obesityobesity

Jordan University of Science and Technology

faculty of Nursing

Outline Introduction. Key fact. Significant of the problem worldwide and locally. Definition and type of obesity. Health Effects of Obesity. Management and community health nursing role. Research finding

Introduction

Obesity is a public health and policy problem because of its increase prevalence, costs and health effect. (WHO, 2012, National heart lung and blood institute. 2012)

. The risk factor for chronic disease are highly prevalence (Zindah, Belbeisi, Walke & Makdad 2008)

. The obesity and the overweight are risk for number of chronic disease include diabetes cardio vascular disease and cancer (WHO,2010)

Introduction

Overweight and obesity are fifth leading risk for global death.

The prevalence of obesity has increase at alarming rate; both low and high income countries; both adult and child; both male and female (WHO,2010)

Obesity is one of the leading preventable cause of death worldwide. (Mokaded, Marks, Stroup, Gerberding, 2004)..

At least 2.8 million adults die each year as a result .of being overweight and obese (who, 2010)

Obesity and overweight the most serious public health challenge of the 21 century

44% of the diabetes burden, 23% of the ischemic heart disease burden and between 7% and 41% of certain cancer burden are attributable to over weigh and obesity (who,2010)

Near 43 million children under the age of five

were overweight in 2010 (WHO, 2010)

Statics….. % of obesity

Obesity and overweight prevalenceCountry Year Male Female

Egypt 2005 60% 72.2%

Iraq 2006 63.6% 69.6%

Jordan 2005 65.5% 77%

Kuwait 2006 78% 81.7%

Lebanon 2002 60.0% 53.0%

Saudi 2005 64.0% 70.0%

Syrian 2004 52.9% 58.8%

Source : (STEP wise Surveillance system, WHO)

Obesity and overweight prevalence

Obesity in Jordan 2010Percentage of adult who are obese is 48.00%

(Adomi, 2010)

Percentage of adult who are overweight is 39% (Adomi, 2010)

Percentage of adult who are normal weight is

18.20% (Adomi, 2010)

Obesity and overweigh prevalence

Definition of obesity

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduce life expectancy and increase health problem (WHO, 2000; Haslam, James, 2005)

Overweight is defined as abnormal or excessive fat accumulation that may impair health.(WHO, 2011)

Am I obese ??

Classification

The obesity classified according to body mass index (BMI), waist circumference.

(National Heart Lung and Blood institute,2012)

BMI is a useful measure of overweight and obesity. Its calculated from your height and weight. BMI is estimate of body fat and a good gauge of your risk for disease that can occur with more body fat.

The higher your BMI, the higher your risk for certain disease type 2diabetes, gall stone, breathing problem and certain cancer (National Heart Lung and Blood Institution, 2012; WHO, 2011)

Classification

BMI Range Weight Classification

Less than 18.5 Underweight

18.5 – 24.9 Ideal weight

25 – 29.9 Overweight

30 – 39.9 Obese 40 – 50 Morbid obese

50 Or greater Super obese

BMI calculated by dividing the subject mass by the square of his height (National Heart Lung Blood institution, 2012)

Classification

Waist circumference (W.C)Measuring waist circumference help screen for

possible health risks that come with overweight and obesity. If most of your fat is around your waist rather than at your hip. You are risk for heart disease and Diabetes mellitus.

(National Heart Lung and Blood institution, 2012).

Classification

A high-risk waist circumference is:

• A man with waist measurement over 40 inches (102 cm).

• A woman with waist measurement over 35 inches (88 cm) (Webmed 2010)

Classification

Waist circumference The risk goes up with a waist size that is greater

than 35 inches.

To correct measure waist circumference , stand and place a tape of measure around your middle, just above hip Bones, measure your waist just after you breath out.

(National Heart Lung and Blood institution, 2012)

measure waist circumference

Waist-to-Hip Ratio:

Waist-to-hip ratio (WHR) is the ratio of a person's waist size to hip size, mathematically calculated as the waist size divided by the hip size.

