Obesity is a multifactorial disease that develops from the interaction between genotype and the environment. Our under-standing of how and why obesity occurs is incomplete; however, it involves the integration of social, behavioral, cultural, physiological, metabolic, and genetic factors.

Obesity is a significant public health crisis in the developed world. The prevalence is also increasing rapidly in numerous developing nations worldwide. This growing incidence represents a pandemic that needs urgent attention if the potential morbidity, mortality, and economic tolls that will be left in its wake are to be avoided.

Obesity is a multifactorial disease that develops from the interaction between genotype and the environment. Our under-standing of how and why obesity occurs is incomplete; however, it involves the integration of social, behavioral, cultural, physiological, metabolic, and genetic factors.

Obesity is a significant public health crisis in the developed world. The prevalence is also increasing rapidly in numerous developing nations worldwide. This growing incidence represents a pandemic that needs urgent attention if the potential morbidity, mortality, and economic tolls that will be left in its wake are to be avoided.

Increase in body weight beyond skeletal and physical standards as the result of an excessive accumulation of fat in the body. More than two times the ideal weight is considered obesity.

Obesity: excess adipose tissue

Overweight: excess weight for height

Increase in body weight beyond skeletal and physical standards as the result of an excessive accumulation of fat in the body. More than two times the ideal weight is considered obesity.

Obesity: excess adipose tissue

Overweight: excess weight for height

The etiology of obesity is multifactorial either:- Metabolic factors, genetic factors, level of activity,

behavior, endocrine factors, race, sex, and age factors, ethnic and cultural factors, socioeconomic status, dietary habits, smoking cessation, pregnancy and menopause, psychological factors, history of gestational diabetes, & lactational history in mothers.

Secondary causes of obesity may include diseases as hypothyroidism, insulinoma & growth hormone deficiency; or drugs as oral contraceptive use, medication-related (e.g., phenothiazines, sodium valproate, carbamazepine, tricyclic antidepressants, lithium, glucocorticoids, thiazolidinediones, sulphonylureas, insulin, adrenergic antagonists, serotonin antagonists), eating disorders (especially binge-eating disorder, & bulimia nervosa.

The etiology of obesity is multifactorial either:- Metabolic factors, genetic factors, level of activity,

behavior, endocrine factors, race, sex, and age factors, ethnic and cultural factors, socioeconomic status, dietary habits, smoking cessation, pregnancy and menopause, psychological factors, history of gestational diabetes, & lactational history in mothers.

Secondary causes of obesity may include diseases as hypothyroidism, insulinoma & growth hormone deficiency; or drugs as oral contraceptive use, medication-related (e.g., phenothiazines, sodium valproate, carbamazepine, tricyclic antidepressants, lithium, glucocorticoids, thiazolidinediones, sulphonylureas, insulin, adrenergic antagonists, serotonin antagonists), eating disorders (especially binge-eating disorder, & bulimia nervosa.

The pathogenesis of obesity is far more complex than the simple paradigm of an imbalance between energy intake and energy output.

Two major groups of factors with a balance that variably intertwines in the development of obesity are genetics, which is presumed to explain 40-70% of the variability in obesity variance, and environmental factors.

The critical enzymes involved in adipocyte metabolism are endothelial lipoprotein lipase (involved in lipid storage), hormone-sensitive lipase (involved in lipid elaboration and release from adipocyte depots), acylcoenzyme A (acyl-CoA) synthetases (involved in fatty acid synthesis), and a cascade of enzymes (involved in beta oxidation and fatty acid metabolism).

The pathogenesis of obesity is far more complex than the simple paradigm of an imbalance between energy intake and energy output.

Two major groups of factors with a balance that variably intertwines in the development of obesity are genetics, which is presumed to explain 40-70% of the variability in obesity variance, and environmental factors.

The critical enzymes involved in adipocyte metabolism are endothelial lipoprotein lipase (involved in lipid storage), hormone-sensitive lipase (involved in lipid elaboration and release from adipocyte depots), acylcoenzyme A (acyl-CoA) synthetases (involved in fatty acid synthesis), and a cascade of enzymes (involved in beta oxidation and fatty acid metabolism).

