Comprehensive Report on Obesity Guidelines, Prevalence, and Management

This report provides a comprehensive overview of obesity, addressing its definition, causes, and global impact, with a specific focus on the situation in Oman. It examines the pathophysiology of obesity, the classification of overweight and obesity using BMI, and the clinical evaluation and assessment of obese patients. The report highlights the rational economic model and dual decision model to explain overeating and obesity. It presents global and Oman-specific prevalence data, emphasizing the increasing rates of obesity and related health issues. The report references various guidelines and studies, including WHO data and the Oman National Nutrition Survey 2017, and discusses the need for effective strategies to manage and prevent obesity, emphasizing the role of public health interventions and individual behaviors.

Obesity Guideline
Introduction
Obesity is considered to be one of the medical condition in which the huge amount of fat
tends to get accumulated in the body that it tends to have a negative impact on the health.
However, it is to be noted that the individuals are claimed to be suffering from obesity when the
body mass index which is a measurement that is acquired by dividing the weight of a person by
the square of the person’s height is more than 30kg/m2 within the range of the 25 to 30 kg/m2
(Dobbs & Manyika, 2015). However, the values tends to differ in the countries of the south east
countries of the Asia. It is to be noted that the obesity tends to increase the other disease and
conditions like that of the cardiovascular diseases, type 2 diabetes, cancer, osteoarthritis and
depression. however, it is to be noted that obesity is mainly caused by the intake of huge amount
of food, through the limited number of physical activity done by individuals and even through
the genetic susceptibility. On the other hand, there are cases in which the it is caused by the
genes, endocrine disorders , mental disorders or through medications (Sahoo et al, 2015). The
perspective that the obese patients tends to eat very little and yet gains huge weight due to the
slow rate of metabolism is something which is not supported medically. However, it is to be
noted that obesity is a cause of the death that tends to happen across the world. the rates are more
in that of the adults and that of the children. various studies that have been conducted indicates
the fact that obesity is very much common among the women in comparison to that of the me
(Hruby & Hu, 2015). Various authorities are of the claim that it is one of the serious public
health problem of the 21st century. However, it is considered to be one of the disease which is
very much marked with stigma (Wadden, & Bray, 2018).

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Obesity remains a metabolic illness (ICD-10 code E66) which has hit epidemic levels.
The WHO has since declared it as the biggest worldwide chronic health concern amongst adults
that is growingly converting into an increasingly severe problem as compared to malnutrition. It
remains an ill-health gateway. Obesity has since turned out to be among the foremost causes of
death and disabilities, which affects both children and adults alongside adolescents globally. In
the year 2014, over 1.90 Billion adults (18+ years) remained overweight. Amongst them, more
than 600 Million stood obese while in 2013, 42 Million were children below 15 years who were
either obese or overweight. The global health figures report by released by WHO in the year
2015 showed that in the region of Europe only, the general rate of obesity amongst adults
remained 21.50% in men and 24.5% in women (as shown in figure 1 below).
Figure 1: Prevalence of Obesity in Europe Adults (Source: WHO 2014 data)

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The very report highlighted that the overweight prevalence amongst the kids below five
years remained 12.40% and it has additionally projected that sixty percent of the global
population, 3.30 Billion individuals, might be overweight (2.2 Billion) or obese (1.1
Billion) by the year 2030 in case the latest trends continue. There are significant
consequences of obesity including disability, morbidity, quality of life, as well as
comprises a greater risks of development of cardiovascular diseases, type II diabetes,
osteoarthritis, and many communal types of cancer alongside additional health concerns.

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In the year 2010, obesity and overweight stood estimated to trigger 3.4 Million deaths,
4.0% of years of life lost alongside 4.0% of disabilities-adjusted life years (DALYs).
Purpose and scope
The main purpose of the assignment is to understand the importance of the obesity as a disease.
It also helps to understand the different strategies that can be implemented in order to limit the
disease and keep the disease under the control.
The scope of the obesity is that it can be caused by both internal and external factors. It is
very important to know the internal factors which are the leading cause of the disease like the
genes, influences of the early life, poor diets, lack of physical activity and sleep (Bray, 2016).
On the other hand, the external factors like that of the fat foods, consumption of the fast food.
However, the behavior is considered to be one of the factor that tends to have a great impact on
the weight gain.
Pathophysiology of obesity- the pathogenesis of the obesity tends to include two processes
which are related and yet distinct from one another which are the sustained positive energy
balance and the resetting of the body weight or the point which is set at an enhanced value
(Volkow, 2013). The former process tends to explain how the loss of the weight through the
change of the diet or the lifestyle tends to be reacquired over the time, it is however considered
to be one of the major hindrance to the effective treatment of the obesity.
Classification of overweight and obesity-
body mass index is considered to be a simple catalogue of weight for height that is being
generally utilized in order to divide the obesity and over weight in the adults. It can however be
defined as the weight of the person in kilograms which is divided by the square of the height of

