Class Nutrition and Dietetics English

Unit Obesity and Underweight as “abnormal or excessive fat accumulation that may impair health”. B . . Aetiology The factors causing obesity are given below: Heredity: Heredity has a major role to play in obesity, as genes contribute to it.

The involvement of genetic factors in the development of obesity is estimated to be - %. Physical Activity: Sedentary life style with lack of an exercise schedule tends to make one obese. Obesity is more common after the age of , when physical activity generally decreases without a corresponding decrease in food consumption. Dietary Habits: Consuming high calorie food without burning off the calories leads to positive energy balance, which is one of the major contributory factor for obesity.

Eating food at a very fast rate tend to chew less and lands up eating more food. Nibbling between meals may contribute extra calories leads to obesity. Endocrine Factors: Endocrine abnormalities in conditions like hypothyroidism, Cushing’s syndrome, polycystic ovarian syndrome is often associated with obesity. Psychological Factors: Lonely, bored and depressed individuals find solace in piling on fast food and junk foods.

Affluence and Abundant availability of food: Eating out has become fashionable leading to an increased consumption of junk food which is rich in calories and short on essential nutrients. Obesity and Underweight . . Assessment of Obesity Standard height and weight for Indian men and women is given in Table below Body Mass Index: BMI is calculated from a person’s weight and height and it provides an indicator of body fat and is used to indicate weight categories.

BMI = Weight (Kg) / Height (m) Height Men women Weight (kg) Weight (lb) Weight (kg) Weight (lb) .52M ( ’ ”) _ _ - - .54M ( ’ ”) _ _ - - .57M ( ’ ”) - - - - .59M ( ’ ”) - - - - .62M ( ’ ”) - - - - .65M ( ’ ”) - - - - .67M ( ’ ”) - - - - .70M ( ’ ”) - - - - .72M ( ’ ”) - - - - .75M ( ’ ”) - - - - .77M ( ’ ”) - - - - .80M ( ’ ”) - - - - .82M ( ’ ”) - - - - .85M ( ’ ”) - - _ _ .87M ( ’ ”) - - _ _ Body Weight: If a person weighs % more than the standard body weight for the specific age, sex and height of the person is termed as overweight. If a person weighs %more, he is termed ‘obese’ B. UNDERWEIGHT < . NORMAL .

- . OVERWEIGHT - . OBESE - . EXTREMLY OBESE < BMI= Weight in Kilograms Height in metres W H A T I S Y O U R B M I ?

Source: Life Insurance Corporation of India Obesity and Underweight Weight status according to BMI range Weight status BMI range Underweight < . Normal . to . Overweight to .

Obesity (Grade ) to . Obesity (Grade ) to . Obesity (Grade ) and above Grade obesity - It is a self manageable condition and does not interfere with day to day activities. The person leads a healthy normal life.

Grade obesity – Medical and dietetic intervention is needed to manage the situation. The person appear obese and have poor stamina. They are predisposed to diabetes, hypertension, heart ailments, fatty liver, arthritis and varicose vein. This excess weight reduces life expectancy and increases the mortality rate .

Grade obesity– Excess fat interferes with day to day activities. They are susceptible to atherosclerosis and have serious psychological disturbances. Calculate your BMI from your weight and height. BMI =Wt (kg) / Ht (m) Categorise yourself as: Normal / over weight / grade obesity/ grade obesity/ grade obesity.

Activity : Waist Circumference:B The circumference of the waist is used to evaluate a person’s abdominal fat. High risk of health problem is indicated as given below: • Men ≥ 94cms and Women ≥ 80cms of waist circumference. • Very high risk of health problem is indicated as in • Men ≥ cms and Women ≥ cms of waist circumference. Waist to Hip Ratio (WHR): The normal waist to hip ratio should be .

In upper body obesity ratio for: Women is . and Men is > . A WHR of . or greater in men and .

or greater in women is indicative of android obesity and increased risk of obesity related disease. Fat is deposited in males and females which cause difference in types of obesity apple or android or male pattern and pear or gynoid or female pattern of fat distribution. ADIPOSE TISSUE DISTRIBUTION IN MEN AND WOMEN Android Obesity Gynoid Obesity Broka’s Index: This is by far the simplest formula to calculate. (IBW) = Height (cm) – = Ideal Body Weight .

