Obesity Solutions

What is obesity 

Obesity is characterized by excessive fat build up to the point that our health and wellbeing are at risk.

It is a chronic disease and have detrimental effects on health.

How to diagnose obesity?

BMI (Body mass index)

 It is a screening tool to have a general look at obesity. It takes into account of person’s height and weight and classify obesity.

It is calculated as person’s weight in kilogram divided by square of their height in meters ( kg / m2)

 Different people of the same BMI may have different body shapes depending on distribution of body fat and skeletal muscle

A high BMI is a strong parameter for occurrence of Non communicable diseases like PCO ,infertility , type 2 diabetes, hypertension , high lipid and many malignancies .

Classification of obesity

 Among several classifications and definitions for degrees of obesity, the following is widely used:

  • Overweight - BMI greater than or equal to 25 to 29.9 kg/m2
  • Obesity class I - BMI 30 to 34.9 kg/m2
  • Obesity class II - BMI 35 to 39.9 kg/m2
  • Obesity class III - BMI greater than or equal to 40 kg/m2 (also termed severe, extreme, or massive obesity)

Dual – energy -x-ray absorptiometry (DEXA) 

DEXA scanning uses low-level X-rays that pass through different types of tissues at different rates providing estimates of fat mass, fat-free mass, and bone density. This method is widely used to measure bone density and can also accurately measure fat mass. A limitation of most DEXA scanners is the capacity to image extremely obese persons. However, half-body scans have been shown to provide an accurate body compositional analysis. DEXA is relatively simple to perform, less expensive, and more accessible than MRI or CT scan.

Waist circumference

Waist circumference is simple to measure and it avoids any consideration of the hip as they convict of bone and skeletal muscle along with fat.

The technique for measuring WC is with measuring tape halfway between the lower rib  and iliac crest.

it is a measure of central /abdominal obesity when is more than 90 cm in men and more than 80 cm in women, they are associated with metabolic problems.

Hip circumference (HC)

It is measured at widest circumference over greater trochanter.

Imaging 

CT scan and MRI can identify visceral fat and subcutaneous fat.

Visceral fat is responsible for metabolic abnormalities

Lab tests- like 

       -       Liver function test

        -       Fasting glucose and glycosylated hemoglobin

        -       Thyroid function tests

        -       Lipid profile

Waist – Hip ratio (WHR)

WHR is obtained by dividing the WC by HC using same units of measurements for both. WHR is straight forward indicator of central obesity.

The WHO classifies abdominal obesity in men if WHR >0.9 and women >0.85

The ratio greater than 1.0 in either sex indicates increased risk of metabolic complications.

Body fat percentage 

Bioelectrical impedance analysis (BIA)is very accurate in diagnosing body fat.

It is more accurate than BMI .

Body impedance analyst is (BIA) is relatively simple quick and noninvasive method to assess body composition.

BIA allows the calculation of fat free mass and body fat percentage.

Body fat percentage of more than 25% men and more than 30% in women are considered obese by Endocrine society of India

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Obesity can have many co-morbidities-

·         Respiratory – increased risk of bronchial asthma, COPD

·         Cardio vascular – High blood pressure, coronary artery disease, cardiomyopathy etc.

·         Psychological -social stigmatization and depression

·         Metabolic -type 2 Diabetes  and dyslipidemia

·         Gastrointestinal - Gall bladder stone, fatty liver, reflux esophagitis .

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