OBESITY AND OVER A person who are naturally very fat are apt to die early than WEIGHT

who are slender (Hippocrates-father of medicine).

Obesity is the most common nutrition related disorder in our society and about 34.5% of male suffering and 36% of female suffering from obesity in Kuwait Obesity implies the excess storage of fat. Obesity starting in the early life is associated with an increased number of cells, while obesity in adults ,these are an increased number and increased amount of fat cells (accumulation of adipose tissue). The human body contains about 30-40 billion of fat cells, they can help to keep him a life for 40 days without food. Everyone has some stored fat that is important and essential to life, but too much fat result in being overweight or obese.

OBESITY AND OVER Some fat is needed by every one as a started WEIGHT

energy, heat insulation, shock absorption, also fat is essential components of many hormones and nervous system. Fat tissue is made of fat cells.

Stages of fat cells formation

1- The first stage of our fat cell formation is completed during our childhood. 2- The second stage of generation of cells is during puberty, when areas in which fat cells grow, after puberty we dont grow any more fat cells and adults has affixed number of fat cells for rest of his/her life. So existing fat cells can just expand or shrink to accommodate more or less fat.

WHY MOST OF PEOPLE NOW OVERWEIGHT OR OBESE?

The key causes are increased consumption of foods and decreased physical activity. They have increased eating of energy-dense foods containing high levels of sugar and fats combined with decreased physical activity. The result is more calories taken (from food). Than calories used ( by physical activity), there for weight increase as bellow:Calories taken more than calories used = weight gain Calories taken less than calories used = weight loss Calories taken equal to calories used = no weight change

WHY MOST OF PEOPLE NOW OVERWEIGHT OR OBESE?

So simply we are not gain weight because we are eating more but because we do not consume all what we eat.

IN TAKE Calories from food

Out put calories used during physical activity

The energy balance

HOW DO WE BURN CALORIES

The body needs energy just to maintain its functions without doing extra work; this is called its BASIC METABOLIC RATE The energy we get from food is measured in calories, and we use up the calories faster if we increase our activity levels, and if we do not take enough calories to match our expenditure we use body reserves of energy and we lose weight. If we take more calories than we need, then they are stored as fat and we gain weight

What are the different causes of over weight and obesity??

1- BEHAVIORE
Eating too many calories than really needed while not getting enough physical activity, This can lead to energy imbalance.

2- ENVIRONMENT
A changing environment had broadened food options and eating habits, food stores are stocked with many food items, prepackaged foods, fast food restaurants and soft drinks Environment strongly influences over weight and obesity. Communities, homes, schools and work places each can contribute and help individuals to take

What are the different causes of over weight and obesity?? 3- GENETICS
1- obesity trend to run in families, suggesting genetic causes . however heredity play role in determining how people are susceptible to our weight and obesity . 2- genes also influence how the body burn calories for energy or store fats

4- PSYCHOLOGICAL
Psychological may also influence eating habits many people eat in response to negative emotions such as boredom, sadness or anger

What are the different causes of over weight and obesity?? 5- AGE
Also a contributing factor for overweight and obesity as where a person gets older, the basal metabolic rate will slow down.

6- Other Causes
A- Some illness includes: Hypo thyroidism , Cushings Syndrome, Depression and psychological problems B- Medications Such as Corticosteroids, antidepressant, ethinylestradiol (contraceptive)

DIAGNOSIS OF OVERWEIGHT AND OBESITY

there are different ways to diagnose overweight and obesity such as:.
Body Mass Index (BMI) Weight - for- high table Waist Circumference Waist to Hips Ratio

Body Mass Index (BMI) It is the preferred one, it become medical standard
to measure over-weight and obesity BMI = Weight in Kilograms ( Height in 2

Classification of overweight and obesity By bmi People classified into:

Under weight normal weight over weight Obesity BMI Less than 18.5 BMI 18.5 to 25 BMI 25 to 30 BMI more than 30

Obesity it self classified into:

BMI 30 to 35 Mild Obesity (Grade 1) BMI 35 - 40 Moderate Obesity (Grade 2) BMI more Sever Obesity than 40 (Grade 3 ) Higher BMI is associated with progressively higher rate of illness, so the risk increase as BMI increase

