OBESITY

Nutrition department Medical school University of Sumatera Utara

Globesity:

a worldwide problem
In 1995 WHO estimated there were 200 million obese people In 2000 more than 300 million people were estimated to be obese 132 million in developed countries

25
BMI < 17

20 15 10 5 0

BMI > 30

Global

Least developed

Developing

Transition

Developed

170 million in other countries

What is Obesity?

Obesity: Definition
Excess body fat Fat cells function to store and release energy Normal body fat is 10 to 20 kg Obese body fat is 40 to100 kg

Levels of Body Fatness

Essential fat Borderline High performance Good fitness health Marginal fitness Overfatness

Men 5% 5-9% 5-15% 10-20% 21-25% > 25%

Women 10% 10-16% 10-23% 17-28% 29-35% > 35%

Etiology
1. Genetics factor - contribute to ones predisposition to or protection from obesity - include determinations of RMR, where fat is stored, physiologic response to overfeeding, eating behavior - Ob gene produce leptin - -3adrenoreceptor gene regulate RMR & fat oxidation

2. Neuroendocrine syndrome (<1%) Rarely causes severe degrees of obesity - hypothiroidism & hypopituitarism - Cushings syndrome - castration & ovarian failure - PCOS (Stein-Leventhal syndrome) - hypothalamic lesion

3. Environmental factor primary causes Dietary excess - active - passive Physical inactivity

4.

Epidemiological studies Age Gender > Ethnicity Educational level & income Marital status ( after marriage) Parity Smoking Alcohol consumption

Decreases with Education

30 25 20 15 10 5 0 1991 2000 < HS HS Some College College +

Body Composition Assessment

Body Composition Assessment Techniques

Underwater weighing Technological assessments Skinfold technique Anthropometric measurements

Underwater Weighing Technique

The "Gold Standard"

Underwater Weighing
Measurement issues

Based on body density calculations

Density of lean tissue = 1.1 g/cc Density of fat tissue = .9 g/cc

General conclusions
Gold standard measure (1-2% error) Impractical for most applications

Technological Assessments of Body Composition

Bioelectric impedance Infra-red spectroscopy Ultrasound Imaging techniques (DEXA, MRI)

Bioelectric Impedence
(Measurement Issues)

Based on resistance to current flow

Lean tissue has more water - less resistance Fat tissue has less water - more resistance

General conclusions
Overestimates lean / underestimates obese Practical, but expensive measure for general population

Infrared Spectroscopy
(Measurement Issues)

Based on differential absorbance rates

Lean tissue has a different energy absorption and reflectance pattern than fat tissue

Sources of error
Validity of absorbance readings is questionable!

General findings
NOT a valid measure!

Ultrasound
(Measurement Issues)

Based on reflection of sound

Fat content increases the time is required for sound to reflect off of bone and muscle.

General conclusions
Highly accurate measure of body fat - especially for obese Expensive and not practical for most applications

Imaging Techniques
(Measurement Issues)

Based on imaging of body tissues

Based on cross sectional area measures calculated at different levels of the body

General conclusions
Very precise measure of body composition Expensive and not practical measure for most uses

Anthropometric Measurements
Body Mass Index (BMI) Waist to Hip Ratio (WHR) Circumference measures

Body Mass Index (kg/m2)

Dose - Response Risk Relationship Underweight < 18.5 Normal 18.5 - 25 Overweight 25 - 30 Obese > 30
Class I Class II Class III 30 - 34.9 35 - 39.9 >40

Body Mass Index (kg/m2) in adult Asians

Dose - Response Risk Relationship Underweight < 18.5 Normal 18.5 22.9 Overweight 23
- At risk - Obese I - Obese II 23 24.9 25 29.9 30

Body mass index and total mortality in the Nurses Health Study
2.5 2 1.5 1 0.5 0 <23 23<25 25<26 26<27 27<28 28<29 All
Source: JAMA 1999;282:1530

29<30

30-35

>35

Regional Fat Deposition

Abdominal body fat poses greater health risks than fat stored in other areas Males store more fat centrally and have increased health risks associated with body fatness

Male (apple) Higher health risk

Female (pear) Lower health risk

Regional Fat Deposition Visceral Fat

Visceral body fat poses greater health risks because this fat is more labile and has greater access to the circulation. The accumulation of visceral body fat is typical of the android (male) fat pattern males: visceral accounts for 10-35% of total fat females: visceral accounts for 8-13%of total fat

Waist to Hip Ratio (WHR)

Waist to Hip Ratio is an effective way to examine regional fat distribution.

HEALTH RISK High Risk

MEN > 1.0

WOMEN > .85

Moderate Risk Low Risk

.90 -1.0 < .90

.80-.85 < .80

Tipe buah Pear

(Obesitas Ginecoid)

Tipe buah Apel

(Obesitas Android)

zt07