OBESITY

BAGIAN GIZI FK UNDIP

OBESITY:
DEFINITION & EPIDEMIOLOGY

Who is too fat

Ancestors were not over fat

Excess body fat is a by-product of
urbanization, mechanization, a
sedentary lifestyle and abundant highcalorie foods
Being fat is beautiful in some societies
Being fat represents a high socioeconomic class
Beautiful = Barbie doll

Obesity: Definition

A condition of abnormal or excessive

fat accumulation in adipose tissue to
the extent that health may be
impaired
Measuring body fat is difficult
surrogate measures such as BMI and
waist circumference are commonly
used

Obesity : Definition

Metabolic disorder resulting from

chronic imbalance between energy
uptake and expenditure
Chronic; lifelong treatment required
Treatment controls do not cure
disease
No short-term solutions
Disease recurs after treatment is
withdrawn

OBESITY : THE
PATHOGENESIS

1. Genetic factors in human

obesity

Obesity tends to run in

families, but does not prove
the role genetic factors in the
development of obesity
However, some people are
genetically more susceptible
to environmental factors
which predispose to obesity
Study in rats: obesity is a
result of a defect in a gene
which should produce leptin,
but the role of leptin remains
unclear

Is it genetic?

ob gene

Regulates production of leptin

Leptin is secreted by fat cells and has dual
activity of decreasing food intake and
increasing metabolic rate
Mice born without the ability to make leptin
(ob/ob mice) eat without restraint

ob/ob mouse normal mice

ob/ob mouse

ob/ob mouse

ob/ob mous
injected wi
leptin

So, just give obese

humans leptin!!!
In

fact, this works in leptindeficient humans, but

99.99% of obese humans have
HIGH levels of leptin, but have
become insensitive to it.

Hereditary factors

The genetic contribution to body

weight is estimated to be between
40 and 70 percent (with some rare
cases of severe obesity linked to
specific gene errors)

 The epigenetics of increasing weight through

thegenerations (One hypothesis is that

maternal obesity before and during
pregnancy affects the establishment of body
weight regulatory mechanisms in her baby.
Maternal obesity could promote obesity in
the next generation." (Waterland, 2008)

2. Physical inactivity

Data on the contribution of inactivity

to the current epidemic of obesity is
limited
Evidence:

People eat more than they did in the

past
Energy expenditure in manual labour or
vigorous leisure activity has declined
with the increase of TV viewing and
labour saving appliances

POPCORN
20 Years Ago

270 calories
5 cups

Today

1700
calories
21 cups
buttered

3. Endocrine

Obese people have endocrine

abnormalities
Polycystic ovary syndrome (PCOS) is
associated with obesity and ovarian
function improves with weight loss
Lack of evidence for primary
endocrine defect as the cause of
obesity

Endocrine Changes

There are various endocrine changes associated with

overweight.
Changes in the reproductive system are among the most
common.
Irregular menses and frequent anovular cycles are
common.
Rates of fertility may also be reduced.

2009

Endocrinol Metab Clin N Am. 2003; 32: 761-786.

Endocrine Changes
Associated with Obesity
Common hormonal abnormalities associated with obesity

Increased cortisol production

Insulin resistance
Decreased sex hormone-binding globulin in
women
Decreased progesterone levels in women
Decreased testosterone levels in men
Decreased growth hormone production
2009

Endocrinol Metab Clin N Am. 2003; 32: 761-786.

Psychological Disorders
Associations with Obesity

Obesity is associated with an impaired quality of life.

Higher BMI values are associated with greater
adverse effects.
When compared to obese men, obese women appear
to be at a greater risk for psychological dysfunction.
This may be due to the societal pressure on women to
be thin.

J La State Med Soc .2005; 157 (1): S42-49.

2009

Endocrinol Metab Clin N Am. 2003; 32: 761-786.

5. Macronutrient
balance

Obesity is a result of excess of

total energy intake relative to
energy expenditure rather than a
certain macronutrient

Neuropeptides and Leptin in Food

Intake and Obesity

BW homeostasis is maintained via a series of

complex interactions of hypothalamus and the
periphery via leptin
Leptin is synthesised in and secreted from
adipose tissue, inhibits orexigenic neuropeptides
and thus, decreasing food intake and body
weight, increasing fat oxidation and energy
expenditure

Orexigenic neuropeptides

Neuropeptides Y
Melanin concentrating hormon
Orexin A and B
Opioids

Anorexigenic peptides

Cocaine- and AmphetamineRegulated Transcript (CART)

Corticotropin-releasing Hormone
(CRH)
-Melanocyte-stimulating hormone
(-MSH)

Mortality
Weight, Fat Distribution, and
Activity

The following factors have been shown to increase

mortality in individuals:

Excess body weight

Regional fat distribution
Weight gain patterns
Sedentary Lifestyle

2009

Endocrinol Metab Clin N Am. 2003; 32: 761-786.