PREDICTION THE RISK DUE TO OBESITY

Can we predict that a person is at risk due to obesity

YES BY
1- Waist Circumference 2- Waist to hips

1- Waist Circumference

PREDICTION THE RISK DUE TO OBESITY

It is common and easy way to assist the abdominal fat. Women collect fat in their waist, hips and buttocks giving them PEAR shape. Men collect fat around their waist and buttock giving them APPLE shape When abdominal fat is in excess in the relation to the total body fat is considered as independent predictor risk factor associated with obesity

Healthy range

in Male is < 37 inches (94 cm) in female is < 31.5 inches ( 80 cm)

Men at risk if the waist measurement is > 40 inches (102 cm) women at risk if the waist measurement is > 35 inches (88 cm)

2- Waist to hips Ratio

PREDICTION THE RISK DUE TO OBESITY

This is the ration persons waist circumference to hips circumference . And it calculated as waist circumference divided by the hip circumference People carrying extra weight around waist increase health risk more than carrying extra weight around their hips or thighs. Men WHR of 0.9 or less is considered safe women WHR of 0.8 or less is considered safe WHR of 1 or more for both men and women is considered risky or in danger zone for health problems such as heart disease and DM.

WHY OVER WEIGHT AND OBESITY ARE DANGEROUS

Obesity now is consider itself a diseases. Every body need to accept that obesity is a chronic Disease, like other chronic Disease (BP., DM.ETC.) We should really re- evaluate our habits and life style because most of us are eating more and exercising less. There are many serious health problems associated with overweight and obesity including respiratory ( breathing problems, sleep apnea.) heart disease, high blood pressure, high blood cholesterol, DM. typeII, osteoarthritis, certain type of cancer, gall stones, liver disease, infertility, complication of pregnancy, menstrual irregularities, in addition to psychological disturbance such as depression, eating disorders, and low self-esteem. Also over weight and obesity increase work disabilities, work accident and injuries, increase sick leaves and increase health care coast

Health problems associated with over weight and

obesity 1- TypeII DM DM is the most serious disease, it is most common in adult and
obese., high blood sugar, heart disease, kidney disease, stroke, blindness, and early death. The developing of type II DM rises with increasing body fat, approximately 58% of diabetes, was attributed to obesity. If you are overweight or obese your chance to be diabetic is 40 folds than normal Weight person. Approximately 58% of people with diabetes are type II and 90% are over weight are obese. You can lower your risk of developing type II DM by losing weight and becoming more physically active. This also can help you to control your blood sugar level and reducing diabetic medication that you take

Health problems associated with over weight and obesity

2Heart Diseases
The heart must work harder to pump the blood to an obese person to reach all over the body. So the obese people are at risk of heart failure Over weight people are suffering from high levels of triglycerides high levels of LDL Cholesterol ( bad cholesterol) and low HDLCholesterol (good cholesterol) leading to atherosclerosis.

Health problems associated with over weight and obesity

The studies have shown that the risk of atherosclerosis increase with increasing body mass index. So the people with abdominal fat obesity are at great risk, also there is a progressive rise in blood pressure with increasing BMI Weight loss can lower your chance for developing heart attack and stroke, also it improves your blood pressure, triglycerides and cholesterol and improves your heart work and your blood flow
Even 5%-10% of weight loss of your starting weight can lead to significant health benefits

Health problems associated with over weight and obesity 3- liver and gall bladder Diseases fat excess, the gall bladder become insufficient Due to food and
and bile starts to accumulate in gall bladder leading to formation of gallstones. Due to excess fat that obese people have, the liver is not able to utilize all of fat, so fat starts to accumulate in liver cells causing FATTY LIVER which may cause injury to liver cell and if it severe may lead to LIVER CIRRHOSIS Losing weight can reduce the build up fat in your liver and resolves the deposited fat droplets in the liver. Slow weight loss 0.5-1 kg/week) is beneficial because fast weight loss (more than 1.5 kg/week) can increase developing gall stones

Health problems associated with over weight and obesity 4Osteoarthritis ( Joint Disorders)knees, hips, ankles and lower back. Are common in
This may be directly related to wearing out of joints associated with excess body weight making movement difficult. There for this make the muscles weak beside the decrease in synovial liquid causing the inflammation of the joints. obesity make change to cartilage and bone metabolism that may lead to osteoarthritis. Weight loss can decrease stress on your ankles, hips, knees and lower back since these joints have the responsibility of carrying the whole body weight. Decrease in BMI of 2 or more decrease the development of osteoarthritis by 50%.

