OBESITY

INTRODUCTION:
Obesity may be defined as an abnormal growth of the adipose tissue due to an enlargement of
fat cell size (hypertrophic obesity) or an increase in fat cell number (hyperplasic obesity) or a
combination of both. Expressed in terms of body mass index (BMI). weight gain affects the
risk associated with obesity, and the kind of disease that results. As a chronic disease, prevalent
in both developed and developing countries, and affecting children (10-20%) as well as adults
(20-40%). The most prevalent form of malnutrition.

EPIDEMIOLOGICAL DETERMINANTS:

A)Age-: Obesity can occur at any age, and generally increases with age. Infants with excessive
weight gain have an increased incidence of obesity in later life.
- most adipose cells are formed early in life.

B) SEX-: Women generally have higher rate of obesity than men, although men may have
higher rates of overweight.
- In the Framingham, USA study, men were found to gain most weight between the ages of 29
and 35 years, while women gain most between 45 and 49 gears of age.
- Woman's BMI increases with successive pregnancies with a weight gain of 1 kg per
pregnancy.

C)Genetic Factors-: Twin studies have shown a close correlation between the weights of
identical twins even when they are reared in dissimilar environments.
- Recent studies have shown that the amount of abdominal fat was influenced by a genetic
component accounting for 50-60 per cent of the individual differences.

D)Physical Inactivity-: Physical activity and physical fitness are important modifiers of
mortality and morbidity related to overweight and obesity.
- Physical inactivity may cause obesity, which in turn restricts activity. This is a vicious circle.
- Sedentary lifestyle particularly sedentary occupation and inactive recreation such as watching
television promote it.

E)Socio-economic Status-: There is a clear inverse relationship between socio-economic status

and obesity.
- Within some affluent countries, however, obesity has been found to be more prevalent in the
lower socioeconomic groups.

F)Eating Habits-: The composition of the diet, the periodicity with which it is eaten and the
amount of energy derived from it are all relevant to the aetiology ofobesity.
- A diet containing more energy than needed may lead to prolonged post-prandial
hyperlipidaemia and to deposition of triglycerides in the adipose tissue resulting in obesity

OBESITY AND IRON DEFICIENCY ANEMIA

- heavy advertisement of fast food outlets of energydense, micronutrient poor food and
beverages is disturbing our eating habits.

G) Psychosocial Factors -: Psychosocial factors (e.g. emotional disturbances) are deeply

involved in the aetiology of obesity.
- Overeating may be a symptom of depression, anxiety, frustration and loneliness in childhood
as in the adult life.

H)Familial Tendency : Obesity frequently runs in family(obese parents frequently having obese
children), but not necessarily explained solely by the influence of genes.

I)Endocrine Factors-: These may be involved in occasional cases. e.g. Cushing's syndrome,
growth hormone deficiency.

J)Alcohol-: A recent review of studies concluded the relationship between alcohol consumption
and adiposity generally positive for men and negative for women.

K)Education-: In most affluent societies. there is an relationship between educational level and
prevalence of overweight .

L)Smoking-: In most populations, smokers weigh somewhat less than ex-smokers: individuals
who have never smoked fall somewhat between the two.

M)Ethnicity-: Ethnic groups in many industrialized specially appear to be especially

susceptible to the development of obesity and its complications.
- Evidence suggest that this may be due to a genetic predisposition to obesity that only becomes
apparent when such groups are exposed to a more affluent life style.

N)Drugs-: Use of certain drugs,e.g.corticosteroids,contraceptives. insulin, p-adrenergic

blockers, etc. can cause weight gain.

USE OF BMI TO CLASSIFY OBESITY:

Body mass index (BMI) is a simple index of weight for height that is commonly used to classify
underweight, over weight and obesity in adults. It is defined as the weight in Kilograms divided
by the square of the height in metres (kg/m²). Example, an adult who weighs 70 kg and whose
height is 1.75 mtr will have a BMI of 22.9.

BMI= 70 (kg)/17.75²(m²) =22.9

The WHO classification is based primarily on theassociation between BMI and mortality.

OBESITY AND IRON DEFICIENCY ANEMIA

 TABLE 1: Classification Of Adult According To BMI

These BMI values are age-independent and the same for both sexes. The risks associated with
increasing BMI are continuous and graded and begin at a BMI above 25. BMI does not
distinguish between weight associated with muscle and weight associated with fat. In addition,
the percentage of body fat mass increases with age up to 60-65 years in both sexes. and is
higher in women than in men of equivalent BMl.