. . Complications of Obesity: General Mortality and Morbidity: Obese are more prone to chronic diseases like cardio vascular disease, including hypertension and dyslipidaemia, non-insulin dependent diabetes, gall bladder disease and gout Cardiovascular disease and stroke: Obesity may be independent risk factor for coronary heart disease. A reduction in weight leads to improvement in cardiovascular risk factors like hypertension and abnormal lipid levels.

When the blood vessels of the brain are Obesity and Underweight diseased, they may rupture or there may be inadequate blood supply to brain resulting in stroke. This may be due to hypertension or fatty deposits in blood vessels of obese. Type II Diabetes: It is an important contributor to morbidity and mortality in obese people. It is associated with insulin resistance and hyperinsulinaemia.

A balanced diet, physical activity and drugs can control blood sugars. Gall bladder disease: Obesity is one of the risk factors for formation of gallstones. The excess adipose tissue contain large amount of cholesterol. The super saturation of bile with cholesterol in obese makes them prone to formation of gallstones.

Cancer: Risk of cancers of colon, rectum and prostate increases in obese men, whereas obese women likely to develop cancer of breast, ovary, endometrial and cervix. Infertility: Obese women are reported to suffer more from menstrual disorder, infertility and PCOS ( Polycystic Ovary Syndrome ), all of which tend to improve on reduction of weight. Sleep Disorder: Commonly known as sleep apnoea is one of the common problems in obese men and women. Obesity causes narrowing of the upper airway when the person is in supine position.

Back pain and Arthritis: Abdominal obesity increases risk of back pain because of extra load on spinal column. The extra stress on weight bearing joints contributes to the development of osteoarthritis. Psychological Problems: Obese people may be exposed to ridicule and discrimination in areas like employment, promotions and social interactions. This results in low self- esteem and depression leading to over eating for consolations.

Hypertension Cancer Stroke Galbladder disease Renal failure Heart failure Atherostenosis NIDDM Obesity Health Risks (NIDDM-Non Insulin Dependent diabetes Mellitus) Management of Obesity: Comprises the Following Three Approaches. . Dietary modifications . Physical activity .

Lifestyle modifications . . . Dietary Principles: A low calorie, restricted carbohydrate, high protein, restricted fat, normal vitamins and minerals (except sodium), liberal fluid and high fibre diet is suggested.

Energy: A low calorie diet helps the body to go into negative energy balance. This promotes use of stored fat as opposed to calories from food. Kcal/kg ideal body weight for sedentary lifestyle and Kcal / kg ideal body weight for moderate lifestyle is prescribed. Carbohydrates: Milled and refined grains and foods made with refined grains like white rice, white bread, white pasta, processed breakfast cereals, potatoes and sugary drinks are rich in rapidly digested carbohydrate having high glycemic index and glycemic load.

These kinds of carbohydrate increase the blood glucose and insulin levels rapidly, hence it causes hunger spikes leading to overeating and resulting in weight gain and consumption should be restricted. Obesity and Underweight Food Groups Examples Grains Whole wheat bread and rolls, Whole wheat pasta, oatmeal, brown rice, unsalted popcorn Fruits Apples, apricots, bananas, dates, grapes, oranges, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, raisins, strawberries. Vegetables Broccoli, carrots, green beans, lima beans, potatoes, spinach, sweet potatoes, tomatoes Fat - free or low - fat milk and milk products Fat - free (skim) or low - fat ( %) milk or butter milk, fat - free, low - fat or reduced - fat cheese, fat - free or low fat regular or frozen yogurt Lean meats, poultry and fish Beef, poultry, pork, game meats, fish, shellfish select only lean;trim away visible fats; broil,roast or poach; remove skin from poultry Nuts, seeds and legumes Almonds, hazelnuts, mixed nuts, peanuts, walnuts, sunflower seeds, peanut butter, kidney beans, lentils, split peas Whole grains, whole wheat, brown rice, barley, fruits and vegetables are digested more slowly than refined grains. So they have a slower effect on blood sugar and insulin, which may keep hunger at bay.

