UGEB 2362 NUTRITION FOR

HEALTHY LIVING
Overweight, Obesity, and Diabetes

Peggy Yip, MPH, RDN(US), RNutr(UKVRN)

Overweight and obesity in HK and
Worldwide
• Approximately 18% overweight and 20% obese among Chinese adults in
2016 in HK1.

• Worldwide obesity has nearly tripled since 19752.

• In 2016, more than 1.9 billion adults, 18 years and older, were
overweight. Of these over 650 million were obese2.

• Over 340 million children and adolescents aged 5-19 were overweight or
obese in 20162.

• 41 million children under the age of 5 were overweight or obese in 20162.

1Statistics
on Behavioural Risk Factors, Centre for Health Protection, Department of Health, HKSAR. Available at:
https://www.chp.gov.hk/en/static/24016.html
2Obesity and Overweight. World Health Organization. 2018. Available at: https://www.who.int/news-room/fact-
sheets/detail/obesity-and-overweight
Think of the following questions……
• Am I too fat / too thin?

• What does your body weight mean to you?

• What is the relationship between body weight and

nutrition/eating?
Definition of overweight & obesity
Abnormal or excessive fat accumulation in the body

BMI: an index to classify weight status

Body weight (kg)

Height (m)2

BMI Categories Asians Non-Asians

Underweight <18.5 <18.5
Healthy Weight 18.5 – 22.9 18.5-24.9
Overweight >22.9 >24.9
Obese >24.9 >29.9
What’s her BMI? Body weight (kg)
Height (m)2

39.64kg
1.6m x 1.6m

BMI = 15.48

What is 15.48 mean?

Height: 1.6m
Weight: 39.64kg
Does the BMI tell you everything about
your body weight?
• It is a good and easy-to-use tool to estimate weight status

• But……

• It does not tell you where the weight come from

• It does not tell you the fat distribution in the body

Waist circumference

• A measurement for central

obesity

• >90cm for men

• >80cm for women

Waist-to-hip ratio
• A measurement for fat stored in midsection

• Equation: waist circumference / hip circumference

• > 0.90 is high risk for men

• > 0.85 is high risk for women

Bioelectrical impedance analysis
• Weight scale measuring body composition, it generates
electrical current which pass through the body

• Estimating fat-free mass and percent of body fat from

body water

• How?

• The body’s fat-free tissue (higher body water content) has a greater
electrical conductivity than fat tissue

• Dehydration will result in overestimation of fat mass

So, what does your body weight
mean to you?
Factors influencing weight and body fat
• Sex • Diet
• Male require higher energy • You intake, that is, how much
intake due to more muscle energy you are taking in
mass
• Exercise
• Age • Your expenditure, that is, how
• Grow age, younger age much energy you are
population require higher spending
energy than older age
population
• Other factors: inadequate
sleep, stress, emotional
• Genes factors, microbiome
• Regulate how much food an
individual eats, how much
energy they expend, and the
way their body fat stored
Diet and Exercise
• The factors that influence one’s weight are CALORIES INTAKE and
EXPENDITURE

• Calories can be obtained from: Carbohydrate (4kcal/g), Protein

(4kcal/g), Fat (9kcal/g), and Alcohol (7kcal/g)

• Expenditure: Physical activity level (higher level  higher

expenditure), Age, Lifestyle, muscle mass

Gain : calories > expenditure

Maintenance : calories = expenditure

Loss : calories < expenditure

Fat Cell Development
• 2 levels to look at: (1) number (hyperplastic obesity) and
(2) size (hypertrophic obesity)

• Obese people have more and larger fat cells

• Fat cells can only decrease in size, but not the number
Fat Cell Metabolism
• Lipoprotein lipase (LPL), an enzyme, remove triglycerides from
the blood, store them in both adipose tissue and muscle cells

• Obese people have more LPL, making fat storage efficient

• Women: fat cells in the breasts, hips, and thigh produce

abundant LPL  pear shaped

• Men: fat cells in abdomen produce abundant LPL  apple

shaped

• When decrease in intake, body adjusts its metabolism to

restore the original weight  regain the lost weight making
sustain of weight loss difficult
The key is ...
PREVENTION
&
BALANCE between INTAKE and
EXPENDITURE

No foods or diet will magically burn fat, change your

genetic code, nor melt fat while you watch TV or sleep.
Overweight, Obesity, Poor Diet &
Physical Inactive --- WHY?
Socio-economic status
• Food price concern, limited food selection, meal frequency, etc.