Good Ratios For men, a ratio of .90 or less is

considered safe. For women, a ratio of .80 or less is

considered safe.

Risky Ratios For both men and women, a waist-to-hip

ratio of 1.0 or higher is considered "at risk" or in the danger zone for undesirable health consequences, such as heart disease and other ailments connected with being overweight.

Who is at higher risk?

For most people, carrying extra weight around their middle increases health risks more than carrying extra weight around their hips or thighs.

Causes

Causes of Obesity?

Generally, Excess fat results from the imbalance between the calorie intake (consumption) and calorie output (expenditure).

Genetic predisposition to weight gain:

Between individuals, and between communities, there are quite large differences in the predisposition to weight gain. Fat distribution is partly genetic.

Recently, scientists at Tufts University solved the mystery. They discovered that most of us have inherited a sluggish ADP gene that enables fat to be stored in our tissues very easily and slows down the way that fat it is burnt off or turned into energy. 

morbid obesity has a stronger genetic component than moderate level of excess overweight.

Diet: major cause of obesity Regular consumption of high calorie food such

as those rich in fat or in sugars.

Extra calories from carbohydrate, protein, and fat itself are converted into the fat stores in adipose tissue to be used if food supplies diminish.

Lifestyle (Exercises ):

Physical inactivity is a major element in the development of obesity

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.

medical disorders: Hypothyroidism, Cushing’s syndrome, pancreatic

insulinoma, growth hormone deficiency, and hypothalamic insufficiency

A variety of psychosocial factors contribute to the development of obesity and to difficulty losing weight

Medications: antipsychotics (phenothiazines, butyrophenones);

antidepressants and antiepileptics, (tricyclic antidepressants, lithium, valproate, carbamazepine); and insulin and some oral hypoglycemics. Whereas most of these medications contribute modestly to obesity,

the large doses of steroids sometimes used to treat autoimmune diseases can cause true obesity

Others factorOthers factor

Socioeconomic status: In some developed countries, poorer children or

those who live in rural settings are more at risk of obesity, whereas in countries undergoing economic transition childhood obesity is associated with a more affluent lifestyle and with living in urban regions.

Sex: Men have more muscle than women, on average.

Because muscle burns more calories than other types of tissue, men use more calories than women, even at rest. Thus, women are more likely than men to gain weight with the same calorie intake.

Age: People tend to lose muscle and gain fat as they

age. Their metabolism also slows somewhat. Both of these lower their calorie requirements.

Emotions: Some people overeat because of depression,

hopelessness, anger, boredom, and many other reasons that have nothing to do with hunger.

Pregnancy: Women tend to weigh an average of 4-6

pounds more after a pregnancy than they did before the pregnancy. This can compound with each pregnancy. This weight gain may contribute to obesity in women.

Alcohol: Alcohol (beer and mixed drinks) is very high

in calories. Drinking alcohol may cause you to gain more weight around your stomach.

Consequences

Health Effects of Obesity

Obesity is associated with more than 30 medical conditions, and scientific evidence has established a strong relationship with at least 15 of those conditions

It has been established that obesity is associated with an increased prevalence of coronary artery disease, hypertension, diabetes mellitus, and other diseases.

In addition, life expectancy is shown to be reduced in those who are obese or overweight.

1

Obesity increase the risk of many physical and mental condition. (Haslam, James, 2005)

The Health problem consequences fall into two broad categories: those attributable to the effect of increased fat mass (osteoarthritis, obstructive sleep apnea) and those due to the increased number of fat cells (diabetes, cancer, cardio vascular disease, non-alcoholic fatty liver disease). (Bray, 2004).

Cont.

Diabetes (Type 2) As many as 90% of individuals with type 2 diabetes are reported

to be overweight or obese.

Obesity has been found to be the largest environmental influence on the prevalence of diabetes in a population.

Obesity complicates the management of type 2 diabetes by

increasing insulin resistance and glucose intolerance, which makes drug treatment for type 2 diabetes less effective.

A weight loss of as little as 5% can reduce high blood sugar.

