesity ► Diabetes ► Hypertension ►  total cholesterol ►  risk of heart disease & stroke ► Arthritis ► Gall-bladder disease

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Argentina Mexico Russia England Germany Finland Spain Italy France

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Obesity Obesity Obesity II. Assessment of Obesity The amount of body fat is difficult to measure directly , and is usually determined from an indirect measure the body mass index (BMI)— which has been shown to correlate with the amount of body fat in most individuals.

Assessment of Obesity:

Obesity Obesity Obesity Assessment of Obesity ► Body weight based on gender and height ► Percent body fat ► Skin-fold thickness ► Underwater weighing ► Electrical impedance ► Body mass index (BMI)

Measuring Body Fatness:

Measuring Body Fatness

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A. Body mass index The BMI gives a measure of relative weight, adjusted for height. The BMI is calculated in both men and women as follows: BMI = (weight in kg)/(height in meters) 2 = (weight in lb)/(height in inches) 2 × 703 Healthy weight BMI 19.5 and 25.0. Overweight BMI 25 and 29.9 Obese BMI ˃ 30 Nearly two thirds of American adults are overweight, and more than 36% are obese.

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B . Anatomic differences in fat deposition Excess fat located in the central abdominal area of the body is called android , “ apple-shaped, ” or upper body obesity, and is associated with a greater risk for hypertension, insulin resistance, diabetes, dyslipidemia , and coronary heart disease. It is defined as a waist to hip ratio of more than 0.8 for women and more than 1.0 for men.

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Obesity Obesity Obesity In contrast, fat distributed in the lower around the hips or gluteal region is call gynoid, “pear-shaped,” or lower body obesity. It is defined as a waist to hip ratio of less than 0.8 for women and less than 1.0 for men. The pear shape is relatively benign healthwise, and is commonly found in females. Some experts feel that the waist-to-hip ratio is better than BMI as predictor of myocardial infarction.

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C. Biochemical differences in regional fat depots ► Abdominal fat cells are much larger and have a higher rate of fat turnover than lower body fat cells. ► The abdominal adipocytes are also hormonally more responsive than fat cells in the legs and buttocks. ► Because men tend to accumulate the readily mobilizable abdominal fat, they generally lose weight more readily than women do. ► Fatty acids taken up by the liver may lead to insulin resistance and increased synthesis of triacylglycerols , which are released as VLDL. ► By contrast, free fatty acids from gluteal fat enter the general circulation, and have no preferential action on hepatic metabolism.

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Hypertrophic and hyperplastic changes occur in severe obesity.

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III. Body Weight Regulation The body weight of most individuals tends to range within ten percent of a set value. The body attempts to add adipose tissue when the body weight falls below the set point, and to lose weight when the body weight is higher than the set point. For example, with weight loss, appetite increases and energy expenditure falls, whereas with overfeeding, appetite falls and energy expenditure increases.

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Obesity Obesity Obesity A. Genetic contributions to obesity It is now evident that genetic mechanisms play a major role in determining body weight. For example, obesity is often observed within the families. If both parents are obese, there is a 70–80% chance of the children being obese. In contrast, only 9% of children were fat when both parents were lean. Rather, obesity behaves as a complex polygenic disease involving interactions between multiple genes and the environment.

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Obesity Obesity Obesity B. Environmental and behavioral contributions Clearly, environmental factors, such as the ready availability of palatable, energy-dense foods, play a role in the increased prevalence of obesity. Furthermore, sedentary lifestyles, encouraged by TV watching, automobiles, computer usage, and energy-sparing devices in the workplace and at home, decrease physical activity and enhance the tendency to gain weight. The importance of lifestyle observed when Japanese or Chinese peoples migrate to the United States, their BMI increases. For example, men in Japan (aged 46–49 years) are lean, with an average BMI of 20, whereas Japanese men of the same age living in California are heavier, with an average BMI of 24. Eating behaviors, such as snacking, portion size, variety of foods consumed

High fat diet:

High fat diet Do we live in a food toxic environment?

