What is obesity?

• Obesity is defined as an excess accumulation of body fat

Why is obesity accelerating in developing countries?

• Increased consumption of energy-dense, nutrient poor foods combined with reduced physical activity.

One-third of Saudi population is obese. The study conducted by the World Obesity Federation and RTI International has found that Saudi Arabia has an obesity rate of roughly 35 percent. But Saudi Arabia is not alone, as every country worldwide is experiencing a spike obesity rates

Obesity in Saudi Arabia costs $19 billion per year.

A recent study in men indicated that waist size predicted death from heart attack or stroke better than any other traditional risk factors including hypercholesteremia or smoking.

Complications of Obesity

• People who are obese are 25% more likely to be depressed
• 30% of people suffering dementia are obese
• People who are obese are 104% more likely to have heart failure
• People who are obese are over 150% more likely to have high blood pressure
• Nearly 10% of all cancer is caused by obesity
• Over 50% of adults living with diabetes are obese
• 33% are more likely to develop asthma
• Obese children are 200% more likely to develop multiple sclerosis

Morbidity Associated with Obesity

• Obstructive sleep apnea
• Osteoarthritis
• Cardiovascular disorders
• Gastrointestinal disorders
• Metabolic disorders
• Enocrinal
• Complications of pregnancy
• Menstrual irregularities
• Psychological disorders

Cardiovascular Disorders Associated with Obesity

• Hypertension
• Stroke
• Coronary Artery Disease

Hypertension

• Blood pressure is often increased in overweight individuals.
• Estimates suggest that control of overweight would eliminate hypertension in 28% in African Americans.
• Overweight and hypertension interact with cardiac function, leading to thickening of the ventricular wall and larger heart volume, and lead to cardiac failure.

Stroke

• There are two forms of stroke: ischemic and hemorrhagic.
• Overweight and obesity increase the risk for ischemic stroke in men and women.
• With increasing BMI, the risk of ischemic stroke increases progressively and is doubled in those with a BMI greater than 30 kg/m² when compared to those having a BMI of less than 25 kg/m². 
• Overweight and obesity do not increase the risk for hemorrhagic strokes directly but maybe du to increase blood pressure

Gastrointestinal Disorders Associated with Obesity

• Colon Cancer
• Gall stones

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.  

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.

Metabolic Disorders Associated with Obesity

• Diabetes Mellitus
• Dyslipidemia
• Liver Disease

Endocrine Changes 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

Treatment of obesity

Treatment of obesity comes into three categories:

• behavior modification {diet and exercise}                            
• pharmacotherapy                                  
• surgical intervention

Pharmacological Therapy

Pharmacological interventions to facilitate weight loss and behavior change include:

• Enhancing satiety
• Decreasing fat absorption
• Increasing energy expenditure
• Decrease appetite

Mechanism of Action

• Activity occurs in the stomach and small intestine.
• Inhibits gastric and pancreatic lipases.
• 30% of ingested fat is unabsorbed and excreted.
• Minimal systemic absorption.
• Low-fat diet (£ 30%) required to minimize side effects.

Surgical Treatment of Obesity

• Patient selection criteria
  • BMI > 40 or > 35 for those with weight related co-morbidities.
  • History of failed conservative weight loss approaches.
  • No substance abuse and/or psychiatric disorders.
• Surgical options
  • Vertical banded gastroplasty (VBG)
  • Gastric bypass (GBP)
• Outcomes
  • Weight loss is 25% to 35% of initial weight.
  • Weight loss is generally well maintained.

Significant improvement in co-morbidities.