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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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