Obesity is a chronic disease without tendency towards spontaneous recovery in which a clinical syndrome is produced by the following factors: extrinsic: abnormal eating pattern, overproduction of food, low level of physical exercise (urbanization, car transportation), stress, emotional disorders intrinsic: genetic, metabolic, regulatory, degenerative Definition of obesity WHO. Obesity: Preventing and Managing the Global Epidemic. WHO/NUT/NCD/98.1 Report of a WHO consultation on Obesity, Geneva, 1998
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Obesity is a chronic disease without tendency towards spontaneous recovery in which a clinical syndrome is produced by the following factors: § extrinsic:
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Obesity is a chronic disease without tendency towards spontaneous recovery in which a clinical syndrome is produced by the following factors:
extrinsic: abnormal eating pattern, overproduction of food, low level of physical
exercise (urbanization, car transportation), stress, emotional disorders
Normal range 18.524.9 AvarageOverweight (Class I obesity) 25.029.9 ModerateClass II obesity 30.039.9 Serious Class III obesity (morbid) 40.0Extremely serious
World Health Organization, 1998
Weight (kg)
Height (m2)BMI =
In children
In sportmen, athletes
In pregnant and breast-feeding women
In the elderly
When BMI is not used in diagnosing obesity?
First of all, obesity is ...
Excessive accumulation of fat tissue
> 10-15% of body weight in men > 20-25% of body weight in women
Different distribution
abdominal obesity femoro-gluteal obesity
How to assess body fat distribution?
Waist circumference measurement (half the distance between lower costal margin and upper margin of iliac crest)
Hip circumference measurement (at the level of trochanter major of the femur)
Waist to hip ratio determination (WHR)
WOMEN: WHR > 0.8 - abdominal (visceral) obesity
MEN: WHR > 1.0
Waist circumference is a good indicator of visceral fat and the risk of obesity-related complications ...
WomenWomen
80 cm = increased risk1
>88 cm = health problems
MenMen
94 cm = increased risk1
>102 cm = health problems
1Lean MEJ, et al. Lancet;1998:351:853–6
cm
History taking
body weight from childhood, through puberty to adult life (studies, marriage, pregnancy, menopause); the pattern of body weight increase, circumstances of weight increase
obesity in family members (genetic factors) eating habits and behaviour in the family :
- response to stress, positive and negative emotions, - binge episodes - physical activity (enviromental factors) - alcohol, cigarettes
previous attempts to reduce body weight (success, failure, relapse)
The role of a physician in the long-term obesity management
Evaluation of indications for treatment
Setting realistic goals according to: - previous attempts of dieting and physical exercise - physical capacity assessment - social and enviromental status assessment - initial assessment of patient’s personality Evaluation of indications and contraindications for drug and surgical treatment
Professional supervision of „patients` support groups”
The aim of obesity management
Prevention of further weight gain
Risk factors reduction
Maintenance of weight reduction at least by 5 - 10%