2. Excess body
fat
accumulated
to the extend
of causing
adverse
effect

4. Obesity in Asia

5. Journal of Obesity in Malaysia by
University Kebangsaan Malaysia states
that:
5.8% of 29,179,952-obese
Number of people obese are
1,692,437
Higher rate-Malays and Indians

6.  Environmental
factors
 Genetic factors
 Lack of sleep
 Age
 Gender

7. Childhood
Obesity
Adult Obesity

8. • Parental obesity
• Prader-Willi
syndrome
Genetic Factors
• Lack of physical
activity
• Sedentary lifestyle
• Over eating
Environmental
Factors

9. Adult
Obesity
Excess
body fat
Adipose tissue
is the form of
tissue that fat
takes in the
body.
Located just
beneath the skin
or between other
organs such as
the muscles and
heart.
Excess
carbohydrates,
proteins and
dietary fats can
be converted
into fatty acids
and stored as
adipose tissue in
the body.
Too much
adipose tissue
on your body,
it contributes
to serious
health
complications.

10. Expansion of the adipose tissue during weight gain leads tissue
undergoes a continuous remodeling process that normally
maintains tissue health, but may spin out of control and lead to
adipocyte death in association with the recruitment and
activation of macrophages, and systemic insulin resistance.

11.  Adipose tissue located beneath the skin
(subcutaneous fat), around internal organs (visceral
fat), in bone marrow (yellow bone marrow) and in
breast tissue.
 Adipose depots in different parts of the body have
different biochemical profiles.
 Under normal conditions, it provides feedback for
hunger and diet to the brain.
 Diseased fat tissue surrounding various organs can
cause illness.

13.  Aromatase which is involved in sex hormone metabolism.
 TNF Alpha, IL-6 and leptin which are collectively termed
„cytokines‟ and are involved in sending messages between cells.
 Plasminogen activator inhibitor-1 which is involved in the clotting
of blood.
 Angiotensin which is involved in blood pressure control.
 Adiponectin which improves the body‟s sensitivity to insulin and
so helps to protect against developing type 2 diabetes.
 Lipoprotein lipase and apolipoprotein E which are involved in
storage and metabolism of fat to release energy.

14. Type 2
diabetes
Excess
body fat
Difficulty
sleeping
extremely
large
waistline
Heavy
sweating
Lack of
energy
Pain and
soreness in
joints and
muscles
Symptoms

15. Consequences
of obesity
Coronary heart
disease
stroke
Type 2 diabetes
Non alcoholic
fatty liver
disease
(NAFLD)
cancer
High blood
pressure

16. Body mass index
BMI : BW / H2
Where :-
BW = Body Weight (kilograms)
H = Height (meters)
 Measure waist circumference
Apple shape ( risk of DM, CVD,
HTN )
Waist larger than 40 inch men
Waist larger than 35 inch women

17.  Overweight: BMI 25 - 29.9
 Obese: BMI > 30
 Obesity Class I: 30 - 34.9
 Obesity Class II: 35 - 39.9
 Extreme Obesity: >40

18.  Diet therapy
 Increased Physical Activity
 Pharmacotherapy
 Behavioral Therapy
 Surgery

19.  Highly ineffective rate 95 % long term failure
 Often result in increase weight than before diet
 Slow weight loss – stable
 Rapid weight loss – gain weight
 Rapid weight loss – increase risk of gallstones
 Low calorie step 1 diet
Women Men
1000 – 1200 kcal/day 1200-1600 kcal/day

20. Male Age 20-49 2900 calories/day
50 + 2500 calories/day
Female Age 20-49 2300 calories/day
50 + 1900 calories/day
Guideline Daily Amount Values
Typical values Women Men
Children (5-10
years)
Calories 2,000 kcal 2,500 kcal 1,800 kcal
Protein 45 g 55 g 24 g
Carbohydrate 230 g 300g 220 g
Sugars 90 g 120 g 85 g
Fat 70 g 95 g 70 g
Saturates 20 g 30 g 20 g
Fibre 24 g 24 g 15 g
Salt 6 g 6 g 4 g

21.  Integral part of weight loss
 Increase activity never loss weight
 Sustained activity does prevent weight regain
 Reduces risk of getting HD & DM
 Recommended activities

22. A) Sibutramine(Serotonin Nor-epinephrine Reuptake Inhibitor) :
initial dose 10mg/day, max 20mg/day. Reduces food intake,
increase HR and BP.
B) Orlistat:
Lipase inhibitor : 120mg PO TID. Alters metabolism, dec
absorption of dietary fat.

23.  Keep a journal of diet/diary
 Set spesific goals
 Keep track of improvement

24. Surgery Restrictive
Combined
restrictive &
malabsorption
Vertical band gastroplasty
Gastric Banding
Laproscopic gastric
banding
Roux-en-y gastric bypass
Biliopancreatic diversion

25. VBG
GASTRIC
BANDING
(LGB)

27.  P. Thamilselvi suffered obesity for years
 She had several complications due to
obesity for instance;
 She had difficulties of breathing while
doing heaving activities
 Stress and depression

28.  Thamilselvi consulted her physical dietician
She started a strict diet :
 Oats
 Green tea
 Green apple
 Cut down rice intake, oily foods and food
contain high fat

29. The latest Thamilselvi

30.  “Sebab mulut badan binasa” – “Body perish
because of the mouth”
 obesity is best tackled at home through improved
self involvement, increased physical exercise,
better diet and restraint from eating.

31.  Ismail MN. The nutrition and health transition in Malaysia.
Public Health Nutrition 2002; 5: 191–195.
 World Health Organization. Obesity: Preventing and Managing
the Global Epidemic. WHO Obesity Technical Report Series
no. 894. WHO: Geneva, 2000.
 Ismail MN, Tan CL. Prevalence of obesity in Malaysia. In:
Inoue & Zimmet (eds). The Asia–Pacific Perspective: Redefining
Obesity and its Treatment. WHO(WPRO)/IASO/IOTF: Health
Communications Australia, 2000 pp 10–13.
 Ismail MN, Vickneswary EN. Prevalence of obesity in
Malaysia: data from three ethnic populations. In: Inoue & Zimmet
(eds). The Asia – Pacific Perspective: Redefining Obesity and its
Treatment. WHO (WRRO)/IASO/10TF: Health Communication
Australia, 2000.