OBESITY

INTRODUCTION

The World Health Organization (WHO) defines overweight and obesity as abnormal or
excessive fat accumulation that presents a task to health. It is a medical problem that
increases the risk of other diseases, such as heart disease, diabetes, high blood pressure and
certain cancers. The fat deposition takes place because over a period of time, people consume
diets which provided much more energy than they were able to expend for their metabolism,
physical activity and growth. The progression from lean state to obesity brings with it a
phenotypic change in adipose tissue and the development of chronic low-grade inflammation.
This is characterized by increased levels of circulating free-fatty acids, soluble pro-
inflammatory factors. The metabolic and cardiovascular aspects of obesity are closely linked.
The chronic inflammatory state associated with obesity is established as a major contributing
factor for insulin resistance, which itself is one of the key pathophysiology's of T2D. Obesity
has enormous healthcare costs exceeding $700 billion each year. The economic burden is
estimated to be about $100 billion annually in the United States alone. The body mass index
(BMI) is used to define obesity, which is calculated as weight (kg)/height (m2). While the
BMI does correlate with body fat in a curvilinear fashion, it may not be as accurate in Asians
and older people, where a normal BMI may conceal underlying excess fat. Obesity can also
be estimated by assessing skin thickness in the triceps, biceps, subscapular, and supra-iliac
areas. Overweight and obesity result from an imbalance of energy intake (diet) and energy
expenditure (physical activity). In most cases obesity is a multifactorial disease due to
obesogenic environments, psycho-social factors and genetic variants. In a subgroup of
patients, single major etiological factors can be identified (medications, diseases,
immobilization, iatrogenic procedures, monogenic disease/genetic syndrome).

The obesogenic environment exacerbating the likelihood of obesity in individuals,

populations and in different settings is related to structural factors limiting the availability of
healthy sustainable food at locally affordable prices, lack of safe and easy physical mobility
into the daily life of all people, and absence of adequate legal and regulatory environment.
The lack of an effective health system response to identify excess weight gain and fat
deposition in their early stages is aggravating the progression to obesity.

One of the goals of assessment in an obese patient is to decide whom to treat. Three main
issues must be considered: 1) whether treatment is indicated, 2) whether treatment is safe for
the patient, and 3) whether the patient is ready and motivated to lose weight. Figure 2 shows
a suggested algorithm for stratifying risk in patients. This algorithm is a simplified version of
the algorithm presented in the Practical Guide. The algorithm takes into account the BMI;
waist circumference; and a finite group of risk factors, including cigarette smoking,
hypertension, elevated LDLcholesterol, low levels of HDL-cholesterol, impaired fasting
glucose, family history of coronary heart disease, and age. Of note, with a BMI of 30 kg/m2
or greater should be considered for treatment regardless of waist circumference or risk
factors. Treatment may be indicated for patients of normal weight if they have a waist
circumference 35 inches for women or 40 inches for men, as well as two or more of the listed
risk factors. The recommendations should not be implemented without first considering their
applicability to an individual patient. In muscular patients and in edematous patients, for
example, BMI can overstate medical risk by overestimating body fat. Because muscle mass
declines with age, BMI can understate risk in the elderly. The relationship between BMI and
body fat can vary with ethnicity and gender (2), although including waist circumference as a
parameter in risk assessment may help compensate for associated difference in fat
distribution

Diagnostic criteria for obesity

Body Mass Index (BMI): It is one way of measuring whether a person's weight or body fat
is higher than what is considered a healthy weight for a given height. This is measured by:
calculating a person's weight in kilograms, then dividing that number by the person's height
in meters squared (kg/m2). If the resulting ratio is high, then it can be an indicator of high
body fat

TABLE: 1 CLASSIFICATION OF OBESITY BASED ON BODY MASS INDEX

Weight status BMI

Underweight Less than 18.5

Normal (healthy wgt) 18.5 – 22.9

Overweight 23 – 24.9

Pre obese 25- 29.9

Obese >30
Assessing obesity accurately is crucial for effective prevention and intervention strategies.
Among the various methods used to measure obesity, waist circumference (WC), hip
circumference (HC), and the waist-to-hip ratio (WHR) are particularly significant due to their
ability to predict health risks associated with obesity. These measurements are especially
relevant in the Asian context, where body fat distribution patterns and health risk thresholds
differ from those in Western populations.

