Biology

Investigatory
Project
On
Obesity

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Obesity a global epidemic
Obesity is a medical condition in which excess body fat has
accumulated to the extent that it may have a negative effect on
health. People are generally considered obese when their BMI, a
measurement obtained by dividing the weight of the person by
the square of their height, is over 30 kg/m2.
Obesity is a complex condition, one with serious social and
psychological dimensions, that affects virtually all age and
socioeconomic groups and threatens to overwhelm both
developed and developing countries. In 1995, there were an
estimated 200 million obese adults worldwide and another 18
million under-five children classified as overweight. As of 2000,
the number of obese adults has increased to over 300 million.
Contrary to conventional wisdom, the obesity epidemic is not
restricted to industrialized societies; in developing countries, it
is estimated that over 115 million people suffer from obesity-
related problems.

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BMI Classification
Body mass index or BIM is a simple method for estimating body fat
mass. BMI us accurate reflection of body fat percentage in the majority
of adult population. It however is less accurate in people such as body
builders and pregnant women. A formula to calculate BMI, age and
gender can be used to estimate the persons body fat mass percentage
up to an accuracy 4%. An alternative method, body volume index (BVI) is
being developed in an effort to better consider different body shapes.
BMI Classification
<18.5 Underweight
18.5 – 24.9 Normal weight
25.0 – 29.9 Over weight
30.0 – 34.9 Class I weight
35.0 – 39.9 Class II weight
40.0 – 49.9 Class III weight
50.0 – 59.9 Class IV weight
>60.0 Class V weight
BMI is calculated by dividing the subject’s mass by the square of his or
𝐾𝑖𝑙𝑜𝑔𝑟𝑎𝑚𝑠
her height, typically expressed either in metric: BMI=
𝑀𝑒𝑡𝑒𝑟 𝑠𝑞𝑢𝑎𝑟𝑒

Some modifications to the Who definitions have been made by

particular bodies. The surgical literature breaks down class III obesity
into further categories, through the exact values are still disputed. The
Japanese have defined obesity as any BMI greater that 25, while China
uses a BMI of greater than 28.
Individuals involved in heavy physical labor or sport’s may have high BMI
values despite having little fat. For example, more than half of all NFL
players are classified obeseand 1 in every 4 are calssified as extremely
obese, according to the metric system.

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The preferred obesity metric in scholarly circles is the body fat
percentage (BF%) i.e the ratio between the total weight of the persons
fat to his or her body weight, and the BMI is viewed is viewed merely as
a way to approximate BF%. Levels in excess of 32% for women and 25%
in men are generally considered to indicate obesity. However, accurate
measurement of body fat percentage is much more difficult than the
measurement of BMI. Several methods of varying accuracy and the
complexity exist.

Waist Circumference and Waist Hip Ratio

In the United States of America, a waste circumference of >102cm
(~40”) in men and women 88 cm (~34.5”) in women or the waist hip
ratio are used to define central obesity.
In the European Union waist circumference of ≥94cm (~37”) in men and
80 cm (~31.5”) are usually cut off for central obesity.

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A lower cut off of 90 cm has been recommended for south Asian and
Chinese men, while a cut off of 85cm has been recommended for the
Japanese men.

Effects on health
Excessive body weight is associated with various diseases, particularly
cardiovascular diseases, diabetes, diabetes mellitus type 2, obstructive
sleep apnea, certain types of cancer, osteoarthritis and asthma. As a
result, obesity has been found to reduce life expectancy.
Mortality
Obesity is one of the leading preventable causes of death worldwide. A
number of reviews have found that mortality risk in lowest at a BMI of
20-25 Kg/m2 in non smokers and at 24-27kg/m2 in current smokers. In
contrast, a 2013 review found out that Grade I obesity (BMI 30 – 35) was
not associated with higher mortality than normal weight and that
overweight (BMI 25 – 30) with lower mortality rate than normal weight
(BMI 18.5 – 25). Other evidence suggests that the association between
waist and hip ratio and waist to height ratio with mortality is more
positive. In Asians the risk of negative health effects begins to increase
between 22 – 25 kg/m2. A BMI over 32kg/m2 has been associated with a
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doubled mortality rate among women over a 16-year period. In the
united states obesity is estimated to cause 11,909 to 365,000 deaths per
year, while 1,000,000 (7.7%) of deaths in Europe are attributed to excess
weight. On average, obesity reduces life expectancy by six to seven
years, a BMI of 30-35kg/m2 reduces life expectancy by two or four years,
while severely obese (BMI>40 kg/m2) reduces life expectancy by ten
years.

