28/03/2025
OBESITY:
Definition:
Chronic, multifactorial disease characterized by excessive adiposity (BMI ≥30 kg/m²), leading to metabolic dysfunction.
Key Pathophysiological Mechanisms:
1. Energy Imbalance: Caloric intake > expenditure (leptin resistance, ghrelin dysregulation).
2. Adipose Tissue Dysfunction: Hypertrophy/hyperplasia → inflammation (↑TNF-α, IL-6) & insulin resistance.
3. Metabolic Disruption: Ectopic fat deposition (liver, muscle) → dyslipidemia, T2DM, NAFLD.
4. Genetic/Epigenetic Factors: >400 loci (e.g., FTO, MC4R) interact with obesogenic environment.
Clinical Consequences:
• Cardiometabolic: Diabetes, stroke, hypertension.
• Systemic: Obstructive Sleep Apnea, osteoarthritis, cancer.
• Psychosocial: Depression, stigma.
Management (Personalized):
1. Lifestyle: Mediterranean diet, aerobic/resistance exercise (≥150 min/week).
2. Pharmacotherapy
3. Surgery: Bariatric procedures (e.g., sleeve gastrectomy) for BMI ≥40 or ≥35 with comorbidities.
4. Emerging: Dual/triple incretin agonists, microbiome modulators.
LIFESTYLE MODIFICATION IN OBESITY MANAGEMENT
Core Pillars of Therapy (First-line, evidence-based, sustainable)
1. DIETARY INTERVENTIONS
• Caloric Deficit: 500–750 kcal/day (↓~0.5 kg/week).
• Macronutrient Focus:
o Protein: 1.2–1.6 g/kg/day (preserves lean mass, ↑satiety).
o Low-Glycemic Load: Whole grains, legumes, non-starchy veggies.
o Healthy Fats: Omega-3s (fish, nuts), MUFA (olive oil, avocado).
• Patterns: Mediterranean, DASH, or time-restricted eating (e.g., 14:10).
• Avoid: Ultra-processed foods, sugar-sweetened beverages.
2. PHYSICAL ACTIVITY
• Aerobic Exercise: ≥150 min/week moderate (e.g., brisk walking) → ↑fat oxidation.
• Resistance Training: 2–3x/week → preserves muscle mass, ↑Basal Metabolic Rate.
• NEAT: Increase non-exercise activity (standing, walking).
3. BEHAVIORAL STRATEGIES
• Cognitive Behavioural Therapy (CBT): Address emotional eating, cues.
• Self-Monitoring: Food diaries, step counters, regular weigh-ins.
• Sleep Hygiene: 7–9 hours/night (↓ghrelin, ↑leptin).
• Stress Management: Mindfulness, yoga (↓cortisol-driven cravings).
4. ADHERENCE & LONG-TERM SUCCESS
• SMART Goals: Specific, measurable, achievable (e.g., "Walk 30 min/day").
• Social Support: Group therapy, family involvement.
• Tech Tools: Apps (MyFitnessPal), wearables (Fitbit).
DR Enu Timipre