Obesity
?.?. ? ??? ???? ?????????
????? ??? ??????
Obesity; is the most common nutritional disorder, especially in developed countries. Obesity means an increase in weight with fat accumulation while over-weight is an increase of weight not more than 20% of normal body weight according to height, physical activity, age, and sex. This may be due to an increase in the number of fat cells (hyperplasia) as occur in children, increases in the size of fat cells (hypertrophy) as occur in adult, or a combination of (hyperplasia) & (hypertrophy)
Causes: Psychological factors. Genetic factors. Metabolic factors. Excess energy intake. Decrease physical activity
Measurements
-Body mass index; weight / (height in meter) ² that;
- < 18 ---- malnutrition (- 18 – 25 --- normal)
- 25 – 30 --- overweight->30 – 35 class (I) obesity
- 35 – 40 class (II) obesity-≥40 class (III) obesity
-Broca index: height (cm) minus 100, e.g. if a person’s height is 160 cm, his ideal weight
=60 kg.
-Waist circumference: is measured at the midpoint between the lower border of the rib cage and the iliac crest. It is a convenient and simple measurement that is not related to height. Changes in waist circumference reflect changes in risk factors for cardiovascular diseases and other metabolic changes for men with waist circumferences 
102 cm, and women with waist circumferences
88 cm.
Treatment; -need to reduce weight according to age, sex, height, and body build ----
- need to maintain ideal weight
Concepts; - proper diet regime- exercise - Doctor consultant
- psychological support
Medical management nutritional management:
- Lifestyle changes - Exercise - Psychological support
- Food choice change, use keto regime or protein regime - Education
- Drug as (reduce lipase enzyme& cholesterol secretion, or reduce satiety center)
- maintain micronutrient supplements intake
Nutritional management:
1. Negative balance of energy that decreases dietary intake to 800-1000 kcal (loss of 3-4 kg/month) for a period of time & uses fat storage of cells, can intake vegetables, brown bread, low-fat diet (2 cups of skimmed milk), a diet rich with fibers, low intake of CHO& legumes, can give protein (1g -1.5 / kg) that gives a feeling of satiety.
- Decrease 1 kg/week need vitamins & minerals supplement
- The person needs energy of about 30 kcal/day when decreases energy from 10-15 kcal /1kg to reduce weight (1-4 kg/month). (example 70 kg=10 x 70 = 700, 15 x 70 = 1050 ---- need to reduce calories 700 – 1050 to be reduced from Total Energy Requirement to decrease (1-4 kg/month).
- age over 30 – for every 5 years should reduce 10% of calories (300 kcal),
Age over 70 should reduce 500 kcal.
- Protein diet regime. - Keto diet regime.