Waist Circumference (WC)

Waist circumference is a simple and effective measure of central adiposity, which is closely
linked to visceral fat. Visceral fat is more metabolically active than subcutaneous fat and is
strongly associated with an increased risk of cardiovascular diseases, type 2 diabetes, and
metabolic syndrome. In the Asian population, the risk of these conditions occurs at lower
levels of waist circumference compared to Western populations. This necessitates the use of
specific criteria to define central obesity.

Asian Criteria for Waist Circumference:

For men: ≥ 90 cm (35 inches)

For women: ≥ 80 cm (31 inches)

These cut-offs are recommended by the World Health Organization (WHO) and the
International Diabetes Federation (IDF) for Asian populations. They reflect the increased
susceptibility of Asians to obesity-related health risks at lower levels of waist circumference.

Hip Circumference (HC)

Hip circumference measures the distance around the widest part of the hips and buttocks.
While not as strongly associated with health risks as waist circumference, hip circumference
is used to calculate the waist-to-hip ratio (WHR), providing additional insight into body fat
distribution.

Waist-to-Hip Ratio (WHR)

The waist-to-hip ratio is calculated by dividing the waist circumference by the hip
circumference. WHR is an indicator of fat distribution, with a higher ratio indicating a greater
proportion of abdominal fat relative to hip fat. This measurement is significant because
abdominal fat, particularly visceral fat, is more closely linked to adverse health outcomes
than fat stored in the hips and thighs.
Asian Criteria for Waist-to-Hip Ratio

For men: ≥ 0.90

For women: ≥ 0.85

These criteria highlight the importance of central obesity as a health risk marker. Asians tend
to have a higher body fat percentage and greater visceral fat deposition at lower BMI levels
compared to Caucasians, making WHR a valuable tool in assessing obesity-related health
risks.

Etiology

• Genetic Susceptibility: Obesity or thinness of an individual is inherited, basically

from the biological mother. If our biological mother has been overweight as an adult,
the likelihood of our being heavy is about 75%.
• Dietary habits: Eating behaviours and food choices that promote excessive energy
intake. Current recommendations for weight management emphasize the importance
of healthy eating patterns that include a variety of nutrient-dense foods, limit portions
of energy-dense foods, and reduce overall energy density
• Physical activity: Sedentary lifestyle with lack of exercise schedule tends to make one
obese. As we approach middle age, our physical activity generally decreases without a
corresponding decrease in food consumption leading to obesity.
• Affluence and abundant availability of food: With increasing affluence, increase In
purchasing power and abundance of food. Eating out has become fashionable leading
to an increased consumption of junk food which is rich in calories.
• Psychological factors: Lonely, bored and depressed individuals may find solace in
eating. When there is nothing else to do, eating provides diversion resulting in
increased Consumption of calories.
• Hormonal imbalance: Certain diseases associated with secretion of hormones, e.g.,
Hypothyroidism, hypogonadism and Cushing’s syndrome exhibit obesity as one of
the Characteristic.
• Birth weight and genetics: slow growth of the foetus in utero and during infancy is
followed by accelerated weight gain in childhood. This condition has been found to be
associated with exaggeration of adiposity, as well as, insulin resistance in later life. In
some people, genes can affect how their bodies change food into energy and store fat.
Pathophysiology

• Obesity is associated with cardiovascular disease, dyslipidemia, and insulin

resistance, causing diabetes, stroke, gallstones, fatty liver, obesity, hypoventilation
syndrome, sleep apnea, and cancers.
• The association between genetics and obesity is already well-established by multiple
studies. The FTO gene is associated with adiposity
• Leptin is an adipocyte hormone that reduces food intake and body weight. Cellular
leptin resistance is associated with obesity. Adipose tissue secretes adipokines and
free fatty acids, causing systemic inflammation, which causes insulin resistance and
increased triglyceride levels, subsequently contributing to obesity.

Obesity can cause increased fatty acid deposition in the myocardium, causing left ventricular
dysfunction. It has also been shown to alter the renin-angiotensin system, causing increasing
salt retention and elevated blood pressure.

Besides total body fat, the following also increase the morbidity of obesity:

• Waist circumference (abdominal fat carries a poor prognosis)

• Fat distribution (body fat heterogeneity)
• Intra-abdominal pressure
• Age of onset of obesity

BENEFITS OF PREVENTING OBESITY

Cardiovascular health

• Weight loss is associated with beneficial changes in several cardiovascular risk markers,
including dyslipidemia, pro-inflammatory/pro-thrombotic mediators, arterial stiffness, and
hypertension.