Morbidity
Obesity increases the risk of many physical and mental conditions. These
co-morbidities are most commonly shown in metabolic syndrome, a
combination of medical which includes: diabetes mellitus type 2, high
blood pressure, high blood cholesterol and high triglyceride levels.
The strength of link between obesity and specific conditions varies. One
of the strongest is the link with type 2 diabetes. Excess body fat
underlies 64% of cases of diabetes in men and 77% of cases in women.

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Health consequences fall into two broad categories: attributable to the
effects of increased fat mass and those due to the increased number of
fat cells. Increases in body fat, alter the body’s response to insulin,
potentially leading to insulin resistance. Increased fat also creates
proinflammatory state and a prothrombotic state.

Survival Paradox
Although the negative health consequence of obesity in general
population are well supported by the available evidence, health
outcomes in certain subgroups seem to be improved at an increased
BMI, a phenomenon known as the obesity survival paradox, the paradox
was first described in 1999 in overweight and obese people undergoing
hemodialysis and has subsequently been found in those with heart
failure and peripheral artery disease.
In people with heart failure, those with a BMI between 30.0 and 34.9
had a lower mortality than those with normal weight. This has been
attributed to the fact that people often lose weight as they become
progressively more ill. Similar findings have been made in other types of
heart disease. People with class I obesity and heart disease dont have
greater rates of further heart problems than people of normal weight
who also have heart disease. In people with greater degree of obesity
however, the risk of further cardiovascular events is increased. Even
after cardiac bypass surgery, no increase in mortality s seen in the

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overweight and obese. One study found that the improved survival
could be explained by the aggressive treatment obese people receive
after a cardiac event. Another found that if one considers chronic
obstructive pulmonary disease in those with PAD, the benefit of obesity
no longer exists.

Causes
At an individual level, a combination of excessive food energy intake and
lack of physical activity is thought to explain most cases of obesity. A
limited number if case is due to primarily to genetics, medical reasons or
psychiatric illness. In contrast, increasing rates if obesity at a societal
level are felt to due to an easily accessible and palatable diet, increased
reliance on cars and mechanized manufacturing.
A 2006 review identified ten other possible contributors to the recent
increase of obesity i.e.
 Insufficient sleep.
 Endocrine disruptors (Environmental pollutants that infer with
lipid metabolism).
 Decreased variability in ambient temperature.

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  Decreased rate of smoking, because smoking suppresses
appetite.
 Increased use of medications that can cause weight gain.
 Proportional increases in ethnic and age groups that tend to be
heavier.
 Pregnancy at a later age.
 Epigenetic risk factors passed on generationally.
 Natural selection of higher BMI.
 Assortative mating leading to increased concentration of obesity
risk factors.

o Diet: The widespread availability of nutritional guideline has done

little to address the problem of overreacting and poor dietary
choices. From 1971 to 2000, obesity rates in the United States
increased from 14.5% to 30%. Most of this extra food energy came
from an increase in carbohydrate consumption rather than fat
consumption. The primary sources of these carbohydrates are
sweetened beverages such as soft drinks, fruit drinks, iced drinks,
iced tea, and energy and vitamin water drinks is believed to be
contributing to the rising rates of obesity and to an increased risk
of metabolic syndrome and type 2 diabetes.
Agricultural policy and techniques in the United States and Europe
have led to lower food prices. In the United States, subsidization of
corn, soy, wheat and rice through the US farm bill has made the
main sources of processed food cheap compared to fruits and
vegetables. Calorie count laws and nutrition facts labels attempts
to steer people towards making healthier food choice, including
awareness of how much food energy is being consumed.