Health problems associated with over weight and obesity 5- Respiratory problems
Obese person gets easily tired, had difficulty in breathing Sleep Apnea is most important respiratory problem associated with obesity Sleep Apnea is a condition in which person stop breathing for short period during sleep.

Why it occur in obese ?

Increase of fat deposits around neck and in tissue surrounding the upper airway in obese person may directly press on airway lumen and make them smaller Also increase airway collapsibility and also it may interfere with the chest function of chest muscles Weight loss usually decrease the neck size and improve sleep apnea and also decrease upper airway collapsibility

Health problems associated with over weight and obesity 6- psychological and social problems Low self-esteem is considered one of the most important
psychological factors, this may lead to depression. Which can become more intense and bring more a lower self-esteem. In our present obese person is expose to public rejection, that is worse if the person is a women.

7- skin changes
Several changes in the skin are associated with obesity. Stretch marks are common. Which come from expanding of subcutaneous deposit of fat Hairsutism in some women Sweating increase in obese which leads to recurrent infections ( fungal and bacterial) in the folding area such as arm pit, groin, thighs and under the breast.

Health problems associated with over weight and obesity 8- other consequences of obesity

Frequent urination and urinary stones Irregular menstruation, lack of ovulation from ovaries, decrease fertility. obese people may have sexual relation problems due to their obesity Hernias are common in obese people due to muscle wall weakness Esophageal reflux Cancer obesity increase the risk of developing several types of cancer including cancer of colon, rectum, esophagus, liver, gall bladder, uterus and breast

Role of different sectors in preventing over weight A- COMMUNITY

B-

C-

D-

Promoting health in food choices, encouraging the availability of low calories and nutritious food items, create opportunities for physical activity such as side walks, sport centers, this will help people to make good choice SCHOOLS encouraging students to have breakfast meal, ensure that school canteen items meet nutrition standard and provide food options low in fat and sugar also provide students HOMES physical education suitable for their with daily Reducing the spent watching TV. Computers ages and other sedentary habits building physical activity into regular daily routine and encouraging healthy home-made food choice. WORK Encouraging active life style offer healthy food choices and create more facilities for

SUCCESSFUL WEIGHT LOSS PROGRAM

MUST INCLUDE THE FOLLOWING CRITERIA:safe, effective, healthy and realistic 1- must be

2- must be slow, gradual and you do not feel suffering and deprivation 3- must include physical activity program 4- must be long-term program The safest and most effective way to loose weight is to decrease calorie intake and increase calorie lost (increase physical activity) while you are eating balanced and healthy diet.

Keep in mind :
ENERGY IN = ENERGY OUT + ENRGY STORED
food and drinks activity fat

1 gm. protein = 4 Kcl, 1gm. Carbohydrate = 4 Kcl, 1gm. Fat = 9 Kcl To loose 1 kgm. of your weight you must burn 7700 Kcl

SUCCESSFUL WEIGHT LOSS PROGRAM

Any weight program must be slow and gradual to ensure success to avoid health complication. Rapid weight loss program will be followed by rapid weight gain A realistic weight goal for a person with life long personal history of obesity, should not be promised a final weight in normal range The key of successful weight loss program is to make change in your eating and physical activity habits that you can keep up for the rest of your life. Obesity is chronic condition and must not be viewed as temporary problem that can be treated quickly in few months with hard, very low calorie diet, weight control must be considered a life long program with long approach, Do not just take any weight loss program that works, but you have to ensure that it works more in your situation

GOLDEN RULES FOR WEIGHT LOSS PROGRAM 1- Decide and stand for your decision
Decide to start on specific date and to be ready to introduce long term changes into your life style gradually. Remember that no one else can make you lose weight except yourself.