• Weight loss was found to reduce the risk for CVD mortality by 41% up to 23 years after the
original weight-loss intervention.

• Evidence including the biological effects of obesity and weight loss, and the increased risk
for stroke with obesity indicates that weight loss may be effective for primary- and
secondary-stroke prevention.
Type 2 diabetes

• The Diabetes Prevention Program (DPP), the Diabetes Prevention Study (DPS), and the Da
Qing IGT and Diabetes (Da Qing) study, have demonstrated that modest weight loss through
short-term lifestyle or pharmacologic interventions can reduce the risk for developing T2D by
58%, and 31%, respectively, in individuals with obesity and prediabetes.

Cancer

• Intentional weight loss of >9 kg reduced the risk for a range of cancers including breast,
endometrium, and colon.

• The overall reduction in the incidence rate of any cancer was 11% for participants who lost
more than 9 kg compared with those who did not achieve a more than 9 kg weight loss
episode.

Strategies to help individuals achieve and maintain weight loss

• Structured lifestyle support plays an important role in successful weight management.

A total of 34% of participants receiving structured lifestyle support from trained‐
nursing staff achieved weight loss of ≥5% over 12 weeks compared with
approximately 19% with usual care
• This structured program, delivered in a primary healthcare setting, included initial
assessment and goal setting, an eating plan and specific lifestyle goals, personalized
activity program, and advice about managing obstacles to weight loss.
• A family history of obesity and childhood obesity are strongly linked to adult obesity,
which is likely to be because of both genetic and behavioural factors.

DIETARY STRATEGIES FOR WEIGHT LOSS

1. Decreased calorie content (altering quantity of diet)

• Low-calorie diets (LCD) reduce the amounts of all macronutrients, including fat, to
achieve a daily caloric intake of 1,000-1,400 Kcal/day.

• Very low-calorie diets recommend a daily caloric intake of less than 1,000 Kcal/day
and invariably restrict fat and carbohydrate, but near normal protein intake is maintained.

2. Adjusting macronutrient balance (altering quality of diet)

• Low fat diets are focused primarily on limiting fat intake with no recommendations
concerning caloric intake.

• Carbohydrate-restricted diets (ketogenic diets) specify either both a modest or severe

restriction of carbohydrate intake and an increase in protein or fat intake.

• Moderate fat (20% to 30%) balanced nutrient reduction diets, high in CHO and
moderate in protein.

MEDICAL MANAGEMENT OF OBESITY

Obesity causes multiple comorbid and chronic medical conditions, and physicians should
have a multiprong approach to the management of obesity. Practitioners should
individualize treatment, treat underlying secondary causes of obesity, and focus on
managing or controlling associated comorbid conditions. Management should include
dietary modification, behaviour interventions, medications, and surgical intervention if
needed. The goal of obesity treatment is to help obese individuals reach and stay at a
healthy weight, limit their risks of developing other serious health issues, and improve
their overall quality of life. This may require the help of a team of health professionals,
including a dietician, to help patients suffering from obesity understand their situation and
make the necessary changes in their eating and activity habits; start exercising and eating
a healthy diet. The doctor sets a goal weight for the patient and explains how it can be
achieved. Initially, the goal may be to lose 5 to 10 percent of their body weight within six
months. The dietary modification should be individualized with close monitoring of
regular weight loss. Low-calorie diets are recommended. Low calorie could be
carbohydrate or fat restricted. A low-carbohydrate diet can produce greater weight loss in
the first months compared to a low-fat diet. The patient's adherence to their diet should
frequently be emphasized. The patient may start feeling better upon losing a small amount
of weight, about 5 to 15 percent of their total weight. That is, if the patient weighs 91 kg
and is obese by BMI standards, then this patient may need a loss between 4.5 to 13.6 kg
for their health to begin to improve.

Surgery

Indications for surgery are a BMI greater or equal to 40 or a BMI of 35 or greater with
severe comorbid conditions. The patient should be compliant with post-surgery lifestyle
changes, office visits, and exercise programs. Patients should have an extensive
 preoperative evaluation of surgical risks. Commonly performed bariatric surgeries include
adjustable gastric banding, Rou-en-Y gastric bypass, and sleeve gastrectomy. Rapid
weight loss can be achieved with a gastric bypass, and it is the most commonly performed
procedure. Early postoperative complications include leak, infection, postoperative
bleeding, thrombosis, and cardiac events. Late complications include malabsorption,
vitamin and mineral deficiency, refeeding syndrome, and dumping syndrome.

