Post on 30-May-2018
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DR ANKIT LOKHANDE
(B.P.T,C.F.N,MIAP)
Obesity
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Scope
Introduction
Definitions
Epidemiology
Mortality
Aetiology
Distribution of body fat andhealth risk
Obesity and the respiratorysystem
Obesity and the
cardiovascular systemObesity and the G.I. sy
Trauma and obesity
Obese patient and inten
care unitChildhood obesity
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Definitions
The prevalence of significant obesity continues to rise.Associated with anincreased incidence of a wide spectru
medical and surgicalpathologies.
These patientsmay provide a considerable challenge.
A thorough understanding of the pathophysiology andspecificcomplications associated with the condition shoallow moreeffective and safer treatment for this unique of patients.
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Medical and Surgical Conditions Associated With Ob
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Definition
Obesity is a condition of excessive body fat.
The name is derivedfrom the Latin word obesus, which fattened by eating.
The difference between normality and obesity is arbitrar
An individual must be considered obese wheamount of fattissue is increased to such an ethat physical and mentalhealth are affectedlife expectancy reduced.
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What is Ideal Body weight (IBW)?
Accurate measurement of body fat content is difficult anrequiressophisticated techniques such as CT scanor MREstimates canbe obtained by evaluating weight for a giv
height and thencomparing that figure with an ideal weigIBW
Originates from life insurance studies Describes the weight associated with the lowest mortality ratefor
height and gender IBW can be estimated from the formula IBW (in kg) = height (in c
where xis 100 for adult males and 105 for adultfemales.
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Body Mass Index-BMI
A more robust measure of the relationshipbetween heigweight
BMI = body weight (in kg)/height2 (in metres) BMI of 30 kg m2 - obese increase in morbidity and mortality
BMI >35 kg m2 - morbidly obese
BMI >55 kg m2 - super obese
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Epidemiology
Worldwide incidence of obesity is on the rise. More than 1 billion overweight adults; more than 300 million adu Obesity levels range from below 5% in China, Japan and certain A
nations, to over 75% in urban Samoa Prevalence of obesity is about 1520% in Europe In the UK over the period 19801991the prevalence of obesity had
increased from 6% to 13% in menand from 8% to 15% in women In the USA the prevalence of a BMI of >25kg m2 being 59.4% for
50.7% for women In India- 7-9 per cent, comprising mainly of urbanites (19th July 1
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Mortality
Morbidity and mortality rise sharplywhen BMI is >30 kparticularly with concomitantcigarette smoking.The risk of premature death doubles in individualswith
of >35 kg m2.Sudden unexplained deathis 13 times more likely in mo
obese women than in their
non-obese counterparts.Morbidly obese individuals areat a much greater risk of
mortality from diabetes, cardiorespiratoryand cerebrovdisorders, and certain forms of cancer, aswell as a host oother diseases
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Aetiology
A complex and multifactorial disease.
Occurs when net energy intake exceeds net energyexpenditureover a prolonged period of time.
Genetic predisposition Children of two obese parentshaving about a 70% chance of becom
obese themselves as comparedwith a 20% risk for children of nonparents.
Influences such as diet andlifestyle
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Aetiology
Ethnic influences In the USA African andMexican Americans being at much higher
than white Americans. Asian immigrants to the UK have a more central distributionof fa
native Caucasians .
Socioeconomic factors Inverse relationship between socioeconomicstatus and the preval
of obesity
Medical disorders Cushings disease or hypothyroidismpredispose to obesity . Use of corticosteroids, antidepressantsand antihistamines
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Central or Android vs. Peripheral or Gynaecoid Ob
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Obesity and the Respiratory System
Frequent episodes of apnoea or hypopnoea during sleep.
Snoring, usually gets louder as the airway obstructs, followedsilence, as airflow ceases, and then gasping or choking, as therouses and airway patency is restored.
Fragmented sleep throughout the night causes daytime sleepiwhich is associated with impaired concentration, memoryproblems and road traffic accidents.
Recurrent apnoea Leads to hypoxaemia, hypercapnia and pulmonary and systemic
vasoconstriction. Recurrent hypoxaemia leads to secondary polycythaemia and is
associated with an increased risk of IHD, CVAs, RHF.
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Normal vs. collapsed Airway
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Obesity and the Respiratory System
Reduction in FRC, ERV and
TLCIncrease in oxygen
consumption and carbon dioxide production.
Sensitive to opioids, sedatives
and anesthetic agents
May be on Bi-PAP support
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Obesity and the Cardiovascular System
Cardiovascular disease Dominates the morbidity and mortality in obesity
Manifests itself in the form of IHD, hypertension and cardiac failu
A recent Scottish health survey found the prevalence of any cardiodisease was 37% in adults with a BMI of >30 kg m2, 21% in thosBMI of 2530 kg m2 and only 10% in those with a BMI of
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Obesity Induced Cardiomyopathy
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Obesity and G.I. disorders
Increased intrabdominal pressure can lead to Delayed gastric emptying Increased incidence of haitus hernia Increased incidence of gastro-oesophgeal reflux Higher risk for aspiration pneumonitis
Obesity is an independent risk factor for diabetes mellitIncreased risk for DVT The increased risk of thromboembolicdisease in obese patients is
result from prolongedimmobilization leading to venous stasis,polycythaemia, increasedabdominal pressure with increased presthe deep venouschannels of the lower limb.
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Other Problems
Positioning and transfer Difficult and risk involved
Intravenous access Difficult in gaining access
Inability to use regular sized monitors
Difficult airway access
Altered drug handling
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Trauma and the obese Patient
Outcome is poor
Higher involvement in car crashes
Higher incidence of rib fractures, pulmonary contusionspelvic fracturesand extremity fractures.
Care of the morbidly obese trauma victim in the resuscitation
likely to prove difficult.
Portable radiographs may be of poor qualitybecause of overly
soft tissue, and clinical signs may bedifficult to elicit.
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Obese Patient and ICU Care
Obese patients are morelikely to be admitted to the intensive care unit.
Acute postoperative pulmonary events were twice as likely in the obese non-obese.Hospitalizedobese patients were at an increased risk of developing
respiratorycomplications.The use of PEEP may help to prevent airwayclosure and atelectasis but
at the expense of the cardiac output.Weaning from mechanical ventilation may be difficultbecause of high o
requirements.The morbidly obese patient is likely to have significant
cardiovascularimpairment and to tolerate fluid loading poorly.Siting of central venous catheters maybe difficult.Nutritional issues
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Childhood obesity
Fifteen percent of youngsters ages 6-19 and ten percent of chi
through 5 are considered seriously overweight Dr. William Stull, Director of the Center for Nutrition and We
Management at Geisinger Medical Center , Danville, PA, high the contribution of the 3 Ns: Netscape, Nintendo, and Nickelode
the current obesity trends among children. Gone are the days of charriving home from school, changing into "play clothes", and partiin outdoor activities until dark. Similarly, adults are no longer requexert themselves physically because of modern conveniences (drivthroughs, remote controls, computers, elevators, etc., ).
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Causes of Childhood obesity
Many factors usually working in combination incre
the child's risk of becoming overweight: Diet
Inactivity
Psychological factors
Family factors Socioeconomic factors
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Clinical Emotional
Diabetes mellitusHypertensionAsthma
Sleep disordersLiver diseaseEarly pubertyEating disordersSkin infections
Healthy eating
Physical activity
Medication Sibutaramine, orlistat
Weight loss surgery
Problems of Childhood obesity
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