2- set a realistic goal

An effective and realistic goal must be specific, achievable and flexible (less than perfect) Walk for 30 minutes 4-5 days a week is specific, achievable and flexible this realistic for the first two months then you can increase 5 minutes every week until reaching 60 mins/day

GOLDEN RULES FOR WEIGHT LOSS PROGRAM 3- do not try to loss weight quickly and do not mislead by some phrases
Some famous phrases and advertisements are misleading such as: Eat any amount of all you want and still lose weight Effortless weight loss and magical Quick and immediate weight loss Lose 10-15 kg in one month Melt fat while you sleep Miracle cure for obesity

GOLDEN RULES FOR WEIGHT LOSS PROGRAM 4- lose weight slowly

Healthy weight loss occurs slowly and steadily the aim is to lose 0.5-1 kg/week to do this you need to burn 500-1000 calories /day through low calories diet and regular physical activity Decreasing calories is easier if you focus on limiting fat and sweets in addition to regular physical activity

5- do not be disappointed
Any one can occasionally over eat or eat foods that should avoid Do not be disappointed or feel guilty if that happen with you. Get back on track and do not expect to be perfect and never give up.

GOLDEN RULES FOR WEIGHT LOSS PROGRAM 6- eat slowly and chew food many times
Remember that eating is pleasure. Changing the way you eat can make it easier to eat less without feeling deprived It takes about 15 minutes for your brain to get massage from your stomach that you have been fed. So slowing rate of eating can allow fullness signals to begin to develop, while eating fast will make you eat more

7- eating IN smaller plates

Eating in small plates make you eating less, put your meal in one plate and dont refill the plate

GOLDEN RULES FOR WEIGHT LOSS PROGRAM 8- eat food that are filling and low in calories
Such as vegetables, fruits, whole-wheat bread and legumes such as lentils and other beans.

9- kick those bad habits out of your life.

A- Eating lots of food that are high in fat and calories. B- un planed eating and likely to overeat watching TV., or when reading newspaper C- Eating more in certain lunch meetings or invitations. D- M any people eat when they are sad, bored, angry or stressed even if they are not hungry.

GOLDEN RULES FOR WEIGHT LOSS PROGRAM 10- record your self monitoring
Record your calorie intake, food items, your exercise sessions, your weight every one or two weeks (using same scale)this will usually change your behavior to desired direction.

11- Reword success ((but not with food))

Reword your self after achieving some weight loss

How can you calculate your calories intake

A healthy weight loss diet must include a variety of food that give you enough calories and nutrients for good health Each person needs 25-35 calories for each 1 kg of his weight/day according to his weight, age, physical activity, physiology and temperature For proper nutrition women weight loss diet must be not less than 1200 calories/day while man not less than 1500 calories/day Most women can lose (0.5-1) kg a week by consuming 1200-1500 calories/day while most men can lose same weight by consuming 1500-1800 calories/day

How can you calculate your calories intake / day

To maintain your body weight multiply your weight in kg by 30 The result represent the average number of calories used up in one day by a moderately active person of your weight For example if your weight 80 kg so calories you use to maintain your weight = 80 x 30 = 2400 calories This means that you use 2400 calories/day to maintain your currant weight so to reduce your weight you must reduce your daily calories below this number.

How can you calculate your calories intake / day

If you are sedentary or get very little exercise multiply your weight by (26) instead of (30) since less active people burn fewer calories For example if your weight 80 kg so calories you use to maintain your weight = 80 x 26 = 2280 calories To lose Kg/week you need to burn 500 fewer calories /day (7 days X 500 calories = 3500 calories which equal kg/week) It is important to allow people eat their normal food but less quantity about 20% less than usually they do if they are suffering from over weight or obesity grade I while obese people grade II or III must eat less about 30%

The component of a healthy Weight Lose Diet

1- vegetables and fruits
Eat plenty of vegetables and fruits they are low in calories and filling

2- carbohydrates
Is major diet component together with vegetables and fruits, they are the base of food pyramids, complex carbohydrate must constitute the majority as whole grains, potatoes (boiled or grilled)

3- milk and milk products

Consume small amounts of skimmed or low fat dairy products A avoid cream, butter and gee

The component of a healthy Weight Lose Diet

4- fat
Eat small amount of fat (content must not > 25%of total food intake) Preferable from plant origin such as olive oil, sunflower and avoid fat from animal origin and use grilled more than fried food

5- protein
Eat small amount of meat of animal origin (without any fat), eat more poultry, fish, 4 eggs/week and nuts.