ASSESSMENT OF OBESITY:

-Body composition are as under-:

A. The active mass (muscle, liver, heart, etc.) B. The fatty mass (fat)
C. The extracellular fluid (blood, lymph, etc.) D. The connective tissue (skin, bones)

-The most widely used criteria are :

A. Body weight B. Skin fold thickness
C. Weist hip ratio D. Others

OBESITY AND IRON DEFICIENCY ANEMIA

 TABLE 2 : Calculation Various

Skin Fold Thickness: It is a rapid and "non-invasive” method for assessing body fat. Several
varieties of callipers (e.g., Harpenden skin callipers). The measurement may be taken at all the
four sites -mid-triceps, biceps, sub scapular and suprailiac regions. The sum of the
measurements should be less than 40mm in boys and 50 mm in girls

Waist-Hip Ratio: There is an increased risk of metabolic complications for men with a waist
circumference > 102 cm, and women with a waist circumference > 88 cm. Over the past 10
years or so, it has become accepted that a high WHR (> 1.0 in men and > 0.85 in women)
indicates abdominal fat accumulation.

COMPLICATIONS OF OBESITY:

•Type 2 diabetes. •High blood pressure. •Stroke.

•Heart disease. •Gallbladder disease. •Osteoarthritis.
•Poor wound healing. •Sleep apnea •Cancer.
•High cholesterol and triglycerides. •Metabolic syndrome. •Depression

OBESITY AND IRON DEFICIENCY ANEMIA

 TABLE 3: Relative Risk Health Problem Associated With Obesity

TREATMENT:

-Drugs:1)Orlistat (Xenical).
2)Lorcaserin (Belviq).
3) Phentermine-topiramate (Qsymia).
4)Phentermine (Adipex-P, Suprenza).
-More exercise: 150 to 250 minutes of moderate intensity activity every week is helpful to
keep away from obesity, and these activities such as fast walking and swimming.
-Eat healthy: low calorie and fibers rich food such as fruits, vegetables are good food to have
every day, but saturated fats and sweets and alcohol are extremely bad , they increase body
weight, and threaten the health.
-Monitor weight: monitoring weigh and calculating body mass indexwill be very helpful to
know the prevention plan work.
-Others: 1)Surgical treatment gastric bypass, gastroplasty, jaw wiring
2)Health education has an important role to play
in teaching how to reduce overweight and prevent
obesity.

OBESITY AND IRON DEFICIENCY ANEMIA

 IRON DEFICIENCY ANEMIA
INTRODUCTION:

Anemia usually refers to a condition in which your blood has a lower than normal number of
red blood cells. Iron is an essential mineral that is needed to form hemoglobin, an oxygen
carrying protein inside red blood cells. Iron deficiency anemia is a condition in which the body
lack enough red blood cell to transport oxygen-rich blood to body tissues. Iron deficiency
anemia is the most common form of anemia and it develops over time if the body does not have
enough iron to manufacture red blood cells. Without enough iron, the body uses up all the iron
it has stored in the liver, bone marrow and other organs. Once the stored iron is depleted, the
body is able to make very few red blood cells. If erythropoietin is present without sufficient
iron, there is insufficient fuel for red blood cell production. The red blood cells that the body
is able to make are abnormal and do not have a normal haemoglobin carrying capacity, as do
normal red blood cells.

ETIOLOGY:

Iron-deficiency anemia is usually due to :

• Blood Loss
-Blood lost causes iron depletion. In women, long or heavy menstrual periods or bleeding
fibroids in the uterus.
-Childbirth.
-Internal bleeding.

• Poor Diet
-Low iron intake.
-During some stages of life, such as pregnancy and childhood.

• Inability To Absorb Enough Iron

-Even if you have enough iron in your diet, your body may not be able to absorb it. This can
happen if you have intestinal surgery or a disease of the intestine.
-Prescription medicines that reduce acid in the stomach also can interfere with iron absorption.

CLINICAL PRESENTATION:

Iron-deficiency anemia can cause:

-Brittle nails.
-Cracks in the sides of the mouth.
-Extreme fatigue (tiredness).
-Chest pain.
-Pale skin.
-Dizziness or lightheadedness.
-Fast heart rate
-Headache
-An enlarged spleen
-Cold hands and feet

OBESITY AND IRON DEFICIENCY ANEMIA

-Frequent infections.
-Irritability.
-Shortness of breath.
-Swelling or soreness of the tongue.
-An unusual craving for non-nutritive
substances such as:
1)Ice
2)Dirt
3)Paint or starch.
(This craving is called pica.)
- Some people who have iron-deficiency anemia develop restless legs syndrome (RLS). RLS
is a disorder that causes a strong urge to move the legs.
-Some signs and symptoms of iron-deficiency anemia are related to the condition's causes.
-A sign of intestinal bleeding is bright red blood in the stools or black, tarry-looking stools.
-Very heavy menstrual bleeding, long periods, or other vaginal bleeding may suggest that a
woman is at risk for iron-deficiency anemia.
-Severe iron-deficiency anemia can lead
to:
1)Problems with growth and development in children
2)angina (chest pain)
3)leg pains (intermittent claudication)

TREATMENT:

Iron deficiency anemia is treated with oral or parenteral iron preparation. Oral iron correct
the anemia just as rapidly and completely as parenteral iron in most cases if iron absorption
from the GIT is normal. Different iron salt provide different amount of elemental iron. In iron
deficient individual, about 50-80mg of iron can be incorporated in hemoglobin daily and about
25% of oral ferrous salt can be absorbed.