Family influence
• Children’s behaviors influenced by their parents

• So, if parents engage in obesity-promoting behaviors, then it is

more likely that they will pass those behaviors on to their children
Workplace / work environment
• Sedentary jobs

• Busy work schedules & long working hours

• Lack of time for exercise

• Female labor participation, less time to cook

School / Study environment
• Academic performance

• P.E. lessons

• Tuck shops / vending machines

• Stress

Source: Ming Pao, 22/10/2008

Sleeping time
• Not getting enough sleep

• Hormone alteration
• Reduce leptine (satiety factor)
• Increase ghrelin (hunger-promoting hormone)

• Thus, increase intake

Technology
• Cars, elevators, escalators

• TVs, movies, video games, computers

• Remote controls, washing machines

• All contribute to sedentary lifestyle

Others
• Culture • Cooking equipment

• Food Advertisements • Educational level

• Lack of parks, sidewalks and

• Supermarkets, food stores,
sports / recreation facilities
food markets
• Low air quality / crime rate
What are the factors influencing your
eating habit?
Problems relating to overweight / obesity
• Type 2 Diabetes

• Cardiovascular Diseases (e.g. coronary heart disease,

high blood pressure, etc.)

• Cancers
“strong evidence that weight gain, overweight and obesity increases the risk of
11 cancers, including bowel, breast, prostate, pancreatic, endometrial,
kidney, liver, gallbladder, esophageal, ovarian and stomach cancers.”
WCRF-HK

• Sleep apnea, osteoarthritis, Alzheimer's

…and many more!
Diabetes
• Body unable to regulate blood sugar

• Type 1 Diabetes

• Prediabetes

• Type 2 Diabetes

• Gestational Diabetes
Diabetes
• Body unable to regulate blood sugar

• There are different types of diabetes

• Gestational Diabetes

• Type 1 Diabetes

• Prediabetes

• Type 2 Diabetes
Gestational Diabetes
What is it?

• High blood sugar during pregnancy, usually develop during the

3rd trimester, or as early as 20th week, but it can happen at any
stage

• Usually blood sugar returns to normal after delivery

• During pregnancy, the body produces various hormones, which

impair the action of insulin (a hormone the regulars blood
sugar)

• Why some women develop gestational diabetes, but some do

not?
Common symptoms:

• Often no noticeable symptoms, which is why it's important

to be tested time during pregnancy

Possible consequences/complications:

• Excessive birth weight or preterm birth

• Low blood sugar (hypoglycemia)
• Type 2 diabetes later in life

• High blood pressure and preeclampsia

• Future diabetes
Management:

• Diet modification
• Exercise
• Medication

Can women with gestational diabetes during pregnancy

delivery a healthy baby?
Type 1 diabetes
What is it?

• It is a chronic condition that the pancreas produces only

little or no insulin, and this cannot be cured.

• There are different factors causing type 1 diabetes, such

as genetics and environmental factors

• Immune-mediate (autoimmune destruction of beta cells)

• Idiopathic (no known etiology)

Immune-Mediate Diabetes Mellitus
• Destruction of beta cells of pancreas, the only cell make insulin

• Insulin is to regulate blood glucose

• Without insulin (or without enough insulin), the body will not able to
regulate blood sugar

• Medication and diet management are required to maintain blood

sugar at normal level

• Usually diagnosed at young age, some can diagnose at older age

(Latent Autoimmune Diabetes of Aging)
Common symptoms

• Polydipsia (excessive thirst)

• Polyuria (frequent urination)

• Extreme hunger

• Significant weight loss

• Fatigue and weakness

Possible consequences/complications

• Nerve damage (neuropathy)

• Eye damage

• Foot damage

• Kidney damage (nephropathy)

Management

• Eat regularly and healthy

• Medication / insulin injection

• Maintain a healthy body weight

Prediabetes
What is it?