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the person in meters. Concerning the adults, the overweight and obesity of the adult are being
classified as follows:
when the overweight is BMI is greater or equal to twenty five and when the obesity is a BMI
greater or equal to 30. However the classification of the overweight and obesity among the adults
tends to differ to a great degree (Everard & Cani, 2013). It must be classified as per the different
age group which are as follows:
children under the five years of age:
 When the overweight is weight for height which is very much higher than two deviation
of the standard
 When the weight for height s higher in comparison to the three standard deviation
Children under the age group of five to 19 years:
 Overweight is considered to be the BMI for the age which is higher in comparison to the
first standard deviation which is above the WHO Growth reference medium (Bardou,
Barkun & Martel, 2013).
 When the obesity is higher than the two standard deviation which is above the WHO’s
Growth reference medium.
Clinical evaluation & assessment of Obesity.
The clinical evaluation of the patients suffering from the obese tends to include the complete
history as well as the complete examination of the patient. However, on the other hand, it is to be
noted that the comorbidities as well as the complication sin the obesity must also be examined.
However, in order to have the clinical evaluation of the patient suffering from obesity, treatment
plans should be very well designed as per the seriousness and complications as per the body
mass index (Hainer & Aldhoon-Hainerová, 2013). On the other hand, it is to be noted that the

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clinical evaluation of the patients suffering from the obesity is very much important as the BMI
alone is not good enough to understand the impact of huge adiposity of the status of the health.
On the other hand, the patient suffering from the obesity must be screened for prediabetes and
must even be evaluated for the metabolic syndrome by the examinination of the circumstances of
the waist (De Pergola & Silvestris, 2013). However, because of the risk of having diabetes, the
patients who are suffering from the obesity must be examined for the danger of T2D which can
be assumed or stratified utilizing the indices or the staging systems that tends to employ the
clinical information,
Rational
The rise in Obesity remains a major concern for public health. Almost one in every three
individuals stood obese in early twenties, up from 1 in 7 a quarter-century ago. If the current
patterns continue, the rate of obesity shall rise to more than 40% by this year. Obesity is
connected to illnesses like diabetes, asthma, hypertension and premature mortalities-if left
unattended, the surge in obesity increasingly threatening to erode conventional gains in
expectancies of life. The surge in this illness is further as significant driver of the healthcare cost
in the country [2]. To comprehend the surge in obesity, it is imperative to comprehend how
people are deciding about eating alongside additional behaviors affecting their body weight. In
comprehending overeating and obesity, two eating models alongside regulation of weight and
examination of empirical data for testing the most consistent model with behavior of persons is
necessary. The rational economic model shows that people are trading off utility/contentment

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from presently eating meals against both expenditure and disutility of future benefit. People are
making superlative decisions possible provided the accessible information alongside limitations
on time and income. Factors like declining food prices remain most probable explications for
obesity rise. In a surrounding whereby foodstuff stays inexpensive, and obtainable freely,
biological programming might culminate in eating too much. Thus, “dual decision” model comes
in with fundamental insight that decisions on eating stay subject to 2-parts of brain which include
the affective alongside deliberative systems. The former system is for sensory inputs’
coordination to yield emotional sates such as happiness and rage and reacts to clues and stimuli.
For instance, food presence might trigger endorphin alongside dopamine reactions. The latter
system integrates greater cognitive process like thinking abstractly along with planning thereby
accounting for long-run actions’ outcomes. Here, eating habits manifest combined influence of
utility-maximizing deliberative system alongside affective system which reacts rapidly as well as
impulsively to outdoor stimuli, without accounting for long-run consequences. Thus, dual
decision model has various implication for body weight alongside eating habits like predicting
that several individuals shall stay weightier than corresponding utility-maximizing weight and
shall try losing weight. Thus, evidence regarding weight loss, body weight, and consumption of
food stays aligned with “mistakes” of eating related to dual decision model and it is difficult to
reunite with standard utility-maximizing framework. Such findings have significant implications
for obesity policy and guidelines. Where affective system is playing an imperative role in eating
decisions, it shall tend to decrease the anti-obesity policies’ effectiveness which depend on
rational decision making like taxing foods with high fat, salt or sugar content or giving detailed
info on food content.
Prevalence (Global situation and Oman situation)