• Bariatric surgery has been shown to improve metabolic parameters in patients

with BMI >35 kg/m2 and to decrease all-cause mortality as well as significant
weight loss.

Types of Bariatric Surgery

Roux-en-Y Gastric Bypass (RYGB)

Procedure: Creates a small pouch from the stomach and connects it directly to the small
intestine, bypassing a large portion of the stomach and part of the intestine.

Mechanism: Reduces the amount of food the stomach can hold and decreases calorie
absorption.

Benefits: Significant and sustained weight loss, improvement in obesity-related conditions.

Risks: Nutritional deficiencies, dumping syndrome, surgical complications.

Sleeve Gastrectomy

Procedure: Removes approximately 80% of the stomach, leaving a tube-like structure.

Mechanism: Reduces stomach capacity and alters gut hormones that regulate hunger.

Benefits: Significant weight loss, less complicated than gastric bypass.

Risks: Irreversible, potential for leakage, nutritional deficiencies.

Adjustable Gastric Band (AGB)

Procedure: Places an inflatable band around the upper part of the stomach to create a small
pouch.

Mechanism: Restricts food intake by making the patient feel full sooner.

Benefits: Adjustable and reversible, less invasive.

Risks: Slower weight loss, possibility of band slippage or erosion, requires frequent
adjustments.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

Procedure: Involves a sleeve gastrectomy followed by rerouting of the small intestine.

Mechanism: Limits food intake and reduces nutrient absorption.

Benefits: Greater and more sustained weight loss, effective for severe obesity.

Risks: Higher risk of nutritional deficiencies, more complex surgery with higher complication
rates.

Criteria for Bariatric Surgery

1. Body Mass Index (BMI): Typically, candidates have a BMI of 40 or higher, or a BMI
of 35 or higher with serious obesity-related health conditions (e.g., type 2 diabetes,
hypertension).
2. Previous Weight Loss Attempts: Patients should have a history of unsuccessful
weight loss attempts through diet, exercise, and medication.
3. Health Status: Candidates must be evaluated for potential surgical risks and overall
health status.
4. Psychological Evaluation: Ensures patients are mentally prepared for the lifestyle
changes required post-surgery.

Post-Surgical Considerations

1. Diet and Lifestyle Changes: Long-term success requires adherence to specific dietary
guidelines and regular physical activity.
2. Follow-Up Care: Regular follow-up visits are essential to monitor weight loss
progress, nutritional status, and any potential complications.
3. Nutritional Supplements: Lifelong supplementation of vitamins and minerals may be
necessary to prevent deficiencies.

Risks and Complications

Short-Term Risks: Infection, blood clots, leaks at the surgical site.

Long-Term Risks: Nutritional deficiencies, bowel obstruction, hernias, gallstones.

Bariatric surgery is a powerful tool for the treatment of severe obesity, offering substantial
weight loss and improvement in obesity-related conditions.

DRUGS

Pharmacotherapy for obesity is indicated for individuals with a body mass index (BMI) of 30
kg/m² or greater, or 27 kg/m² or greater with obesity-related comorbidities. The primary goals
of drug therapy are to reduce body weight, maintain weight loss, and improve obesity-related
health conditions.

Classes of Anti-Obesity Medications

Appetite Suppressants

• Phentermine: An appetite suppressant that stimulates the release of

norepinephrine in the brain, reducing hunger. It is typically prescribed for short-
term use due to potential side effects such as increased heart rate and blood
pressure, insomnia, and nervousness.
• Diethylpropion: Similar to phentermine, it suppresses appetite through central
nervous system stimulation and is approved for short-term use. Common side
effects include dry mouth, insomnia, and increased blood pressure.

Lipase Inhibitors

• Orlistat: Works by inhibiting pancreatic lipase, an enzyme necessary for the

digestion of dietary fats. By preventing the absorption of fats, orlistat reduces
caloric intake. It is available over-the-counter (as Alli) and by prescription (as
Xenical). Side effects primarily involve the gastrointestinal system, such as oily
stools, flatulence, and frequent bowel movements, which can be mitigated by
adhering to a low-fat diet.

