Written by Dr.Md.Redwanul Huq (Masum)

Sunday, 15 January 2012 16:20

Obesity:

Definition:

It can be defined as deposition of excess fat in the body.

Causes of obesity:

1. Behavioral factors:

a) Intake of high fat diet
b) Intake of energy dense foods
c) Smoking
d) Alcohol intake

2. Specific causes:

a) Genetic predisposition
b) Hormonal factors-

• Hypothyroidism
• Hypopituitarism
• Cushing’s syndrome
• Insulinoma
• Hypogonadism

c) Drugs:

• Oral contraceptives
• Steroids
• Insulin
• Phenothiazine
• Tri Cyclic Antidepressant(TCA)

Measurement:

Obesity is measured by BMI. In case of obesity BMI is more than or equals to 30.

Signs-symptoms of obesity:

1. Over weight in relation to height
2. Skin fold thickness over the triceps muscles is much more than the normal limit, normal range : man-10mm ,woman- 13mm.
3. Features of Complications of obesity like:

a) Cardiovascular disorders – Hypertension, ischemic heart diseases
b) Metabolic disorders:

• Type II DM
• Hyperlipidaemia
• Gall stones
• Gout

c) Weight related musculoskeletal disorders and arthritis
d) Abdominal and diaphragmatic hernias
e) Increased risk of certain cancers
f) Stress incontinence
g) Menstrual abnormalities
h) Hirsutism
i) Exertional breathlessness
j) Pregnancy complications
k) Obstructive sleep apnoea
l) Phychological:

• Anxiety
• Depression
• Sexual disorders.

Hyperlipidemia:

Definition:

Increased serum lipid level is known as hyperlipidemia.

Causes of hyperlipidemia:

1. Primary Hyperlipidaemia: Idiopathic
2. Secondary Hyperlipidaemia:

a) Diabetes mellitus
b) Nephrotic syndrome
c) Chronic renal failure
d) Hypothyroidism
e) Intake of excess alcohol
f) Drugs, e.g.

• Thiazide diuretics
• Beta- blockers
• Oestrogen replacement therapy.

Signs-symptoms of hyperlipidemia:

1. Xanthelasma around eyes
2. Tendon xanthoma
3. Corneal lipid arcus

Investigations for Obesity and Hyperlipidemia:

•  Fasting lipid profile: To rule out dyslipidemia.
• Blood glucose: To rule out diabetes.
• Urine R/M/E: To see the evidence of renal disease and diabetes mellitus (including microalbuminuria).
• Serum Creatinine: To exclude renal disease.
• Hematocrit.
• Resting ECG: may be normal, may show Q waves as evidence of previous myocardial infarction,
• Exercise ECG: Exercise tolerance test (ETT)- ECG shows down-sloping ST segment depression of 1 mm or more.
• Echocardiogram
• Coronary arteriogram: It provides anatomical information about the extent and nature of coronary artery disease.
• Thyroid function test (if needed).

Management of Obesity and Hyperlipidemia:

i) Drug treatment of obesity and hyperlipidemia:

I. Tab. Orlistat (120 mg)- 1 tab tid ………………….. 4 Years
II. If Serum Cholesterol level is high-
Tab. Atorvastatin (10 /20/40 mg)
Or,
Tab. Rosuvastatin Calcium(5/10mg)
1 tab-once daily( +M) ———————–contd.
III. If serum Triglyceride level is high-
Cap. Fenofibrate (200 mg)
1 cap-once daily (AM)————————2 /3 Months or contd.
Or,
Cap. Gemfibrozil(300mg)
1 Cap- once daily/bid ( ½ HBM) ———————2 /3 Months or contd.

ii) Surgery (For Obesity only):

Reduction of the size of the stomach (Bariatric surgery) is the effective surgery for obesity.

iii) Treatment of complications (if any)

iv) Treatment of associated risk factors (if any)

v) Lifestyle modification:

• Increase physical activity
• Avoid smoking
• Exercise regularly (at least 30 – 45 minutes of moderate intensity physical activity like walking, jogging, cycling or swimming on most days of the week),
• Avoid extra salt
• Stop taking alcohol
• Control your body weight.

vi) Dietary modification:

•  Decrease intake of saturated fat, polyunsaturated fat and trans fatty acids and therefore decrease intake of butter, fatty meats, margarine, dairy products made from 2% or whole milk.
• Use oils containing monounsaturated fatty acids and n-3 fatty acids (eg, canola and olive oil).
• Eat at least five to seven servings of vegetables and fruits daily.
• Eat soy products and legumes daily.
• Eat garlic.
• Increase intake of soluble fiber ( Present in Apples, Barley, Citrus fruits, Strawberries, Carrots, Guar,Legumes).

 Food Lists for Fat – Modified Diet in obesity and hyperlipidemia:

Foods Allowed	Foods to Avoid
Skim milk or 1% low – fat milk, Cheese (without salt ),Yogurt , Sour curd.	Buttermilk , Ice-cream , Desserts (made from whole milk) ,Sweets, salt , Cheese.
Leafy vegetables, Carrot, Pumpkin, Lemon like fruits, Ripen papaya.	Fried food ,Parata , Luchi ,Chips.
Meat (without fat), Fish ,Egg white, Whole Egg (1 or 2 times in a week).	Liver, Brain , Prone ,Egg yoke ,Meat (with fat) ,Chicken /Duck (with skin) ,Roast or steak ,Birani (fried rice)
Vegetable oil	Ghee, Dulda , Coconut, Chocolate, Pastry.
Candies ,Honey , Molasses (limited amount)	Candies ,Honey , Molasses, Sugar

Sample Menu Plan For obesity and hyperlipidemia

(Prepared by Mrs. Sharmin Sultana , M.S. in Food & Nutrition )

Meal	Menu	Amount
Early Morning	Tea	1 cup
Breakfast	chapatti	2
	Soft cooked egg (without yolk)	One
	Pulse carry	½ cup
	Mixed vegetables	½ cup
Mid Morning	Skim milk	1 cup
	Toast	1
Lunch	Rice (soft)	2 cup
	Mixed vegetable	2½ cup
	Fish carry / Chicken (low spicy)	30gm / 1piece
	Pulse (Dal) carry	1 cup
Evening Tea	Tea	1 cup
	Bread	2 slices
Dinner	Chapatti Or Rice	2 -3 Or 2 cup
	Chicken carry	1piece
	Mixed vegetables	2½ cup
Before bed time	Skim milk	1 cup

From this list you can get protein – 52 gm , fat – 24 gm, & total calorie -1450 Kcal.