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Globally, the global obesity has virtually trebled beginning 1975. In 2016, over 1.9
Billion adults, 18+ years, stood overweight and among them, over 650 Million stood obese.
Thirty-nine percent of adults 18+ years stood overweight in the year 2016, and thirteen percent
stood obese. Most of the global populace live in economies whereby overweight alongside
obesity is killing more individuals as opposed to underweight. Forty-one million kids below the
age of five stood obese/ overweight in 2016 while more than 340 Million kids alongside
adolescents between five and nineteen years stood obese/ overweight in 2016. Obesity, however,
remains preventable.
The economic development in Oman have improved the standard of living and provided
services to people. This development has been accompanied by a marked change in the nutrition
situation. Undernutrition in children has consistently declined over the past few decades.
However, this economic revolution also has had some negative effects that resulted in poor
dietary habits and physical activity patterns. These lifestyle changes have contributed to the
increased prevalence of overweight and obesity, as well as related NCDs such as diabetes,
hypertension, cardiovascular disease and cancer. Over the last 2 decades the prevalence of
obesity in Oman has increased dramatically (STEP survey 2017). It has been reported that
approximately 60% of adults are overweight or obese, with more than 30% adult Omani’s
considered obese (STEP survey 2017). The prevalence of obesity in females has increased from
almost 22% in 2000 (NCD 2000) to nearly 42% and in males from 15.3% in 2000 to 28.5 % in
2017 (STEP survey 2017). Oman’s health crises come as no surprise to medical practitioners
who remain well aware of the challenges, described as a “ticking time bomb” that is probable to
explode something near 2030 when the figures of diabetes in Sultanate is projected to surge to a
whopping 124%, according to International Diabetes Federation (IDF). Oman is increasingly

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getting bigger, though not in terms of populace, but in terms of growing and soaring rates of
obesity and diabetes besides heart disease and high BPs. Kids growing up on fast-food diet
remain being classed as obese as early as 5 years old while the high cholesterol alongside heart
disease remain observed in individuals in barely twenties.
Definition and classifications
Obesity remains a long-lasting illness which is characterized by a surge in store of
fats in the body. Clinically, fatness of the body is often estimated by Body Mass Index (BMI).
This is computed as measured body weight in kilograms divided by measured height squared
(M2). Among adults, (18+), obesity remains well-defined by the BMI of 30kg/m2 alongside
overweight (pre-obesity) by the BMI between 25.0 and 29.90kg/m2. Lower cut-off points of BMI
remain applicable to certain ethnicities including Southeast Asians as shown in table1, level 1
below.
Table 1: BMI Categories (Source WHO 1997)
The intra-abdominal fat accumulation stays linked to higher metabolic alongside
cardiovascular disease risks as shown in level 1 in the above table 1. The abdominal fat amount
might be evaluated by waist circumference (WC) that extremely links with content of intra-
abdominal fat. WC gets measured in horizontal plane halfway in distance of superior ilia crest as
well as lower last rib margin. The utmost latest IDF agreement defines central/visceral/apple,
android-shaped/upper body-obesity in Europids as the WC of ≥ 94 centimeters in males and ≥ 80

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in non-expectant females. Its lower cut-off points remain projected for diverse ethnicities as
shown in level 4.
Clinical Evaluation and Assessment
A detailed history, physical exams as well as lab assessment appropriate to the obesity of
the patient need to be obtained.
Taking History:
 Additional determinants including drugs, genetics, endocrine abnormalities, smoking
cessation, chronic stress and psychological factors
 Dietary behaviors
 Eating patterns and potential existence of eating disorder like night eating syndrome,
binge eating disorder or bulimia
 Ethnicity
 Expectations of patients and their motivation for change
 Family history
 Past obesity treatment
 Physical exercise nature and frequency
 Presence of depression alongside additional mood disorders
 Obesity health consequences (table 2 below)
Table 2: A guide for decision on initial level of intervention level for patient-practitioner
discussion

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Lab Examination
 Cardiovascular assessment, in case indicated (RBP)
 Endocrine evaluation in case of Cushing’s syndrome/hypothalamic disease suspect
 Fasting blood glucose
 Liver function (hepatic enzyme)
 Liver probe (ultrasound, biopsy) in case of abnormal liver function test suggesting
NAFLD or additional liver pathology
 Serum lips profile (total, LDL and HDL cholesterol, triglycerides)
 Sleep lab probe for sleep apnoea
 The minimum set of data needed shall encompass (RBP):
 Thyroid function (thyroid-stimulating hormone (TSH) level
 Uric acid
Analysis of Body Composition
Waist Circumference (WC) is utilized as the substitution for abdominal fat (level3). With
equipment and devices expansion for increased accurate measurement of body fat, which include