Cont.

Hypertension Over 75% of hypertension cases are reported to be directly attributed to

obesity.

Weight or BMI in association with age is the strongest indicator of blood pressure in humans.

The association between obesity and high blood pressure has been observed in virtually all societies, ages, ethnic groups, and in both genders.

The risk of developing hypertension is five to six times greater in obese adult Americans, age 20 to 45, compared to non-obese individuals of the same age.

Cont.

Cardiovascular Disease (CVD) Obesity increases CVD risk due to its effect on blood lipid levels. Weight loss improves blood lipid levels by lowering triglycerides

and LDL (“bad”) cholesterol and increasing HDL (“good”) cholesterol.

Weight loss of 5% to 10% can reduce total blood cholesterol. The effects of obesity on cardiovascular health can begin in

childhood, which increases the risk of developing CVD as an adult.

Overweight and obesity increase the risk of illness and death associated with coronary heart disease.

Obesity is a major risk factor for heart attack, and is now recognized as such by the American Heart Association.

Cont.

Stroke

Elevated BMI is reported to increase the risk of ischemic stroke independent of other risk factors including age and systolic blood pressure.

Abdominal obesity appears to predict the risk of stroke in men.

Obesity and weight gain are risk factors for ischemic and total stroke in women.

Osteoarthritis (OA) Obesity is associated with the development of OA of the hand,

hip, back and especially the knee.

At a Body Mass Index (BMI) of > 25, the incidence of OA has been shown to steadily increase.

Modest weight loss of 10 to 15 pounds is likely to relieve symptoms and delay disease progression of knee OA.

Sleep Apnea Obesity, particularly upper body obesity, is the most significant

risk factor for obstructive sleep apnea.

There is a 12 to 30-fold higher incidence of obstructive sleep apnea among morbidly obese patients compared to the general population.

Among patients with obstructive sleep apnea, at least 60% to 70% are obese.

Cont.

Cancers

Carpal Tunnel Syndrome (CTS)

Chronic Venous Insufficiency (CVI) & Deep Vein Thrombosis (DVT)

Gallbladder Disease

Gout

abdominal hernias

Cont.

Impaired Respiratory Function

Infertility

Liver Disease

Low Back Pain

Surgical Complications

Daytime Sleepiness

Mortality

. Obesity is one of the leading preventable cause of death worldwide. (Mokaded, Marks, Stroup, Gerberding, 2004).

. One million of deaths in European are attributed to excess weight. (Friend etal 2007)

. Obesity reduce life expectancy by six to seven year (peeters etal, 2003)

BMI of 30-35 reduce life expectancy by two year (Whitlock, etal 2009)

BMI of more than 40 reduce life expectancy by 10 year (Whitlock, etal, 2009)

BMI above 32 has been associated with a doubled mortality rate among women above 16 year old (Manson, etal, 1995)

life expectancy

Treatment of obesity

Treatment of obesity comes into three categories:

behavior modification.

{diet and exercise} Pharmacotherapy.

surgical intervention .

National institutes of health guidelines for treatment of overweight and obesity:

BMI range

Behavior mod.

pharmacotherapy

Endoscpic balloon

surgery

25-26.9 Yes* No No No

27-29.9 Yes* Yes* No No

30-34.9 Yes Yes Yes No

35-39.9 Yes Yes Yes No

40 or more

yes Yes Yes* Yes

comorbidities present*

Dietary modification tow forms:Low calorie diet (LCD) Aims for an energy deficit ranging from 500 to

1000 kcal/dayLCD is a low fat diet LCD Helps losing 0.5 kg/week That lead to a 10% weight loss over 6 months Very low calorie diet (VLCD) VLCD is high protein diet with less fat &no

carbohydrateLimits energy intake to fewer than 800kcal/day VLCD helps losing 1-1.5 kg/week

Cont…..

Short term weight loss with VLCD is dramatic with some people losing up to 20kg in 3 months.

But long term doesn’t differ from LCD VLCD require physician supervision

Increasing energy expenditure:

exercise is very effective in preventing long term weight regain.

