Obesity India S. Sharp, BSN, RN November 02, 2013

Objectives  Provide knowledge of the pathophysiology, epidemiology, symptoms, & non- pharmacological treatments

Obesity  Obesity is a label for ranges of weight that are greater than what is considered healthy for a given height.  Obesity is having an excessive amount of body fat. It increases risk of disease and health problems such as Type 2 Diabetes, Coronary artery disease (CAD), hypertension, stroke, gallbladder disease, cancer, osteoarthritis, and hyperlipidemia. Weight loss can reduce these risks by 10%.  Obesity is a chronic relapsing disease needing management in other disease such as diabetes and hypertension with physical, psychological, and social consequences.  Abdominal obesity, rather than body fat, can be a useful indicator of cardiovascular and cancer related outcomes. Measuring abdominal obesity includes waist circumference, hip circumference, and waist-to-hip ratio.

Epidemiology  More than one-third (35.7%) of the adults in the United States are obese in  Obesity effects all groups in society, irrespective of age, sex, race, ethnicity, socioeconomic status, educational level, and geographic group.  Adults over the age of 60 were more likely to be obese than younger adults.

National Prevalence

Pathophysiology Hypertophic versus Hypercellular obesity  Hypertrophic obesity usually starts in adulthood and responds to weight reduction measures.  Hypercellulary obesity typically occurs in persons who develop obesity in childhood or adolescence. Hypercellular obesity may find it difficult to lose weight without surgical intervention.

Adult Obesity by BMI Classification of Adult Obesity by BMIBMI (kg/m 2 ) Underweight<18.5 Normal Overweight (Pre-obese) Obesity Severely Obese>40.0 Morbid Obese Super Obese>50.0 Super-Super Obese (SSO)> 60.0

Etiology  Obesity is the imbalance between energy intake (Eating too much) and energy output (not exercising or too little).

Predisposing Factors  Metabolic factors (Leptin levels)  Genetic factors (Family history of obesity)  Level of activity (Lack of exercise/sedentary lifestyle, Television (TV), computer, and hand-held game use more than 3 hours/day, and increase leisure time)  Endocrine factors  Race, sex, and age factors  Ethnic and cultural factors (Ethic background: African American, Hispanic)  Socioeconomic status  Smoking Cessation  Pregnancy and menopause  Psychological factors  History of gestational diabetes  Lactation history in mothers  Dietary habits (consuming too many calories/high fat diet, Poor dietary choices, and/or Readily available food sources, especially fast foods) Predisposing Factors

Common Complaints/Signs and Symptoms  Difficulty performing routine daily activities, including hygiene.  Inability or lack of interest in exercising  Shortness of breath and/or asthma exacerbation  Incontinence  Obstructive Sleep Apnea (OSA)  Infertility/polycystic ovarian syndrome  Symptoms of cholelithiasis (heartburn, indigestion, nausea, vomiting, fatigue, headaches, light or chalky colored stool, and dark urine)  Hypertension

Treatment Non-Medical  Diet changes  Low calorie  Increase fruits and vegetables  Eliminate alcohol and sugar-containing beverages  Reduce intake of sweets and sugars  Reduce fat intake  Reduce portion sizes  Increase water intake  Exercise ( Increase activity as tolerated)  Encourage getting up for 10 minutes each hour  Start off with just walking as tolerated

Specialist  Dietitian  Psychologist consultation

Discussion