• Blood sugar levels that are higher than normal but not yet
high enough to be diagnosed as diabetes

• With diet modification, exercise, and weight loss, type 2

diabetes may not be developed or may be delayed
Common symptoms

• Polydipsia (excessive thirst)

• Polyuria (frequent urination)

• Fatigue

• Blurred vision
Causes

• Family history and genetics

• Gestational diabetes

• Inactivity

• Excess fat or overweight

Possible consequences/complications

• Developing of type 2 diabetes

Management

• Eat healthy

• Exercise

• Weight loss if overweight

Type 2 Diabetes
What is it?

• Body unable to stabilize blood sugar

• 90-95% of all diagnosing cases

• Develop gradually, and no noticeable symptoms at early

stage

• It cannot be cured
Common symptoms:

• Polydipsia (excessive thirst)

• Polyuria (frequent urination)

• Increased hunger

• Unintended weight loss

• Fatigue
Causes

• Caused by eating too much sugar?

• Excessive amount of body fat lower insulin sensitivity or

the body doesn’t produce enough insulin

• However, not all obese people develop type 2 diabetes

• Other causes include pre-diabetes, gene, family history,

physical inactivity, prior history of gestational diabetes, etc.
Possible consequences/complications

• High blood pressure

• High cholesterol
• Heart disease
• Stroke
• Kidney disease
• Blindness
• Amputations
Management

• Medications

• Weight loss

• Diet modification

• Physical activity
Diet modification for controlling blood sugar
• Carbohydrate influences blood sugar
• Starch
• Fruits and some vegetables
• Milk and dairy
• Beans
• Sugar

• So, should people with diabetes consume carbohydrate or avoid

carbohydrate?

• Emphasize fiber and whole grain, reduce fat intake

Glycemic Index
• Glycemic Index (GI) is developed to measure the effect of
carbohydrate on glucose

• High GI (70 or more), white bread, instant oatmeal

• Medium GI (55-69) – whole wheat bread, brown rice

• Low GI (55 or less) - most fruit, non-starchy vegetables

Carbohydrate exchange
• A way to count carbohydrate
• 1 exchange = 15g carbohydrate(or 10g)

Example
• 60g of carbohydrate is required at each meal

1 exchange equals to Meal plan 1 Meal plan 2

• 1 slice of bread, 2 slices of bread (2) 1 slice of bread (1)
• 1 cup milk, 1 slice of cheese (1) 1 tsp butter (0)
• 1 orange, 1 slice of ham (0) 1 scramble egg (0)
• Half banana 1 apple (1) 1 cup milk (1)
• 1 apple, or
1 banana (2)
• 1 slice of cheese
Goals
• Improve eating pattern

• Weight improvement

• Blood glucose stable

• Delay or prevent complications of diabetes

Complications of uncontrolled of diabetes

• Amputation

• Blindness

• Kidney disease

• And many other obese-relate diseases

• High blood sugar - cause of death?

Treatment
• Oral medications

• Insulin injection, by needle or pump (a medical device

attaches to body to provide insulin)
• How does it affect daily life (for example, taking shower)?

• Artificial pancreas (device monitoring blood sugar and

injecting insulin)
Treating diabetes with bariatric surgery?

• Diabetes is considered as an untreatable disease

• No treatment, but only control

• Bariatric surgery may be a hope for diabetic patients

• Diet modification is the KEY!

Key Messages
• Overweight and obesity is a common health problem
worldwide

• Balancing energy intake and expenditure is the key to

prevent overweight or obesity

• There are many factors influences one’s eating behavior,

making adopting a balanced diet difficult

• Consequences of obesity include type 2 diabetes

• There are also other types of diabetes, gestational
diabetes, type 1 diabetes and prediabetes

• Server and irreversible consequences can occur if fail to

maintain blood glucose

• Diet modification, exercise, maintaining a healthy weight,

and taking medications are vital for maintain blood
glucose stable