Sedentary lifestyle:

Sedentary lifestyle

Physical Inactivity and Overweight Trends Among Youth:

Physical Inactivity and Overweight Trends Among Youth 1 in 6 Youth ages 6-19 is Overweight 1 in 3 high school youth do not engage in vigorous physical activity Less than 30% attend daily physical education Children watch more t.v. in a year than attend school Data Sources: 2000 YRBSS, 2000 NHANES, 2002 National TV Turnoff Week Data

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Obesity Obesity Obesity Some afferent signals reflecting the nutritional state of the body. CCK = cholecystokinin . IV. Molecules that Influence Obesity

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Obesity Obesity Obesity A. Hormones of adipose tissue Although the adipocyte's primary role is to store fat, it also functions as an endocrine cell that releases numerous regulatory molecules, such as: Leptin Adiponectin Resistin

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Obesity Obesity Obesity B. Other hormones influencing obesity Ghrelin , a peptide secreted primarily by the stomach, is the only known appetite-stimulating hormone. Cholecystokinin , released from the gut following ingestion of a meal can act as satiety signals to the brain. Insulin not only influences metabolism, but also promotes decreased energy intake.

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V. Metabolic Changes Observed in Obesity The metabolic abnormalities of obesity reflect molecular signals originating from the increased mass of adipocytes. The predominant effects of obesity include ► Dyslipidemia ► Glucose intolerance ► Insulin resistance

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The Scenario Worsens – A formula for metabolic disaster Insulin resistance  Failure to inhibit hormone–sensitive lipase  Increased lipolysis  Increased fatty acids in the blood  Fatty acids

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Body mass index and changes in blood lipids.

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Body mass index and the relative risk of death. VI. Obesity and Health

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Weight Reduction ► Pharmacotherapy ● A. Physical activity ● B. Caloric restriction ● C. Pharmacological (Drug) treatment - Sibutramine ( appetite suppressant, that inhibit the uptake of both serotonin and norepinephrine ). - Orilistate ( lipase inhibitor that inhibit gastric and pancreatic lipase). ► Other medical procedures ● Stomach stapling ● Medically-supervised low calorie ● Liposuction

Vertical banded gastroplasty:

Vertical banded gastroplasty

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Effect of orlistat treatment and surgery on weight loss.

MEAL REPLACEMENT:

MEAL REPLACEMENT We recommend MRT Complex , a meal replacement therapy designed for people who wish to embark on a fast, safe and effective weight loss and maintenance program E D MARK

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MRT Complex A delicious, low calorie and highly soluble nutritional drink, with complex vitamins, proteins, and energy- releasing amino acids that replaces your meal to help you reduce weight safely, fast and effectively while avoiding the hunger pangs

ACTIVE INGREDIENTS :

ACTIVE INGREDIENTS L-CARNITINE Accelerates fat metabolism to turn body fat into energy. It stimulates fat breakdown and reduces triglycerides and fatty acids to prevent fat accumulation in the veins and arteries. LECITHIN Contains choline which helps in burning fat that is stored in the body’s tissues to support weight loss. Helps restore liver function ISOLATED SOYA PROTEIN This is easily digested and absorbed by the body, and it helps to lose excessive fat but not muscles

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FRUCTOSE A natural sweetener that is extracted from fruits and honey that is safe both for people with diabetes mellitus or hypoglycemia (low blood sugar) EDIBLE FIBER Gives bulk satisfaction and reduces hunger pangs BENEFITS : Breaks up fats and cholesterol, Burns and reduces the build up of fats good for the heart Cleanses liver & kidney Good for diabetic people Helps the body absorb nutrient Anti-cancer

KEY characteristics:

KEY characteristics Organic Formulation Suitable for vegetarians. Excellent source of carbohydrates and protein. Low calorie No cholesterol and low fat. Each sachet of MRT Complex contains only 83kcal Balance Nutrition Contains essential vitamins and minerals, including Vitamins C,E and Vitamin B Complex and energy releasing amino acids

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