1)ORAL IRON THERAPY

Oral iron treatment may require 3-6 months to replenish body stores.

TABLE 4: Some Common Iron Medication

Ferrous sulfate is the DOC (Drug Of Choice) for iron deficiency anemia.
• Dosage: 325 mg tid, which provides 180 mg of iron daily of which 10mg is usually absorbed.
• Patients who cannot tolerate iron on an empty stomach should take it with food.
• Administration: PO

OBESITY AND IRON DEFICIENCY ANEMIA

IRON SUPPLEMENT:
*Important points about Iron Supplement:
Before using iron medication, check if you are allergic to any drugs or food dyes, or if you
have:
• iron overload syndrome • liver or kidney disease
• if you are an alcoholic • if you receive regular blood transfusion.
• thalassemia (a genetic disorder of red blood cells) • hemolytic anemia
• porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous
system)
-Most iron medication are taken on an empty stomach, at least 1 hour before or 2 hours after
meal.

GENERAL MECHANISM OF ACTION OF IRON SUPPLEMENT:

During the process of absorption, oxygen combines with iron and is transported into the plasma
portion of blood by binding to transferrin. From there, iron and transferrin are used in the
production of haemoglobin (the molecule that transports oxygen in the blood) and myoglobin(
helps your muscle cells store oxygen.)

COMMON ADVERSE EFFECTS OF ORAL IRON THERAPY:

• Nausea • Epigastric discomfort

• Abdominal cramps • Constipation and diarrhea.
• Black stool • These effects are usually dose-related.

CONTRAINDICATIONS:

1)Avoid taking any other multivitamin or mineral product within 2 hours before or after taking
your iron supplement.
2)Avoid antibiotic such as ciprofloxacin ,demeclocycline , doxycycline , levofloxacin,
lomefloxacin , minocycline , norfloxacin , ofloxacin , or tetracycline.
3)Avoid antacids within 2 hours before or after meals when taking your iron medication.
4)If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory (NSAID)
drugs, as well as aspirin, because these drugs may interfere with blood platelets, prolong
bleeding, and irritate your stomach.

2)PARENTERAL IRON THERAPY:

1)Iron Dextran- Is a stable complex of ferric hydroxide and low-molecular weight dextran
containing 50mg of elemental iron per milliliter of solution. It can be given deep IM injection
or IV infusion.
-Adverse effect:
light-headedness, fever, arthralgias, back pain, urticaria, bronchospasm and hypersensitivity
reaction.

2)Iron sucrose complex & iron sodium gluconate complex- These are indicated for patient
with hypersensitivity reactions to oral iron salts. They are only given by IV route. For patient
who are treated chronically with iron, it is important to monitor the iron level to avoid serious
toxicity associated with iron overload.
-Adverse effect: same as iron dextran.

OBESITY AND IRON DEFICIENCY ANEMIA

3)Non- pharmacological treatment:

• Iron-rich diet
• Good sources of iron includes:
– meats - beef, pork, lamb, liver, and other organ meats
– poultry - chicken, duck, turkey, liver (especially dark meat)
– fish - shellfish, including clams, mussels, and oysters, sardines, anchovies
– leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards
– legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black
eyed peas, and canned baked beans

REFERENCE:

OBESITY:
• https://en.wikipedia.org/wiki/Obesity
• http://www.who.int/topics/obesity/en/
• https://en.wikipedia.org/wiki/Anti-obesity_medication
•https://www.mayoclinic.org/diseases-conditions/obesity/diagnosis-treatment/drc-
20375749

IRON DEFICIENCY ANEMIA:

• The HealthCentralNetwork, Inc.Copyright © 2001-2011. Treatment of Iron
Deficiency,retrieved on 2011-10-05. Retrieved from
http://www.healthscout.com/ency/68/575/main.html#TreatmentofIronDeficiency
• A-Z Drug Facts for the Professional,Copyright © 2000-2011. Iron supplement, retrieved on
2011-10-03. Retrieved from http://www.drugs.com/ppa/
• A-Z Drug Facts for the Professional,Copyright © 2000-2011. What should I avoid while
taking iron supplement, retrieved on 2011-10-03. Retrieved from
http://www.drugs.com/ferrous_sulfate.html
• National Center for Biotechnology Information, U.S. National Library of Medicine 8600
Rockville Pike, Bethesda MD, 20894 USA Iron supplements: a common cause of drug
interactions, retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1368348/
• Basic and clinical pharmacology 10th edition, Beram.G. Katzung,MD,PhD.
Professor Emertus, Department of cellular & Molecular Pharmacology,
University of California San Francisco.

OBESITY AND IRON DEFICIENCY ANEMIA