GLP-1 Receptor Agonists

• Liraglutide (Saxenda): Mimics the action of the hormone glucagon-like peptide-1

(GLP-1), which regulates appetite and food intake. It is administered as a daily
injection and has been shown to significantly reduce weight and improve
glycemic control. Side effects may include nausea, vomiting, and diarrhea, which
often diminish over time.
 • Semaglutide (Wegovy): Another GLP-1 receptor agonist that has gained attention
for its potent weight-loss effects. It is administered as a weekly injection and has
shown superior efficacy compared to many other weight-loss medications.
Common side effects include gastrointestinal disturbances, which usually
improve with continued use.

Combination Medications

• Phentermine/Topiramate ER (Qsymia): Combines the appetite suppressant

phentermine with topiramate, a medication used to treat epilepsy and migraines
that also promotes weight loss. This combination is effective for long-term
weight management but requires careful titration and monitoring due to potential
side effects like cognitive impairment, metabolic acidosis, and mood changes.
• Bupropion/Naltrexone (Contrave): Combines bupropion, an antidepressant, with
naltrexone, an opioid antagonist. This combination affects the brain's reward
system and appetite regulation. It has been shown to promote moderate weight
loss, but it carries risks such as increased blood pressure, psychiatric symptoms,
and potential drug interactions.

The efficacy of anti-obesity medications varies, but clinical trials typically show an average
weight loss of 5-10% of initial body weight over 6-12 months. This level of weight loss can
significantly improve obesity-related conditions, such as type 2 diabetes, hypertension, and
dyslipidemia.

Dietary management of obesity

A fat-reduced diet, combined with physical activity, reduces almost all risk factors for
cardiovascular disease and reduces the incidence of type 2 diabetes. The combination of
reduction of dietary fat and energy, and increased physical activity has been shown to reduce
the incidence of diabetes by 58% in 2 major trials. In post hoc analyses, the reduction in
dietary fat (energy density) and increase in fiber were the strongest predictors of weight loss
and diabetes-protective effects. However, there is evidence that increasing the protein content
of the diet from 15% up to 20%-30%, at the expense of carbohydrates, increases the satiating
effect of the diet, and induces a spontaneous weight loss, and this could turn out to be a
preferred option for patients with metabolic syndrome and type 2 diabetes.
Energy: it is important to reduce the energy intake to achieve weight loss and once weight
loss is achieved, the lower energy intake has to be sustained to prevent weight regain.

• The low calorie diet should be individualized for carbohydrates, using the sources
such as vegetables, fruits, pulses and whole grains.
• Very Low-Calorie Diets (VLCD) are designed to produce rapid weight loss and
preserve lean body mass by providing below 800Kcals,50-80g of protein and
100% of the recommended intake for vitamins and minerals per day.

Carbohydrates: Carbohydrates in the form of non-starch polysaccharides provide bulk and

satiety value to the reducing diet. They are also important for regular bowel Movements;
about 50-55% of total calories may be from complex carbohydrates and 10% from simple
carbohydrates. Include liberal amounts of fresh high fibre vegetables and fruits preferably
raw and with their edible peels in the diet.

Proteins: Adequate amount of proteins should be included in the diet to ensure proper
metabolism and prevent weakness which is usually experienced by patients after weight loss
which is achieved by consuming an unbalanced diet. Protein rich Foods provide a higher
satiety as compared to those rich in carbohydrates i.e., 1g/kg body weight.

Fats: Excess dietary fat promotes much more weight gain than carbohydrate or protein of the
same amount. Further, the gain in weight due to excess intake of fat is in the form of adipose
tissues which is not conducive to good health. Include fat in the form of vegetable oils, rich in
MUFA’s and PUFA’s so that sufficient essential fatty acids are supplied in the diet and at the
same time the risk of developing coronary artery disease can be minimized.

• Low Fat Diets (LFD) -10% decrease in fat calories is required for successful weight
loss but an aggressive reduction of dietary fat rather than minimal modification is
essential for this strategy to be effective. A low fat diet does appear to be important
for long-term weight loss maintenance.

Vitamins: If adequate number of fresh fruits and vegetables are included in the diet, the body
stores of water soluble vitamins are usually not depleted. However, when we restrict fats for
prolonged periods, the diet may be deficient in fat-soluble vitamins A and D. They may need
to be supplemented for the chronic cases.
Minerals: A diet high in sodium may promote retention of fluid in the body. Moderate
restriction in the use of common salt may be helpful in a weight reducing diet, particularly if
the patient is also hypertensive.

Fluids: Liberal amounts of water and zero/low calorie fluids may be included in the diet. It
may be helpful to have a glass of water before meal to reduce food intake.

