Obesity is one of the fastest growing health concerns in the world today and is determined by a person carrying too much body fat for their height and gender. Experts believe the growth in obesity can be partly attributed to the average lifestyle being less physically active than it used to be. Being obese increases the risks of developing certain serious diseases such as coronary heart disease, diabetes and some cancers, as well as having a significant impact on psychological wellbeing.
Being underweight also poses serious health risks, sometimes leading to irregular periods, fertility issues, osteoporosis, anaemia, depleted energy levels and an inability to keep warm. Much like being overweight and obese being underweight can also affect psychological wellbeing, with those who are underweight often feeling unhappy with their body image. If you are below a healthy weight range then increasing the amount of nutrients will help to lower the risk of these problems.
NUTRITIONAL CARE IN WEIGHT MANAGEMENT
Weight management is the process of adopting long-term lifestyle modification to maintain a healthy body weight on the basis of a person’s age, sex and height. Methods of weight management include eating a healthy diet and increasing physical activity levels.
- EXPLAIN THE IMPORTANCE OF MAINTAINING A DESIRABLE WEIGHT THROUGHOUT THE LIFE.
- ENUMERATE THE GUIDELINE FOR CALCULATING THE IDEAL BODY WEIGHT.
- DESCRIBE THE CAUSATIVE FACTORS,PREVENTION AND TREATMENT OF VARIOUS CONDITIONS RELATED TO WEIGHT MANAGEMENT (OBESITY,UNDERWEIGHT).
OBESITY IS ONE OF THE MAJOR PUBLIC HEALTH PROBLEM OF THE WORLD .EARLIER A PROBLEM OF DEVELOPED NATIONS,IT IS NOW INCREASINGLY AFFLICTING OUR COUNTRY.MAINTAINANCE OF A FAIRLY CONSTANT BODY WEIGHT IS VITAL IMPORTANCE IN INCREASING THE LIFE EXPECTANCY,AS WELL AS,QUALITY OF LIFE OF INDIVIDUALS COMMUNITIES.
- 338million adults in developing countries are underweight while 58 million are overweight.
- During the past 30 years there is 18.5% rise in overweight and 16.1% rise in obese Americans while is 17% in percentage of overweight children (5-14 years).
- Roughly 40-50 million Indians belonging to the upper middle class are over weight. With increasing numbers of years, obesity could become a public health problem in adults.
Obesity is a medical condition in which excess body fat has accumulated to the extent that it has an adverse effect on health. measure of how much fat a person has in its body would serve as a tool for classification of obesity. No, because the measurement of direct body fat is difficult, so we use an indirect methods.those are :-
- BMI (Body Mass Index)
- Waist to Hip Ratio (WHR)
BMI (Body Mass Index)
BMI is calculated by dividing the subject’s mass (Kg) by the square of his or her height (meter).
|30.0–34.9||class I obesity|
|35.0–39.9||class II obesity|
|≥ 40.0||class III obesity|
Waist to Hip Ratio (WHR):
Two individuals who have the same BMI and the same total body fat may different abdominal fat mass. Abdominal fat accumulation increases the number of chronic degenerative diseases. The waist-hip ratio (waist divided by hip circumference) therefore is a simple method for distinguishing between fatness in the lower trunk (hip and buttocks) and fatness in the upper trunk (waist and abdomen area). A WHR of > 1.0for men and > 0.85 for women is an indicator of abdominal obesity. Lower trunk fatness lower waist to hip ratio) is often referred to as ‘gynoid obesity’. Upper or central fatness (higher waist to hip ratio) is called ‘android obesity’.
Obesity is a condition resulting from of excess body fat. The fat deposition takes place because over a of time, people consume diets which provided more energy than they were able to expend for their physical activity and growth.
We cannot change our heredity but we can, to a certain extent, exercise control over environmental factors by carrying out suitable modifications in our life style.
Genetic Susceptibility: A number of genes are implicated in pathogenesis of obesity.The two genes which recently have received much attention are the ob-gene and the b3-adrenoreceptor gene. *ob-gene: The ob-geneproduces leptin (a hormone) which is normally secreted from fat cells. Mutations in the ob-gene cause obesity. *b3-adrenoreceptor-gene: It regulates Resting Metabolic Rate and oxidation of fat in human beings.
Dietary Habits: eating habits which may lead people to obesity, those who eat food at a very fast rate tend to chew food less and land up eating more food. Similarly, nibbling between meals may contribute extra calories to the total intake than is normally realized. Also, those who tend to eat whenever food of their liking is available or those who just follow meal times even if they are not hungry tend to put on weight. Mothers generally eat leftovers of children because they want to avoid wastage of food, adding more calories to their own calorie intake.
