OBESITY

This is an unhealthy medical condition where an individual has excessive accumulated body fat. To know if one is really overweight or obese, measuring body mass index (BMI) is necessary.

BMI is the ratio of the a person’s weight in kilogram to that person’s height in meters squared (kg/m2). If the person, for instance, weighs 84kg with a height of 1.82 meters, his BMI is 84/1.822 = 25.36. Adult BMI ranges are shown below:
· Acceptable range 18.5 – 24.9
· Overweight 25.0 – 29.9
· Obese 30.0 – 39.9
· Morbidly obese greater than or equal to 40.

Obesity can be classified as
1. Hyperplastic: The increase I body fat as a consequence of increase in the number of fat cells.
2. Hypertrophic: Body fat increase due to enlargement of fat cells with little change in the number of fat cells.

It can also be classified as follows:
a. According to body fat: central, peripheral
b. According to the age of onset: early childhood, gestational, middle-aged, etc.
c. According to its pathogenetic mechanism: regulatory, metabolic.
d. According to its cause: genetic, hypothalamic, physical inactivity, dietary, endocrine disorders.

Risk Factors
· Imbalance between energy intake and energy expenditure.
· Leptin, produced in men by adipose tissues and in women by the placenta, has been found to reduce appetite and increase energy expenditure by interacting with hypothalamus receptors. Obesity is associated with high serum leptin concentrations which suggests that it is leptin resistance, rather than deficiency, that causes obesity.
· Heredity
· Psychological factors, like anxiety or depression especially in women, cause people to over eat.
· Endocrine and metabolic factors
· Age: Although it can occur at any age, obesity is common in middle-age life.
· Occupation: cooks, barmen, directors of companies and all those whose jobs are mainly sedentary are easily predisposed to obesity.
· Hormonal changes: in pregnancy, during puberty and menopause
· Brain damage i.e. of the hypothalamus may cause obesity.
· Drugs like steroids, tricyclic antidepressants, sulphonylureas and other steroidal contraceptive can cause obesity because they are appetite stimulants.

Behavioral changes
· High-fat diets do not easily quench appetite. Fat also induces very little energy expenditure as most of it is stored. Obesity has been shown to be prevalent in those eating foods with high fat.
· Eating snacks without regular food eating pattern reduces the conscious recognition of foods eaten.
· Alcohol encourages weight gain in that it stimulates appetite and loosens restraint.
· Decreased physical activity ultimately leads to obesity o a long term.

Signs and Symptoms
· Evidenced increase in body weight and body fat.
· Increased sweating
· Metabolic disorders like insulin resistance resulting to mild diabetes mellitus, impaired glucose tolerance and hyperglycemia.
· Increased sleeping tendencies
· Cardiovascular problems which includes hypertension and increase in cardiac output.
· Orthopaedic problems which includes osteoarthritis, low back pain and flat heel.
· Abdominal and diaphragmatic hernia, varicose vein, and mild to moderate oedema of the feet and ankles.

Treatment
The best way of treatment is to reduce calorie intake or increase energy expenditure or do both. This treatment mode may be difficult in less motivated patients. Dieting is necessary. Prescribed weight-reducing diet must contain adequate nutrients including minerals and vitamins. Alcohol and sugar containing drinks should be, if possibly, avoided.

The consumption of appetite-suppressant drugs like amphetamine may be beneficial to some , not all, patients though long term use can be addictive.