Obesity

• A person is considered obese if they weigh more than 20% above the ideal weight for their height, age, and body type
• Obesity is considered a public health problem in most economically advanced countries
• Prevalence of obesity in Malaysia:

  • 15.1% in 2011
  • 17.7% in 2015
  • 19.9% in 2019
• Prevalence of obesity in the US:

  • 41.9% of adults
  • 19.7% of adolescents and children
  • 14.7 million individuals have obesity
• Class I obesity: BMI 30 to <35 kg/m²

  Class II obesity: BMI 35 to <40 kg/m²

  Class III obesity: BMI 40+ kg/m²
• Factors contributing to obesity:

  • Diet high in calories & fat
  • Lack of exercise
  • Overconsumption of food
  • Genetic predisposition
  • Different nutrient metabolism
  • Family lifestyle
• Complications of obesity:

  • Diabetes mellitus
  • Hypertension
  • Hyperlipidemia
  • Coronary artery disease
  • Obstructive sleep apnea
  • Cholelithiasis
  • Cancer
  • Arthritis
  • Increased susceptibility to infectious diseases
  • Decreased wound healing
• Diagnosis of obesity:

  • Height & weight chart
  • Body mass index (BMI)
  • Waist & hip circumference ratio
  • Thyroid function
• Direct methods of dietary assessment:

  1 - 24-hour food recall

  • Strengths: assess large population, inexpensive
  • Weaknesses: relies on memory, can be inaccurate

  2 - Weighed Food Record

  • Strengths: accurate data
  • Weaknesses: time-consuming, expensive
• Factors leading to an increase in calorie intake:

  • Fast and convenience foods
  • Sugar in many products
  • Marketing and advertising
  • Psychological factors
  • Hormones
  • Medications
• Dietary therapy for obesity:

  • Adjust diet to reduce energy intake
  • Teach how to modify dietary intake
  • Reduce total energy intake to that of a normal weight individual
• Desirable weight loss:

  • 0.5 - 1 kg per week
  • Reduce weight by 5-10%
• Energy requirements assessment:

  • Resting metabolic rate (RMR)
  • Total energy expenditure estimation
• Exercise for weight control:

  • Important component
  • Diet more effective than physical activity
  • Recommended at least 45-60 minutes of moderate to intense physical activity
• Treatment options for obesity:

  • Dietary control
  • Exercise
  • Drugs
  • Surgical procedures
• Surgical treatment:

  • Bariatric surgery
  • Gastric restrictive procedures
  • Malabsorptive procedures
  • Roux-en-Y gastric bypass
  • Complications like dumping syndrome and nutritional deficiencies
• Nutrition care for dumping syndrome:

  • Liquids between meals
  • Limit simple carbohydrates
  • Protein, fat, and complex carbohydrates
  • Regular evaluation by a dietician
  • Adequate fluids to prevent dehydration
• Obesity is the most common nutritional disorder worldwide, with an estimated 650 million adults being overweight or obese.
• A person is considered obese if they weigh more than 20% above the ideal weight for their height, age, and body type
• Obesity is considered a public health problem in most economically advanced countries
• Prevalence of obesity in Malaysia:

  • 15.1% in 2011
  • 17.7% in 2015
  • 19.9% in 2019
• Prevalence of obesity in the US:

  • 41.9% of adults
  • 19.7% of adolescents and children
  • 14.7 million individuals have obesity
• Class I obesity: BMI 30 to <35 kg/m²

  Class II obesity: BMI 35 to <40 kg/m²

  Class III obesity: BMI 40+ kg/m²
• Factors contributing to obesity:

  • Diet high in calories & fat
  • Lack of exercise
  • Overconsumption of food
  • Genetic predisposition
  • Different nutrient metabolism
  • Family lifestyle
• Complications of obesity:

  • Diabetes mellitus
  • Hypertension
  • Hyperlipidemia
  • Coronary artery disease
  • Obstructive sleep apnea
  • Cholelithiasis
  • Cancer
  • Arthritis
  • Increased susceptibility to infectious diseases
  • Decreased wound healing
• Diagnosis of obesity:

  • Height & weight chart
  • Body mass index (BMI)
  • Waist & hip circumference ratio
  • Thyroid function
• Direct methods of dietary assessment:

  • 24-hour food recall
  • Weighed Food Record
• Factors leading to an increase in calorie intake:

  • Fast and convenience foods
  • Sugar in foods
  • Marketing and advertising
  • Psychological factors
  • Hormones
  • Medications
• Dietary therapy for obesity:

  • Adjust diet to reduce energy intake
  • Teach how to modify dietary intake
  • Reduce total energy intake
  • Energy deficit for different classes of obesity
• Desirable weight loss for most people is 0.5 – 1 kg per week after the first month of dieting
• Energy requirements assessment:

  • Resting metabolic rate (RMR)
  • Total energy expenditure estimation
• Exercise is an important component of weight control programs

  • Diet is more effective for weight loss than physical activity
  • Recommended at least 45 – 60 minutes of moderate to intense physical activity most days of the week
• Treatment options for obesity:

  • Dietary control
  • Exercise
  • Drugs
  • Surgical procedures
• Surgical treatment:

  • Bariatric surgery
  • Gastric restrictive procedures
  • Malabsorptive procedures
  • Roux-en-Y gastric bypass (RYGB)
• Complications of RYGB procedure:

  • Dumping syndrome
  • Symptoms and management strategies
  • Risk of nutrition deficiencies
  • Nutrition care for dumping syndrome