Measurement of blood pressure, (Bp), the body mass index (Quetelet’s index ) or BMI, plasma cholesterol and blood glucose are now well known as some of the ways an individual can estimate the risk of dying suddenly from heart disease or a cerebrovascular condition such as stroke. In some cases, the blood pressure may be within the range considered normal for age, gender, occupation, etc: an unsuspecting individual could even have a BMI below 25 kg/m2, also within normal range. However, the dangerous effects of obesity especially truncal, mid body or upper body obesity may give the patient the false optimism that he or she is well, where as, organ damage goes on un observed
Obesity is now a major public health problem and affects children, adolescents and adults, all over the world, such words as metabolic syndrome and Globesity have begun to emerge in order to capture the pandemic nature of the problem
Obesity is associated with not only heart disease but in an obese patient, various degrees of damage to the brain and kidneys eyes, organs of reproduction, blood vessels amongst others occur in a vicious circle that without intervention results in incapacitation or death. From studies across the world , women are now more likely to carry excess weight and die from dangerous complications, compared with men of same age; beyond that studies have also shown that in Nigeria, most overweight or obese women either resort to self medication, or seek help mostly from alternative medicine practitioners.
Current estimates, suggest that world wide about one billion adults are obese and over 400 million are overweight
In Nigeria, different reports, studies put the prevalence of overweight at 22%, and Prevalence of obesity, 33%
The condition affects people of all ages, and can begin in the unborn child. Child hood obesity, is now on the increase especially in affluent Families living in cities. Awareness/family history of death of parents and other adult family members dying in middle age should influence patterns of behavior towards healthy styles of living
Anatomy and obesity
Gynoid obesity occurs when fat distribution in an obese individual is primarily around the upper thigh and gluteals (region of buttocks)
This type of obesity is more resistant to the chemicals released during exercise but easily responds to insulin, and so fatty acids are quickly extracted and stored in the buttocks and thighs. They are difficult to lose and majority of women on poorly supervised weight loss programs who are unaware of this fact may die in the process without achieving any set goals
Obesity and pregnancy:- When obesity complicates pregnancy, the situation is best handled in the province of specialists in Internal medicine, Obstetrics and Gynecology, Paediatrics, Dietetics and behavior change counseling
Gestational diabetes and insulin dependent diabetes are more common in obese pregnant women. In Pregnant women, many of the physiological changes that occur are in the direction of an increase. Thus in pregnancy there is increase in the concentration of the lipoprotein lipase (enzyme which breaks down fat) present in adipose tissues, more fat is available for storage, and as they are stored in the thighs and buttocks, where they contribute to the overall burden of the Heart. The blood volume also increases by as much as one and a half liters, and. A major path physiological issue in obesity is the marked reduction in the ability of the patient to excrete salt and water . Put together, the risk of developing a hypertension in pregnancy, Heart failure, and if kidney involvement, pre eclampsisia and eclampsia
Investigation and treatment panel for morbid obesity do not come cheap, because of the multiple nature of organ involvement
Lab tests include general as well as specific such as lipid profile, cholesterol, Interleukin 6, C-reactive protein,Echocardiography, Electrocardiography, Cardiac enzymes, Leptin, , Uric acid, Blood Glucose, and many others are not readily available and in centers that have them, they are quite expensive.
However studies done in the past ten years have confirmed that, simple, non-invasive measurements that can be done quickly and at very little cost produce results from which you can draw conclusions very identical to the evidence obtainable from the sophisticated laboratory tests
For these measurements, you need an inelastic tape, or if you cant get that, the one used by Taylor will do. A note book of fairly good quality for your records is advisable.
Waist circumference- This provides an estimate of fat around vital organs such as the heart, kidneys. Compared with obesity in the arms thigh and leg regions, large amounts of fat around the chest and abdomen have been found proved to be much more dangerous from the dynamics of clinical anatomy and biochemistry in relation to the different ways fat is metabolized in the regions of the body. Molecules of free fatty acids are more readily released from abnormal deposit sites in the cells , tissues and organs in the chest and abdomen in response to various stimuli, internal and external. the mobilization and release of free fatty acid from the omenta(greater and lesser), the mesentery, and subcutaneous fat is relatively simple and faster compared with the biochemical processes from other sites.To estimate the circumference of your waist-Stand straight but relaxed, preferably without shoes . Identify the highest point of the hip bone on your right flank where the thigh seem to begin(anterior superior iliac spine), do the same thing on the left side Run your finger tips along the lowest part of the bony ring formed by the lowest ribs of your chest(rib cage or costal, margin), opposite where you took note of the highest point on your hip bone from the point on the hip bone to that on the rib cage, . Measure the circumference of your waist by passing the tape round at a position midway between the two points making sure it passes exactly half way between the two points on both right and left sides,. The mid point may run through the umbilicus, and this is often easier., but in very obese individuals using the umbilicus as a guide becomes useless
Hip circumference;
Wearing light clothing, place your tape around your buttocks ensuring that it passes on and around the most prominent part , and with the tape held loosely.
Waist circumference:hip circumference ratio(waist:hip)
This ratio estimates the degree of upper to lower body obesity, and can be derived by simple division after the relevant measurements have been done as above
Neck circumference:- Sit or stand straight with face forwards directly in front of you to clearly expose the laryngeal assembly(Adams apple). Run your finger from the highest point of the upper part of the throat down the Adams apple downwards to the bottom of it on the front part of the neck. Place your tape around the neck at this point to measure the neck circumference