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dual energy X-ray, bioimpedance analysis (BIA), absorptiometry (DEXA) and other procedures,
it has been feasible to effortlessly classify a person based on body fat degree, autonomously of
BMI. Such a mechanism has further drawn significant courtesy to non-adipose tissue function-
i.e. fat-free mass (FFM) or lean mass-as well as the FFM’s contribution to pathology,
physiological functioning alongside wellbeing. Assessment body composition is never
indispensable for management of obesity in monotonous clinical run-through, however, it might
be helpful technique in fat alongside FFM measurement prior to and in the course of treatment
[3].
Comprehensive Obesity Management
Relevant goalmouths of managing weight stresses truthful weight loss to accomplish a
decrease in risk to health alongside need to encompass weight loss promotion, weight regain
maintenance and prevention as shown in figure 2 below.
Fig2: Algorithm for assessing and stepwise obese and overweight adults’ management. * BMI &
WC cut-off points remain dissimilar for certain ethnicities.

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The patients need to comprehend that because obesity remains a chronic illness,
managing weight shall have to be continued lifelong.
Treatment Aims
The treatment and management of obesity (figure 2) above have broader objectives than
solitary weight loss and encompass reduction of risk and improvement of health. Substantial
clinical gains might be accomplished even by slightest weight loss (that is 5 to 10 percent of
initial weight of the body) alongside modification of lifestyles (enhanced dietary nutritional
content besides diffident surges in physical exercises and fitness for level 1). Managing obesity

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can never emphasize solely on weight alongside BMI decrease. Additional consideration must be
paid to waist circumference and body composition improvement that is emphasizing on
maintaining or ameliorating FFM and lowering fat mass. Managing co-morbidities, obese
patients’ quality of life and well-being improvement are further encompassed in aims of
treatment. Suitable management of overweight and obesity complication besides weight
management need to entail managing dyslipidemia, optimization of glycaemic control in type II
diabetic individuals, normalization of BP in hypertension, pulmonary disorders management like
sleep apnoea syndrome (SAS), attention to pain control alongside osteoarthritis’ mobility needs,
managing psychological instabilities which include eating disorders, affective disorders, low
self-esteem as well as disturbance of body image. Management of obesity might decrease the
need for treating co-morbidities by medication for level 1, grade A.
Further Weight Gain Prevention
Amongst overweight individuals (BMI 25.00–29.90 kg/m 2) with no overt co-
morbidities, preventing additional weight gain (via dietary advice alongside surge in physical
exercise) instead of weight loss per se might remain a suitable target. Objectives of weight loss
objectives need to stay realistic, individualized as well as aimed at long run (see table 3 below).

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Table 3: Pharmacotherapy for Obesity
Practical Weight Loss Objectives
A five to fifteen percent loss of weight over a six-month duration remains representative
and evident health gains for level 1. A significant (20 percent plus) loss of weight might be
regarded for such people with higher obesity degrees ((BMI ≥ 35 kg/m2). Maintaining weight
loss alongside preventing and treating co-morbidities remain the two major success criteria.
Failure to maintain and lose weight
Referral to the obesity expert or team for managing obesity need to be regarded in case
the individual does not lose weight in reaction to recommended intervention as shown in figure 2
above. Weight cycling which is defined by recurrent loss alongside recuperate of body weight,
remains increasingly frequent in females and might be related to psychological distress alongside

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depression and might call for relevant psychological or anti-depressant therapies or a
combination of the two [1].
Patient Follow-up
Obesity remains a lasting illness, therefore, a follow-up alongside sustained supervision
stays essential to deter regain of weight (level2) and to effectively monitor illness risks besides
properly treating co-morbidities like type II diabetes mellitus, alongside CVDs.
Conclusion
Physicians and practitioners have responsibilities of recognizing obesity as a disease
gateway and assist the victims with suitable treatment and prevention plans for obesity and
associated co-morbidities. Besides physicians, every caregiver has same responsibilities and
obesity care must be rendered by certified specialists in specialized alongside qualified obesity
facilities. Treating needs to be anchored on decent clinical-care alongside evidence-based
interventions and must be individualized alongside multidisciplinary, focusing on genuine
goalmouths, weight gain prevention and maintenance. Everyone in the field with inclusion of

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patients need to comprehend that because obesity remains a chronic illness, management of
weight must stay lifelong.

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