Meal replacements and very low-calorie diet (VLCD)

In recent times, the use of meal replacements to formulate a VLCD, low in carbohydrates, is
being researched. In a real-world study, dietary restriction with 830 kcal/day with 50–55%
carbohydrates in people with a baseline BMI of 31.9 kg/m2 showed significant improvement
in obesity indices and other metabolic parameters. Despite being an effective method for
short-term significant weight loss, VLCD is neither practical nor sustainable in the long term.
 A day’s menu plan for an obese individual

Time Cooked items Cooked volume or Weight of raw

number ingredients
(cup/no) (g/ml)
Early morning Lime juice 1 Lemon-20
Honey-10
Breakfast Oats upma 1 Oats-60
Tomato-50
Beans-10
Onion-50
Carrot-10
Tomato-85
Tomato chutney ¼ Onion-50
Mid-morning ABC juice 1 Apple- 50
Reetroot-50
Carrot- 50
Sesame balls 2 Sesame- 25
Jaggery-15
Lunch Rice 1 Rice-50
Fish-30
Fish curry ½ onion-8
Tamarind- 5
Evening Veg sandwich 1 Wheat bread-30
Tomato- 15
Cucumber-15
Dinner Cheera chappathi 2 Cheera- 100
Wheat flour- 25
Tomato dal maseel 1 Dal- 20
Tomato-10
Onion- 40

OIL USED FOR COOKING- 20

 Nutrient composition of planned menu (obesity)

Food items Weigh Energy Carbohy Protein (g) Fat Ca Fe Vit c

t (g) (kcal) drate (g) (mg) (mg) (mg)
(g)
Cereals
Oats 50 187 35.4 6.8 3.8 25 1.9 -
Sesame 25 126.9 5.57 3.79 10 416 13.9 -
Rice- 50 175 48.5 3.91 0.28 4 0.36 -
(parboiled)
Wheat bread 30 81.9 16.1 3.57 1.62 24 0.57 -
Wheat flour 25 80.14 14.1 2.64 0.38 7.73 1.02 -
Pulses
Peas 5 17 0.59 1.15 0.07 4.05 0.32 -
Dal 20 65.82 19.34 40.03 1.06 9.26 1.22 -

Green leafy
vegetables
2.05
Spinach 100 24.38 2.14 0.64 82.24 2.45 30.26
Vegetables
Beans 10 4.02 0.26 0.36 0.04 12.1 O.39 1.8
Tomato 160 31.36 4.34 1.44 0.75 16.27 0.48 43.95
Cucumber 15 2.55 0.52 0.1 0.02 - -
0
Onion 190 91.28 18.1 2.85 - 31.96
3.7
36
Carrot 60 19.23 3.33 0.57 0.28 21.05
Fruits
Lemon 10 4.02 1.1 0.01 0.04 12.1 0.39 1.8
Tamarind 5 13.65 3.37 0.16 0.02 5.5 0.21 0.15
Apple 50 31.32 6.56 0.14 0.32 6.54 0.13 1.79
Miscellaneous
Jaggery 15 51 22.7 0.15 0.03 245.7 - -
Honey 20 31.9 15.9 0.03 - 0.5 0.07 -
oil 20 170 0.17 - - 15 - -

TOTAL 1320 220 40.08 22.82 969.3 24.9 96.84

RDA 1350 250- 36 Less 800 15 55
300
than
30
 Percent calorie distribution from macronutrients

Percent calorie Carbohydrate (%) Fat (%) Protein (%)

ACTUAL 62% 15.5% 22%

RDA 55-60 20-35 15-20

Reference- A brief note on nutrient requirements for Indians, the recommended dietary
allowances and the Estimated Average Requirements (EAR), ICMR- NIN, 2020.

Percent calorie distribution from macronutrients

Total calorie supplied by the diet- 1320kcal Protein

(g) supplied by the diet-40.8

Fat (g) supplied by the diet- 22.82

CONCLUSION

Obesity is a multifactorial disease, with both individual and environmental factors influencing
dietary adherence. Dietary approaches with a reduction in energy intake that have led to success
at weight loss have focused on macronutrient composition and food patterns. A unifying
principle for weight loss across eating patterns is dietary energy density.

The obesity epidemic continues to worsen and has become a public health issue. There is no
cure for obesity, and almost every treatment available has limitations and potential adverse
effects. Lifestyle changes alone can help obese people reverse the weight gain, but the problem
is most people are not motivated to exercise.
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