OBESITY OBESITY Dr Rasmieh Alzeidan Cardiac Sciences Department
OBESITY
OBESITY Dr. Rasmieh Alzeidan Cardiac Sciences Department
Outlines Definition of Obesity Prevalence of obesity among Middle East and GCC countries Prevalence of obesity in King Saud University employees and their families Obesity indices
Definitions Obesity is a multifactorial disease; genetic, metabolism environmental, and Beh. RFs. WHO Defined the Obesity as : an excessive fat accumulation in the body, and simply obesity is an imbalance between energy intake (food) and energy expenditure (physical activity)
Introduction…. . conted Obesity is strongly associated with co-morbidity & mortality: § Diabetes § Coronary artery disease § Peripheral artery disease § Stroke § Hypertension § Hyperlipidemia § Arthritis § Obstructive sleep apnea § Pulmonary disease § PCOS/infertility § Dysmenorrhea § § § § § Pregnancy complications Gallbladder disease GERD Skin infections Urinary incontinence Depression Eating disorders Social stigma Some types of cancers Increase in all causes mortality
Obesity indices (BMI) WC: 102 cm (40 in)M &88 cm (34. 5 in) F WHR: 0. 95 M& 0. 88 F WHt. R: 0. 5 (M&F) WHO classification BMI (kg/m 2) Underweight < 18. 5 Comorbidity risk Low Normal weight 18. 5 -24. 9 Average Overweight 25. 0 -29. 9 Increased Obese 30. 0 -34. 9 Moderate Morbid obese >35 Sever to Very sever
Obesity trends among Arab Nations Country Overweight % Morocco Lebanon Obesity % Male Female 43 67 54 11 23 77 Egypt 46 23 Jordan Gulf Cooperation Council Countries (GCC) Oman Saudi Arabia UAE Kuwait 58 70 71 78 57 73 74 81 19 30 30 37 data source : Global status report on non-communicable disease 2011 26 44 43 52
Obesity trends among Arab Nations Prevalence of Obesity in Middle East 81% 77% Overweight % Male Overweight % Female 78% 70% 67% 54% 58% 73% 57% 43% Morocco Egypt Lebanon Jordan Oman Kuwait Saudi Arabia data source : Global status report on non-communicable disease 2011
Obesity trends among Arab Nations Prevalence of Obesity in Middle East Obesity % Male 52% Obesity % Female 46% 39% 37% 30% 26% 27% 19% 26% 19% 11% Morocco Egypt Lebanon Jordan Oman Kuwait data source : Global status report on non-communicable disease 2011 Saudi Arabia
Obesity trends among Arab Nations con’t • KSA has been reported to have the second highest prevalence of overweight and obesity ranging from 35% 60% after Kuwait (Musaiger, 2011). • A recent systematic review projects that by 2030 among populations of nine Middle Eastern countries (Bahrain, Egypt, Iran, Jordan, KSA, Kuwait, Lebanon, Oman, and Turkey), the Kuwaiti population is expected to have the highest prevalence of overweight and obesity (around 90%), followed by Saudis (80%) (Kilpi et al. , 2013).
Methodology Cross-sectional survey using WHO STEPwise Q’aire 4500 participants (employees & their families), above 18 years old and nonpregnant woman Duration: between July 2013 -June 2014
Methodology…. . cont’d 1 st phase: Screening for Clin. RFs& Beh. RFs v Anthropometric Measurements( HT, WT, waist/ hip circumferences, & BP). v Biochemical tests (lipid profile, FBG, HBA 1 c) v Calculating CVR score using the Framingham scale to identify low risk <10%, intermediate 10<20%, and high risk >20% group. 2 nd phase: Intervention and management of those participants identified with intermediate and high risk score.