At least ,doing exercise 3 times /week for 45 minute

Or doing 20 minute exercise each day

community health nursing role Prevention, early detection and the appropriate

treatment of obesity are of great importance in nursing practice in all settings and should not be undervalued.

Nurses can and should participate in health promotion and education for the prevention of obesity.

Nurses can promote appropriate nutrition advice not only to the general public, but most importantly to policy-makers.

■ Advocating for the promotion of increased physical activity at governmental level.

■ Supporting efforts to preserve and enhance parks, to develop walking and bicycle paths, and to promote the use of physical activity opportunities by families.

■ Engaging families with parental obesity in prevention activities

■ Encouraging parenting styles that support increased physical activity and reduce sedentary behaviors

Encouraging parental modeling of healthy dietary choices.

community and school nurses, in collaboration with a multidisciplinary team, are involved in screening programmes and support for children who are underweight or at risk of being overweight or obese.

Nurses can promote healthy lifestyle patterns that reduce the risks of being overweight or obese. For example, breastfeeding, physical activity, regular meals, and nutrition and weight counseling are all areas where nurses may help to reduce the risk of obesity.

Obesity education programme. Community and school nurses may use research

evidence in designing health promotion for different populations .

Research finding

The study conducted by khader & etal in 2008 to estimate the prevalence of overweight and obesity and determine their associated factor among school children age 6-12 year in the north of Jordan.

Research finding

* The prevalence of obesity and overweight among school children in Jordan was 25.0%; 19.4% were overweight and 5.6% were obese.*associated factor with obesity and overweight school children:. Watch TV. Daily bucket money more than 20 piasters. Having overweight and obese mother and father

HOW TO DESIGN A FITNESS PROGRAM?

Consider your goals. Think about your likes and dislikes. Choose activities you’ll enjoy. Plan a logical progression of activity. Build activity into your daily routine. Think variety. Allow time for recovery. Put it on paper. A written plan may encourage you to stay on track.

GETTING STARTED

Start slowly and build up gradually. Break things up if you have to. Be creative. Include other activities such as walking, bicycling, rowing or dancing in your routine. Listen to your body. Don’t push yourself too hard. Be flexible. If you’re not feeling good, give yourself permission to take a day or two off.

MONITOR YOUR PROGRESS

Assess your progress at six weeks after you start your program and then again every three to six months.

You may need to increase the amount of time you exercise in order to continue improving.

If you lose motivation, set new goals or try a new activity.

Exercising with a friend or taking a class at a local fitness centre may help.

Ready

Steady

GO!

References

Haslam DW, James WP (2005). “obesity”. Lancet 366 (9492): 1197-209 Manson JE, willet WC, Stampfer MJ, et al. (1995). “body weight and mortality among women”. N. Engl. J. med. 333 (11):677-85Friend M, Hainer V, basdevant A, et al. (April 2007). “inter-disciplinary European guidelinesPeeters A, Barendergt JJ, Willekens F, Mackenbach JP, Al mamun A, Bonneux L (January 2003)

Yusuf S, Hawken S, Ounpuu, S,Dans T, Avezum A, lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, INTERHEART Study investigators. (2004). “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. “lancet 364 (9438): 937-52

Bleich S, Cutler D, Murray C, Adams A (2008). “Why is the developed world obese?”. Annu Rev Public Health 29: 273-95

Shick SM, Wing RR, Klem ML, McGuire MT, Hill JO, Seagle H (April 1998). “Persons successful at Long-term weight loss and maintenance continue to consume a low-energy, low-fat diet”. J Am Diet Assoc 98 (4): 408-13Hamaideh S, Al-Khteeb R, Rawashdeh A, (2010). Overweight and Obesity and Their Correlates Among Jodanian Adolescents. Journal of Nursing Scholarship. 42(4): p 387-394.

Khader, et al (2009) Overweight and Obesity Among School Children in Jordan: Prevalence and Associated Factors. Maternal Child Health J. 13:424-431.

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