5. Clinical course
Physician educated her about basic
nutrition, exercise tips and diabetes
Patient motivated to decrease weight when
she understood that all of her medical
problems could possible be resolved by
weight loss.
6. Monthly summary progress
Month weight BP Notes
1 110 146/94
2 100 138/90 Feeling
motivated,
taking stairs at
work, feels
healthier and
report having
more energy
3 91 125/80 Patient
continues to be
motivated, do
well
4 85 128/80 Patients blood
sugar improving.
9. Obesity is defined as excess of adipose tissue that imparts
Health risk ,It means too much of body fat.
10. BMI
Most widely used method to evaluate obesity is BMI.
Which is equal to weight in kg by height in square
meter i.e., wt/(ht)2.
For a healthy individual BMI value ranges from 18-
25.
11. BMI Classification
Normal 18.5 - 24.9
Overweight 25.0 - 29.9
Obesity
I 30.0 - 34.9
II 35.0 - 39.9
III > 40.0
12. Global Health burden of obesity
The latest WHO projections indicate that at
least one in three of the world's adult
population is overweight and almost one in
10 is obese. Additionally there are over 20
million children under age five who are
overweight.
13. Global Health burden of obesity
Overweight and obesity are important
clinical and public health burdens
worldwide.
WHO recommends that national programs
for prevention and treatment of overweight,
obesity and related comorbidities and
mortalities should be a public health priority
15. Obesity Virtually Guarantees Bad
Health
Diseases Tied to Obesity
Hypertension Some cancers
Type 2 diabetes Osteoarthritis
High lipids Stroke
Cardiovascular disease Respiratory disease
Gallbladder disease etc..
16. The good news is that overweight and obesity
are largely preventable.
What Are the secrets?
17. Regular Physical Activity is the key.
Improves maintenance of
weight loss
Improves cardiovascular
and other health risks
18. When one walks on the streets of Kigali,
you see an increased number of obese
people. The thought that first comes to your
mind is “These people should start
exercising.” But then, after seeing people
exercise and stay the same, the question
comes whether exercise alone really helps
in losing the extra and unwanted kilos.
19. Exercises alone do not help much.
35
Men
30
Loss of Fat-Free Mass
(% Total Weight Loss)
Women
25
20
15
10
5
0
Exercises Exercises plus Diet
20. To be clear!
Regular physical activity is
very good to keep healthy.
But when it comes to weight
loss, exercise alone won’t
help. It will be effective if
coupled with a sensible diet.
21. What is the situation in our
country?
A survey done in Rwanda and published in
2005 by the WHO showed that among
women 15 to 49 years old who had given
birth, 12.5% were overweight (with a body
mass index of 25kg/m2 and be-yond), with
1.3% being obese (with a body mass index
of 30kg/m2 and beyond).
22. Survey Year(s): 2000.
Survey Population: national, both urban and rural women who have
given birth from 2000 to 2005
23. Growing tendency of obesity in
Rwanda
Many people especially in Africa are found
of being fat.
In Rwanda, fatness is associated with
financial ability and as it is a country which
is rapidly developing ,obesity tend also to
increase.
However, being obese is a risk to health!
24. Causes of obesity in Rwanda
Increase of beverages and food from
industries in public service venues
Fear of loosing weight
Insufficient physical education in school
Genetic factors
Lack of education
25. Challenges and barriers faced in Rwanda
regarding obesity
Lifestyle changes
Cultural behaviours
Poverty
Urbanization
26. What measures can the governement take to
reduce obesity?
1 The government Should Increase and improve
Availability of Healthier Food in Public Service Venues.
The government Should Increase Opportunities for
2
Extracurricular Physical Activity.
The government Should Increase Physical
3 Education in Schools.
27. Our Responsibility
Educate ourselves on
available options for
obese clients.
Make sure patients
are aware of the risks
involved.
28. What can our community and individuals
do to reduce obesity?
Discourage consumption of sugar
1 sweetened beverages
Increase support for breast feeding
2
Participate in community coalitions or partnership to
3 address obesity
4 Enhance walking for short distance
29. Summary
Obesity in itself is preventable but it cannot be
managed solely at the individual
level.Communities,governments and medical
proffessionals need to work together to modify the
environment so that it is less conductive to weight
gain.
Benefits of regular physical activity in obese persons Regular physical activity is an important component of any weight loss program because it is associated with long-term weight maintenance and has beneficial health effects, such as decreasing coronary heart disease and diabetes, that are independent of weight loss itself. The important physiological and clinical issues regarding the use of physical activity as part of obesity therapy will be reviewed in this section.
Physical activity helps preserve fat-free mass during weight loss Approximately 75% of weight that is lost by dieting is composed of fat and 25% is fat-free mass (FFM) [1]. Adding a physical activity program to dietary therapy can affect the composition of weight loss. Two meta-analyses that pooled data from 46 [1] and 28 [2] published trials found that exercise can attenuate the loss of FFM. In subjects with a mean weight loss of 10 kg, regular exercise decreased the percentage of weight lost as FFM by half, from approximately 28% to 13% in men and from 24% to 11% in women ( P <0.05). However, this large difference in percentage of weight lost as FFM represented only a small (approximately 1 kg) difference in the absolute amount of FFM lost between groups. Moreover, conservation of FFM does not necessarily represent conservation of muscle protein; the greater retention of FFM associated with exercise may be related to increased retention of body water and muscle glycogen. It is not known whether performing resistance exercise while dieting leads to greater conservation of FFM than performing endurance exercise because of limited and conflicting data [3,4]. Ballor DL, Poehlman ET. Exercise-training enhances fat-free mass preservation during diet-induced weight loss: a meta-analytical finding. Int J Obes Relat Metab Disord 1994;18:35-40. Garrow JS, Summerbell CD. Meta-analysis: effect of exercise, with or without dieting, on the body composition of overweight subjects. Eur J Clin Nutr 1995;49:1-10. Wadden TA, Vogt RA, Anderson RE, et al. Exercise in the treatment of obesity: effects of four interventions on body composition, resting energy expenditure, appetite and mood. J Consult Clin Psychol 1997;65:269-277. Geliebter A, Maher MM, Gerace L, et al. Effects of strength or aerobic training on body composition, resting metabolic rate, and peak oxygen consumption in obese dieting subjects. Am J Clin Nutr 1997;66:557-563.
Five steps to facilitate behavior change Five steps that clinical practitioners can take to facilitate behavior changes in their patients are: 1. Identify the specific behavior change that is desired. 2. Review when, where, and how the new behaviors will be performed. 3. Instruct the patient to keep a record of the behavior change. 4. Review the patient’s progress at each treatment visit. 5. Congratulate the patient on successes that have been achieved, but do not criticize failures. Criticism may cause embarrassment and a loss of self-esteem, which may make it uncomfortable for the patient to continue treatment. Wadden TA, Foster GD. Behavioral treatment of obesity. Med Clin North Am 2000;84:441-461.
Five steps to facilitate behavior change Five steps that clinical practitioners can take to facilitate behavior changes in their patients are: 1. Identify the specific behavior change that is desired. 2. Review when, where, and how the new behaviors will be performed. 3. Instruct the patient to keep a record of the behavior change. 4. Review the patient’s progress at each treatment visit. 5. Congratulate the patient on successes that have been achieved, but do not criticize failures. Criticism may cause embarrassment and a loss of self-esteem, which may make it uncomfortable for the patient to continue treatment. Wadden TA, Foster GD. Behavioral treatment of obesity. Med Clin North Am 2000;84:441-461.