Results: king Saud University EMPLOYEES & their families Saudis n (%) Total number Employees Families Male Female Age BMI ≥ 25 kg/m 2 Non-Saudis n (%) 3062 (68) 1438(32) 1694(55) 1021(71) 1366(45) 418 (29) 1155(38) 841(58 ) 1907(62) 597(42) 39± 13 41± 12 69% 76%
Results: king Saud University EMPLOYEES & their families 45% Prevalence of Obesity in KSU Employees & 40% their Families 35% 30% 25% 20% 15% 10% 5% 0% Male Female Saudi Arab non. Saudi (ANS) Overweight Obese Morbid Obesity Sout Asia
Results Obesity in KSU employees and their families
Results…. . cont’d Obesity indices BMI >30 kg/m 2 WC, AO> 102 cm (M)& 88 cm (F) WHR, AO> 0. 95 (M)& 0. 88 (F) WHt. R AO >0. 5 The whole study cohort 1633 (36%) 1118 (25%) 1607( 36%) 2672 (59%) Saudis n=3062 1126 (37%) 731 (24%) 936 (31%) 1689 (55%) Non-Saudis n=1438 507 (35%) 387 (27%) 671 (47%) 983 (68%)
Results…. . cont’d "keep your waist circumference to less than half your height“ Ref: Ashwell et al (2012)>Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis
Prevalence of Clin. RFS HTN DM Pre-DM High Level of TC Low HDL-C TC/HDL-C≥ 5 44% 37% 31% 26% 25% 26% 20% 18% 20% Non-Saudis
Results Obesity &CVRFs…. . cont’d Saudis population n=3062 Obese Male Female 212(31) 307 (35) Male Female 173(25) 298 (34 ) Male Female 228(33) 286 (33) Male Female 294(43) 405(42) Male Female 347(50) 184(21) Male Female 289 (42) 158 (18) Normal Hypertension n(%) 39(8) 54 (5) Diabetes 78(17) 51 (5) IFG 26(6) 51(5. 0) Hypercholesteremia 119 (26) 345(34) Low HDL-C 152(33) 101 (10) TC/HDL-C 94 (20) 68 (7) OR (95% CI) P 3. 9(2. 74 -5. 63) 5. 6(4. 1 -7. 6) <0. 0001 1. 6(1. 2 -2. 14) 5. 6( 4. 2 -7. 8) 0. 001 <0. 0001 6. 4 (4. 2 -9. 7) 5. 5 (4. 0 -7. 5) <0. 0001 1. 8(1. 4 -2. 27) 1. 1(0. 97 -1. 4) <0. 0001 0. 09 1. 7(1. 3 -2. 1) 1. 8 (1. 4 -2. 3) <0. 0001 2. 2(1. 8 -2. 9) 2. 3 (1. 7 -3. 1) <0. 0001
Results Obesity &CVRFs…. . cont’d Obese Male Female 203 (35) 114 (34) Male Female 144 (25) 84 (25) Male Female 225 (38) 110 (33) Male Female 246 (42) 144 (43) Male Female 361 (62) 95 (28) Male Female 288 (49) 86 (26) Non-Saudis population n=1438 Normal OR (95% CI) Hypertension n(%) 30 (12) 2. 9 (1. 9 -4. 4) 21 (8) 4. 2(2. 6 -6. 9) Diabetes 20 (8) 3. 1(1. 9 -5. 1) 12 (5) 5. 4(2. 9 -10. 1) IFG 75 (10) 1. 3 (0. 9 -1. 8) 39 (15) 2. 1 (1. 5 -2. 2) Hypercholesteremia 84 (33) 1. 3(0. 95 -1. 7) 56 (22) 2. 1 (1. 4 -2. 8) Low HDL-C 130 (51) 1. 2 (0. 9 -1. 5) 49 (19) 1. 5( 1. 0 -2. 2) TC/HDL-C 95 ( 37) 1. 3 (0. 9 -1. 7) 26 (10) 2. 6 (1. 6 -4. 1) P <0. 0001 0. 08 <0. 0001 0. 11 0. 0001 0. 14 0. 038 0. 05 0. 0001
Discussion Some of the reasons behind high prevalence of overweight and obesity in Saudi Arabia are: Massive improvement in wealth leading to changes in demographic and socio-economic status, globalization, access to domestic helper, automobile-car, office work and urbanization (84%). High rate of insufficient physical activity due to hot climate, cultural norms, no designated leisure places, crowded city and air pollution. Unhealthy dietary pattern; low fruit/veg. intake, wide range of global fast-food chains, influence of westernized food and diet.
Implications for practice Substantial evidence from our study supports the important role of lifestyle interventions programme; physical activity and healthy diet not only in preventing CVRFs, but also reducing the chronic disease complications. Our recommendations to policy/decision makers therefore are : To encourage screening approach e. g. at contract renewal to cover Clin. RFs ( lipid profile , FG, HBA 1 C) To follow up the sub-clinical diseases ( borderline results)
Implications to practice…cont’d To add a dietitian clinic to the employees clinics (3) To encourage the physical activity among University employees through longer lunch break, provision of recreation centers, week-end group walking/running in the university campus. To encourage healthy dietary pattern through provision of healthy food in the canteen, health promotion programme and nutrition education.
Limitations of study Cross-sectional study In specific category of population (generalizability)
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