Ghrelin: .Ghrelin is a new endogenous peptide, discovered in 1999

This peptide is composed of 28 amino acids with a unique octanoyl modification of hydroxy group on serine at the third position that is essential for its function. Ghrelin is usually produced by cells called Gr cells that are part of.the endocrine system of the digestive tract

This peptide also plays an important role in signaling hypothalamic centers which regulate feeding and caloric.state

Some research demonstrated that the intracereberal and peripheral administration of ghrelin leads to an increase of food intake and a decrease of energy expenditure. In addition, ghrelin is a potent stimulator of gastric motility .and gastric acid secretion

Ghrelin: Ghrelin is a new endogenous peptide, discovered in 1999.

This peptide is composed of 28 amino acids with a unique octanoyl modification of hydroxy group on serine at the third position that is essential for its function. Ghrelin is usually produced by cells called Gr cells that are part of the endocrine system of the digestive tract.

This peptide also plays an important role in signaling hypothalamic centers which regulate feeding and caloric state.

Some research demonstrated that the intracereberal and peripheral administration of ghrelin leads to an increase of food intake and a decrease of energy expenditure. In addition, ghrelin is a potent stimulator of gastric motility and gastric acid secretion.

Cigarette smoking

Hypertension

High-risk low-density lipoprotein (LDL)

Low high-density lipoprotein (HDL)

Family history of premature CHD

Age more than or equal to 45 years for men or age more than or equal to 55 years for women (or postmenopausal)

Cigarette smoking

Hypertension

High-risk low-density lipoprotein (LDL)

Low high-density lipoprotein (HDL)

Family history of premature CHD

Age more than or equal to 45 years for men or age more than or equal to 55 years for women (or postmenopausal)

Atherosclerosis

Hypertension

Diabetes mellitus

Renal Failure

Heart Failure

Stroke

Gallbladder Disease

Atherosclerosis

Hypertension

Diabetes mellitus

Renal Failure

Heart Failure

Stroke

Gallbladder Disease

Full lipid panel (fasting cholesterol, triglycerides, low-density lipoprotein,

and high-density lipoprotein)

Hepatic panel

Thyroid function tests

Twenty four hours urinary free cortisol

Fasting glucose and insulin

Full lipid panel (fasting cholesterol, triglycerides, low-density lipoprotein,

and high-density lipoprotein)

Hepatic panel

Thyroid function tests

Twenty four hours urinary free cortisol

Fasting glucose and insulin

Assessment of a patient should include:

1. The evaluation of body mass index (BMI)

2. Waist circumference

3. Overall medical risk

Assessment of a patient should include:

1. The evaluation of body mass index (BMI)

2. Waist circumference

3. Overall medical risk

Goals for weight loss & management-: Reduce body weight Maintain a lower body weight at long term Prevent further weight gain-:Weight Management Techniques ,Dietary Therapy, Physical Activity, Behavior TherapyPharmacotherapy, & Weight Loss Surgery

Goals for weight loss & management-: Reduce body weight Maintain a lower body weight at long term Prevent further weight gainWeight Management Techniques:-Dietary Therapy, Physical Activity, Behavior Therapy, Pharmacotherapy, & Weight Loss Surgery

Physical activity should be an integral part of weight losstherapy and weight maintenance. Initially, moderate levels ofphysical activity for 30 to 45 minutes, 3 to 5 days per week, shouldbe encouraged. An increase in physical activity is an important component of weight loss therapy, although it will not lead to a substantially greater weight loss than diet alone over 6 months.

Physical activity should be an integral part of weight losstherapy and weight maintenance. Initially, moderate levels ofphysical activity for 30 to 45 minutes, 3 to 5 days per week, shouldbe encouraged. An increase in physical activity is an important component of weight loss therapy, although it will not lead to a substantially greater weight loss than diet alone over 6 months.

Self-monitoring refers to observing and recording some

aspect of behavior, & eating behaviors such as caloric

intake, exercise sessions, medication usage torecognize

the relation between these habits & increase in thebody

weight

& To break the relationship between these habits .ingestion of meal

Positive feedback

Self-monitoring refers to observing and recording some

aspect of behavior, & eating behaviors such as caloric

intake, exercise sessions, medication usage to recognize

the relation between these habits & increase in the body

weight

To break the relationship between these habits & ingestion of meal.