6- water
Use 2.5 liters of water daily and increase 0.5-1 litter in case of activity in hot weather, beverages that provide large amount of energy must be avoided

Why people stop losing weight

Why people stop losing weight after a short period of starting weight loss program? Any weight loss program will lead to some weight loss in the first few weeks or month and then the body stop losing weight although the person is still following the same program why? The body reacts to weight loss as if it were starving and in response slow its metabolism and burn fewer calories, there fore the body stops losing weight as natural life saving strategy after few months of starting a weight loss program the body will be adapted to the new calorie intake and calorie expenditure The solution is to increase your physical activity a regular physical activity (at least 30 minutes walking for 3 days/week) raise your calories expenditure while exercising and also your resting calories exercising (after resting)

Why people stop losing weight

Walking 6 km/Hr cycling 16 km/Hr swimming 6 km/Hr running 14 km/Hr Any way walking for 30 minutes 5.5 Kcl/m 7 Kcl/m 11 Kcl/m 14 Kcl/m 150-250 calories

How you can lose weight and keep it off?

1- Eat breakfast every day
People who eat breakfast are less likely to over eat later in the day, breakfast give you energy that helper you to thing, learning and work, breakfast helps in maintaining a healthy weight

2- Eat three meals every day

It is not advised to skip meal, have low fat low calories snack on hand , skip meals is not a smart way to cut out calories

3- Avoid weight loss diet suggests you eat a certain formula, food or combination for easy weight loss
It these diet will work in short term because they are low in calories but they may not give all nutrients that your body needs and they do not teach healthy eating habits, also eating pre packaged meals dose not let you learn food selection which you will need to maintain weight loss in the long term

How you can lose weight and keep it off?

4- avoid weight loss program that dont include physical activity
Regular physical activity is good for health in general it decrease the risk for colon cancer, DM and high blood pressure, it also helps control weight strengthen bones, muscle and joints

5- reduce fat in any weight loss diet

Fat in general gives 9 calories/gm, you must use less than 25 % fat from you total calorie intake mainly from olive or corn oils. You can cut out hundreds of calories/day just by avoiding fat-rich products and high calories food

6- avoid all kinds of soft drinks, sweetened juices, sweets and deserts
May have a very small amount just one/2weaks

How you can lose weight and keep it off?

7- a void fast food meal
Hamburgers, chicken nuggets, fried potato, they are high in fat and calories, for examples double cheese burger with large fries and soft drinks equal 1500 calories

8- Avoid high-fat and high cholesterol snacks

Both types are high in calories Food items labeled as low-fat may be misleading. They are often high in calories because they contain large amount of sugars and other carbohydrates.

9- Chose your food wisely and eat small pro portions

If you feel Hungary between meals, drink water or eat a piece of fruit (apple or orange) or eat cucumber, lettuce, tomato and carrots and stay out of the kitchen

How you can lose weight and keep it off?

10- Eat slowly
Eat slowly and chew your food well many times your food will taste better and you will be more satisfied Do not swallow until all flavor is gone from each bite

11- ensure a long-term weight loss program

It is important that the food should be pleasant and acceptable and the physical activity should be enjoyable, easy to perform and close to your house, stay active and dont give up your exercise even if you reached your target weight this will help you to lose weight and keep it off

12- weight your self once a week or every two week

More frequent weighing may become disappointing and discouraging

How you can lose weight and keep it off?

13- eat your dinner early
Kick the habit of eating late at night, have your dinner early and dont eat any food after 8 PM this help in digestion. And you will have good appetite in the morning to have your breakfast

14- drink enough water every day

A normal person should drink at least 2.5 liter of water each day, this works great as it helps to curb your appetite The water is necessary to carry a way the waste-product of fat breakdown

15- appreciate your self

Dont let negative comment of people and social pressure have power over you this positive attitude will lead to higher selfesteem , will help you on your long term weight loss program and it will make your journey easier and enjoyable

The final advise

You are what you eat Eat sensibly, stay physically active and enjoy your food