Mortality
Regional Fat Distribution
Android

Gynoid

Regional fat distribution can contribute to mortality.

This was first noted in the beginning of the 20th century.
Obese individuals with an android (or apple) distribution of
body fat are at a greater risk for diabetes and heart disease
than were those with a gynoid distribution (pear).

2009

Endocrinol Metab Clin N Am. 2003; 32: 761-786.

Centralisation of Body Fat

Fat accumulates predominantly in

central deposit
Serves

as an easily available
substrate for important liver and
periphery functions
Reserve depot for periods when the
surrounding milieu is threatening

Android fat distribution results in

higher free fatty acid levels,
higher glucose and insulin levels and reduced HDL
levels.
higher blood pressure and inflammatory markers.

Mortality and Morbidity

Associated with Obesity

The effects of excess weight on mortality and

morbidity have been recognized for more than 2,000
years.
It was Hippocrates who recognized that sudden
death is more common in those who are naturally fat
than in the lean.

2009

Endocrinol Metab Clin N Am. 2003; 32: 761-786.

Mortality
Weight Gain

In addition to overweight and central

fatness, the amount of weight gain after
ages 18 to 20 also predicts mortality.

The Nurses Health Study and the Health

Professionals Follow-up Study showed
that a marked increase in mortality from
heart disease is associated with
increasing degrees of weight gain.
2009

Endocrinol Metab Clin N Am. 2003; 32: 761-786.

Morbidity
Associated with Obesity
Individuals who are obese are at a greater risk of
developing:

Obstructive sleep apnea

Osteoarthritis
Cardiovascular disorders
Gastrointestinal disorders
Metabolic disorders

Endometrial, prostate
and breast
cancers
Complications of pregnancy
Menstrual irregularities
Psychological disorders
2009

CDC

Cardiovascular Disorders
Associated with Obesity
Obese individuals are at a greater risk of developing these
cardiovascular disorders:

Hypertension
Stroke
Coronary Artery Disease
2009

Hypertension

Blood pressure is often increased in overweight individuals.

Estimates suggest that control of overweight would eliminate
48%
of the hypertension in Caucasians and 28% in
African Americans.
Overweight and hypertension interact with cardiac
function, leading to thickening of the ventricular
wall and larger heart volume, and thus to a
greater likelihood of cardiac failure.

2009
J La State Med Soc .2005; 157 (1): S42-49.

Colon Cancer
Findings Relating to Obesity

Colon cancer has been shown to occur more

frequently in people who are obese than in people
who are of a healthy weight.

An increased risk of colon cancer has been

consistently reported for men with high BMIs.

Women with high BMI are not at increased risk of

colon cancer.

There is evidence that abdominal obesity may be

important in colon cancer risk.
2009

NCI

Gallstones
Findings Related to Obesity

Obesity appears to be associated with the development of gallstones.

More cholesterol is produced at higher body fat levels.
Approximately 20 mg of additional cholesterol is synthesized for each
kg of extra body fat.
High cholesterol concentrations relative to bile acids and
phospholipids in bile increase the likelihood of precipitation of
cholesterol gallstones in the gallbladder.

2009

Endocrinol Metab Clin N Am. 2003; 32: 761-786.

Gallstones
Findings Related to Obesity

In the Nurses Health Study, when compared to those having a BMI of 24 or

less,
Women with a BMI > 30 kg/m 2 had a 2-fold increased risk for
symptomatic gallstones.
Women with a BMI > 45 kg/m 2 had a 7-fold increased risk for
symptomatic gallstones.

The relative increased risk of symptomatic gallstone development with

increasing BMI appears to be less for men than for women.
2009

J La State Med Soc .2005; 157 (1): S42-49.

Cancer
Findings Relating to Obesity

Overweight and obesity are associated with an

increased risk of:
esophageal, gallbladder, pancreatic, cervical,
breast, uterine, renal, and prostate cancers.

Obesity and physical inactivity may account for 25

to 30 percent of several major cancers, including--colon, breast (postmenopausal), endometrial,
kidney, and cancer of the esophagus.
2009

J La State Med Soc .2005; 157 (1): S42-49.

[People] dig their graves

with their own teeth and
die more by those fatal
instruments than the
weapons of their enemies.
1600

-- Thomas Moffett,