Positive feedback

Drug therapy may also be useful for patients with a BMI more than or equal to 27 who also have concomitant obesity related risk factors or diseases. The drugs used to promote weight loss have been anorexiants or appetite suppressants. Three classes of anorexiant drugs have been developed, all of which affect neurotransmitters in the brain

They may be designated as follows: those that affect catecholamines, such as dopamine and norepinephrine; those that affect serotonin; and those that affect more than one neurotransmitter. These drugs work by increasing the secretion of dopamine, norepinephrine, or serotonin into the synaptic neural cleft, by inhibiting the reuptake of these neurotransmitters into the neuron,

or by a combination of both mechanisms.

Drug therapy may also be useful for patients with a BMI more than or equal to 27 who also have concomitant obesity related risk factors or diseases. The drugs used to promote weight loss have been anorexiants or appetite suppressants. Three classes of anorexiant drugs have been developed, all of which affect neurotransmitters in the brain

They may be designated as follows: those that affect catecholamines, such as dopamine and norepinephrine; those that affect serotonin; and those that affect more than one neurotransmitter. These drugs work by increasing the secretion of dopamine, norepinephrine, or serotonin into the synaptic neural cleft, by inhibiting the reuptake of these neurotransmitters into the neuron,

or by a combination of both mechanisms.

Sibutramine inhibits the reuptake of norepinephrine and serotonin. Orlistat is not an appetite suppressant and has a different mechanism of action; it blocks about one-third of fat

absorption. These drugs are modestly effective in their ability to produce weight loss. Net weight loss attributable to drugs has generally been reported to range from 2 to 10 kilograms (4.4.(to 22 lbs

Sibutramine inhibits the reuptake of norepinephrine and serotonin. Orlistat is not an appetite suppressant and has a different mechanism of action; it blocks about one-third of fat

absorption. These drugs are modestly effective in their ability to produce

weight loss. Net weight loss attributable to drugs has generally been reported to range from 2 to 10 kilograms (4.4 to 22 lbs).

Weight loss surgery is an option for weight reductionin patients with clinically severe obesity, i.e., a BMI more than or equal two 40, or a BMI more than or equal two 35 with comorbid conditions. Weight loss surgery should be reserved for patients in whom other methods of treatment have failed and who have clinically severe obesity (once commonly referred to as “morbid obesity”). Weight loss surgery provides medically significant sustained weight loss for more than 5 years in most patients.

Two types of operations have proven to be effective: thosethat

,restrict gastric volume (banded gastroplasty) and those thatin-addition to limiting food intake, also alter digestion (Roux-enY

gastric bypass.)

Weight loss surgery is an option for weight reductionin patients with clinically severe obesity, i.e., a BMI more than or equal two 40, or a BMI more than or equal two 35 with comorbid conditions. Weight loss surgery should be reserved for patients in whom other methods of treatment have failed and who have clinically severe obesity (once commonly referred to as “morbid obesity”). Weight loss surgery provides medically significant sustained weight loss for more than 5 years in most patients.

Two types of operations have proven to be effective: those that

restrict gastric volume (banded gastroplasty) and those that, inaddition to limiting food intake, also alter digestion (Roux-en-Y

gastric bypass.)

Late complications are uncommon, but some patients may develop incisional hernias, gallstones, and, less commonly & weight loss failure. Patients who do not follow the instructions to maintain an adequate intake of vitamins and minerals may develop deficiencies of vitamin B12 and iron with anemia. Neurologic symptoms may occur in unusual cases. Thus, surveillance should include monitoring indices of inadequate nutrition. Documentation of improvement in preoperative comorbidities is beneficial and advised

Late complications are uncommon, but some patients may develop incisional hernias, gallstones, and, less commonly & weight loss failure. Patients who do not follow the instructions to maintain an adequate intake of vitamins and minerals may develop deficiencies of vitamin B12 and iron with anemia. Neurologic symptoms may occur in unusual cases. Thus, surveillance should include monitoring indices of inadequate nutrition. Documentation of improvement in preoperative comorbidities is beneficial and advised