This results in controlled eating and weight management . Proteins: Protein rich foods provide higher satiety, high specific dynamic action and Obesity and Underweight improved body composition. About 1g protein per kg body weight is suggested. Inclusion of plant proteins like nuts and beans are low in fat but high in dietary fibre and replacing red and processed meat with fish and poultry are emphasized.

Fats: Fat, being a concentrated source of energy need to be restricted. Include fat in the form of vegetable oils (rich in MUFA and PUFA ) so that sufficient essential fatty acids are supplied and at the same time the risk of developing coronary artery disease can be minimized. Vitamins: Inclusion of fruits and vegetables in the diet will avoid deficiency of water soluble vitamins due to restriction of fat. Minerals: Sodium in common salt causes retention of fluid and therefore salt should be restricted in the diet .

Fluids: Liberal amounts of water and low calorie fluids may be included in the diet . A glass of water intake before meal will reduce food intake . Fibre: Fibre provide satiety, bulk, slow digestion and increased transit time. High fibre foods such as fruits and green leafy vegetables are low in calorie density, help in regulating bowel movement, reduce blood cholesterol, promote chewing and decrease the rate of ingestion Here are some weight loss friendly snack ideas: .

Small handful of nuts. . Sliced fruit with unsweetened yogurt. .

Vegetable chat. . Sprout salad. .

Roasted pumpkin seeds. . Sliced fruit with nuts or nut butter. .

Roasted chickpeas List FIVE foods to be included and FIVE foods to be avoided Activity : . . Physical Activity: Higher levels of regular activity are associated with lower mortality. Effect of Physical Activity On Health Reduces The Risk Of Following: • Cardio vascular disease • Non insulin dependent diabetes mellitus • Obesity • Osteoporosis • Cancer Although it is difficult to prescribe the optimum amount physical activity, it is important to note that any exercise programme has to be consistent for affecting some degree of weight loss.

Types of Exercise to Loose Weight Walking Cycling Acve recreaon Swimming Gardening Hiking Dancing What counts as moderate physical acvity The benefits of exercise as follows: . Reduces blood pressure . Helps lessen angina pain . Decreases body fat .

Increases HDL cholesterol Simple tasty home made foods provide less calories. Knowing the calories in the food helps to maintain weight. Obesity and Underweight . Makes the heart stronger and more efficient .

Helps in increasing bone density . Reduces risk of cancers . Increases longevity . .

Life Style Modification: The following strategies related to lifestyle modifications are helpful. . Have regular meal time. Irregular eating habits put a lot of strain on the body .

Do not read or watch television while eating. . Keep healthy snacks at home like fruits, vegetables and sprouts. .

Avoid nibbling between meals . Eat slowly, chewing the food properly. . Include a regimented exercise routine in the day.

. Handle stress in a positive manner through exercises, yoga and meditation . Avoid drinking of alcohol and smoking . Wake up early and sleep early.

Sleep for at least - hours daily as poor sleep has been linked to weight gain What are junk foods? Foods that are pre - prepared are packed and the low nutritional value. Junk Food varieties • Chips • Candy • Soft drinks • Gum • Chocolates • Cookies • Cake • Sugar • Butter • Fired fast food Obesity and Underweight How can stress be managed? Stress management can be done by meditation, guided imagery, music therapy, dance therapy, aroma therapy, sleep, humour, touch and rearing a pet.

CONCLUSION A balanced diet with adequate amounts of vegetables, proteins, and fruits is the key to managing weight. Do not Diet to lose weight but Eat Right. • Include more fiber in the diet • Reduce junk food and snacks • Consume low-fat dairy products, lean meat and nuts • Do not skip meals • Eat small and frequent meals, follow meal patterns a day. • King size Breakfast.

This indicates not the quantity, as misunderstood by many, instead indicate the quality of your Breakfast. • Control or limit the intake of sugar, salt, spices and oil.