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o Sedentary Lifestyle: A sedentary lifestyle plays a significant role in
obesity. Worldwide there has been a large shift towards less
physically demanding work and currently at least 30% of the
world’s population gets insignificant exercise. This is primarily due
to increasing use of mechanized transportation and greater
prevalence of labor-saving technology in the home. In children,
there appear to be declines in levels of physical activity due t less
walking and physical education.
In both children and adults, there is an association between
television viewing time and the risk of obesity with increased
media exposure with rates of childhood obesity with increased
media explorer with rates increasing proportionally to time spent
watching television.

o Genetics: Like many other medical conditons, obesity is the result

of interplay between genetic and environmental factors.
Polymorphisms in various genes controlling apetite and
metabolism predisposes to obesity when sufficient food energy

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present. As of 2006, more than 41 of these sites on the human
genome have been linked to the development of obesity when
favorable environment is present. People with two copies of the
FTO gene (fat mass and obesity associated gene) have been found
on average to weigh 3-4kg more and have 1.67-fold greater risk of
obesity compared to those without the risk allele.
Obesity is a major feature in several syndromes, such as Prader-
Willi syndrome, Bardet-Biedl syndrome, Cohen syndrome and
MOMO syndrome. In people with early-onset severe obesity
(defined by an onset before 10 years of age and body mass index
over three standard deviation above normal), 7% harbor a single
point DNA mutation.
Studies that have focused on the inheritance patterns rather than
on specific genes have found that 80% of the offspring of two
obese parents were also obese, in contrast to less than 10% of the
offspring of two parents who were of normal weight. Different
people exposed to the same environment have different risk of
obesity due to their underlying genetics.

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o Other Illnesses: Certain physical and mental illnesses and the
pharmaceutical substances used to treat them can increase risk of
obesity, medical illnesses that increases obesity risk includes
several rare genetic syndromes as well as some congenital or
acquired conditions: Hypothyroidism, Cushing’s Syndrome, Growth
Hormone Deficiency and Eating Disorders (Bing Eating and Night
Eating syndrome). However, obesity is not regarded as psychiatric
disorder, and therefore is not listed in the DSM-IVR as a psychiatric
illness. The risk of overweight and obesity is higher in patients with
psychiatric disorders than in persons without psychiatric disorders.
Certain medications may cause weight gain or changes in the body
composition; These include insulin, sulfonylureas,
thiazolidinedione, atypical antipsychotics, antidepressants,
steroids. Certain anticonvulsants (Phenytoin and valproate),
pizotifen and some forms of hormonal contraception.
o Social Determinants: The correlation between social class and BMI
varies globally. A review in 1989 found that in developed countries
women of a high social class were likely to be obese. No significant
difference were seen among men of this review carried out in
2007 found the same relationships, levels of adult obesity and
percentage of teenage children who are overweight, are
correlated with income inequality. A similar relationship is seen
among US: more adults, even in higher social classes, are obese in
more unequal states.
It is thought that in developed countries, the wealthy are able to
afford more nutritious food, they are under greater social pressure
to remain sim and have more opportunities along with greater
expectations for physical fitness. In underdeveloped countries the
abilities to afford food, high energy expenditure with physical labor
and cultural values favoring a larger body size are believed to
contribute to the observed patterns. Attitudes towards body
weight held by people in one’s life may also play a role in obesity. A