Physical Activity: Sedentary life style with lack of an exercise schedule tends to make obese. As we approach middle age, our physical activity generally decreases without a corresponding decrease in food consumption leading to obesity. Activity may be decreased because of a debilitating illness like arthritis or cardiac disease.
Psychological Factor: Lonely, bored and depressed individuals may find eating. When there is nothing else to do, eating provides diversion resulting in increase consumption of calories.
Hormonal Imbalance: Certain diseases associated with secretion of hormones,e.g., hypothyroidism, hypogonadism and Cushing’s syndrome exhibit obesity as one of the characteristic features. A large number of persons who are unsuccessful in reducing their weight tend to site hormonal imbalance as causative factor for their obesity but the fact is that only a very small percentage actually suffers from it.
Birth weight and childhood growth pattern:It has been shown that slow growth of the fetus in uterus and during infancy is followed by accelerated weight gain in childhood. This combination of small size at birth and accelerated childhood weight has been found to be associated with of adiposity, as well as, insulin resistance in later life.
Obesity is a state of positive energy balance created by consumption of calories in amount excessive to the total energy expenditure (TEE) by the body. TEE comprises the following:
Metabolic Aberrations and Clinical Manifestation
Management Of Obesity
Dietary and Lifestyle Modification
Dietary Modification: The dietary modifications serve as a guide for the obese to make healthy food choices.
Energy: any degree of weight loss, the energy has to be restricted to the level enables mobilization of fat stores for carrying out the daily activities of the body. The energy requirements can be determined on the basis of ideal body weight. Three main categories, depending upon the individual’s size and level of activities been determined on the basis of ideal body weight and have been mentioned in the Table below:-
|Energy Requirement (Kcal/Kg IBW/day)|
Proteins: Adequate amount proteins should be included in the diet to ensure proper metabolism and prevent weakness which is usually experienced by patients after weight loss which is achieved by consuming an unbalanced diet. about 1 gm protein per kg body weight.
Fats: Fats, being a concentrated source of energy need to be restricted. Excess dietary fat promotes much more weight gain than carbohydrate or protein of the same amount. Not more than 20% of the total energy should come from fat. Foods rich in saturated fatty acids such as red meats, whole milk products should be strictly avoided.
Carbohydrates: Carbohydrates in the form of non-starch poly-saccharides provide bulk and satiety value to the reducing diet. They are also important for regular bowel movements; constipation being a common problem among obese. About 50-55% of total calories may be from complex carbohydrates and 10%from simple carbohydrates. Vitamins and Mineral: If adequate amount of fresh fruits and vegetables are included in the diet, the body stores of water soluble vitamins are usually not depleted. However when we restrict fats for prolonged periods, the diet may be deficient in fat-soluble vitaminsA and D. A diet high in sodium may promote retention of fluid in the body.
Fluids: Liberal amounts of water and zero/low calorie fluids may be included in the diet. It may be helpful to have a glass of water before meal to reduce food intake.
Effects of Physical Activity
A person with obesity and having above clinical manifestations may require pharmaceutical management in addition to dietary and lifestyle modifications. Anti-Obesity Drug: The anti-obesity drug can classified into two broad group.See below-
Underweight results when there is negative energy balance. A failure to consume proper food which is further insufficient to fulfill the energy requirement of the body for whatever reason is responsible for not maintaining optimum weight.
Metabolic Aberrations and Clinical Manifestations
The diet prescribed for effecting weight gain should be high in calories, proteins, fat and carbohydrates.
Energy: Energy requirements based on activity levels for obese, normal and underweight subjects
|Energy Requirement (Kcal/Kg IBW/day)|
Proteins:Proteins are required for tissue building, as well as, to take care of the daily wear and tear. Under weight individuals generally have depleted lean body mass and poor reserves of amino proteins. Thus, the patient may benefit by consuming around 1.2 g per kg body weight of proteins per day.
Fats:We know that fats are concentrated source of energy (lg = 9 kcal) Fats are capable of increasing the energy value of the diet without adding much bulk to it. Add. extra fat gradually, a sudden increase in fatty foods like butter, cream and oil may produce diarrhoea. About 30% of calories should come from unsaturated sources of fat.
Carbohydrates: Liberal amounts of easy to digest carbohydrates should be included in the diet. The intake of dietary fibre should be minimized so as to prepare meals which are nutrient dense and have a small volume. Include more of high calorie vegetable like potatoes, colocasia and yam instead of raddish, cucumber, leafy vegetables which are low in the carbohydrate content. All cereals provide high calories at low cost and should provide about 55-65% of total kilocalories.
Vitamins and Minerals: If the diet provides good amounts of fresh fruits and vegetables, vitamin or mineral supplements are usually not required. However, if the patient indicates clinical signs of a severe nutritional deficiency, it may be imperative to use supplements or employ other essential medical measures.
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