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 correlation in BMI changes over time has been found among
friends, siblings and spouses. Stress and perceived low social status
appear to increase risk of obesity.
Smoking has a significant effect on an individual’s weight. Those
who quit smoking gain an average 4.4 kg for men and 5 kg for
women over ten years.
In the United States the number of children a person has is related
to their risk of obesity. In China overall rates of obesity are below
5% however, in some cities rate of obesity is greater than 20%.
Malnutrition in early life is believed to play a role in rising rate of
obesity in developing world. Endocrine changes that occur during
periods of malnutrition may promote the storage of fat once more
energy becomes available.
o Gut Bacteria: Gut flora has shown to differ between lean and obese
humans. There is an indication that gut flora in obese and lean
individuals can affect the metabolic potential. This apparent
alteration of the metabolic potential is believed to confer a greater
capacity to harvest energy contributing to obesity has yet to be
determined unequivocally.
An association between viruses and obesity has been found in
humans and several different animal species. The amount that
these association may have contributed to the rising rate of
obesity is yet to be determined.

Public Health
The World Health Organization predicts that overweight and obesity
may soon replace more traditional public health concerns such as
undernutrition and infectious diseases as the most significant cause of
poor health. Obesity is a public health and policy problem because of its
prevalence cost and health effects. The US Preventative Services Task
Force recommend screening for all adults followed by behavioral
interventions in those who are obese. Public health efforts seek to
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understand and correct the environmental factors responsible for the
increasing prevalence of obesity in the population. Solutions look at
changing the factors that cause excess food energy consumption and
inhibit physical activity. Efforts include direct federally reimbursed meal
programs in in schools, limiting direct junk food marketing to children
and decreasing access to sugar sweetened beverages in schools. When
constructing urban environment, efforts have been made to increase
access to parks and to develop pedestrian routes.
Treating Obesity
There are a number of ways to treat obesity:
o Diet: A healthy diet should consist of:
 Plenty of fruit and vegetables
 Plenty of potatoes, bread, rice, pasta and other starchy
foods.
 Some milk and dairy foods
 Some meat, fish, eggs, beans and other non-dairy
sources of protein.
 Just small amounts of food and drinks that are high in
fat and sugar.
 Try to avoid food which has high levels of salt because
they can raise your body blood pressure, which can be
dangerous for people who are already obese.

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o Exercise: Maintaining a healthy weight requires physical activity
to burn energy. The Chief Medical Officers recommend that adult
should do at least 150 minutes of at least moderate intensity
activity a week – for example, five 30 minutes bouts a week.
Something is better than nothing and doing just 10 minutes of
exercise at a time is beneficial. Moderate intensity activity is any
activity that increases your heart and breathing rate such as:
 Brisk walking
 Cycling
 Recreational swimming
 Dancing

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 Alternatively, you could do a 75 minutes of vigorous intensity
activity a week or a combination of moderate and vigorous activity.
During vigorous activity, breathing is very hard, your heart beats
rapidly and you may be unable to hold a conversation. Example
include:
 Running
 Most competitive sports
 Circuit training
o Surgery: Weight loss surgery, also called bariatric surgery, is
something used to treat people who are severely obese.
Bariatric surgery is considered as a possible treatment option for
people with a BMI of 30 to 35 who have recently) in the last 10
years) been diagnosed with type 2 diabetes.
In rare cases, surgery may be recommended as the first treatment
(instead of lifestyle treatment and medication) if a persons BMI is
50 or above.

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Conclusion
Obesity is the most ominous harbinger of poor health. With necessary
lifestyle modification, the trend can be reversed. These is no shortage of
guidelines have proliferated in recent years, to the point where it is
increase difficult even to be aware of all the guidelines and use them
appropriately. Weight control has been the subject of extensive study
and writing. The simple conclusion of weight control research is the
need for dietary modification and increased physical activity. Treating
professional should devote time to counsel the patient and bring him/
her back to a diet and physical activity regime that will solve this issue.
Obesity is a serious illness that can be insidious in its development abut
literally fatal in its consequeneces. It is reversable obese individuals can
normalize their BMI as was tried with this patient.

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