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Nutrition

Obesity and Overweight

Condition characterized by abnormal or excessive fat accumulation that presents a risk to health, diagnosed using Body Mass Index (BMI) in adults or Weight-for-Height (WFH) Z-scores in children.

Also known as: Overweight, Obesity

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Referral and warning signs

When to refer

Refer to Nutritionist/Dietitian. Refer to Physician/Specialist for comorbidities or consideration of pharma/surgical options.

Red flags

  • Rapid unintentional weight gain.
  • Symptoms suggesting severe complications.
  • Signs of underlying endocrine cause.

Signs and symptoms

  • Excess body weight/fat.
  • Shortness of breath on exertion.
  • Joint pain (knees/hips).
  • Poor sleep / Snoring / Sleep apnoea.
  • Low self-esteem.
  • Symptoms of complications (HTN, DM).

Risk factors

  • High intake energy-dense foods (fat, sugar).
  • Low intake fruits/veg/fibre.
  • Sedentary lifestyle.
  • Genetics.
  • Medical conditions (hypothyroid, Cushing's, PCOS).
  • Medications (steroids, antidepressants).
  • Socioeconomic/Psychological factors.

Diagnosis

Clinical assessment

  • Assessment of weight/height (BMI/Z-score). Waist circumference (adults).

Investigations

  • Anthropometry (Wt, Ht, BMI, Waist Circ, WFH Z-score).
  • Assess complications: BP, Blood Glucose, Lipid Profile.
  • Consider TSH.

Diagnostic criteria

Adults: Overweight BMI 25-29.9, Obesity BMI >=30. Children(5-19): Overweight BMI-for-age >+1SD, Obesity >+2SD. Children(<5): Overweight WFH >+2z, Obesity >+3z.

Management

Non-pharmacological management

  • Lifestyle Modification (Cornerstone):
  • - Dietary Changes (Reduce calories, fat, sugar; Increase fruits/veg/fibre; Portion control).
  • - Physical Activity (Increase regular activity: >=150min/wk moderate adult; >=60min/day child).
  • - Behavioural Changes (Self-monitoring, goal setting, triggers).
  • - Environmental Changes.
  • Referral to Nutritionist/Dietitian.

Pharmacological treatment

  • Not first-line. Specialist consideration if lifestyle fails + high risk (Orlistat etc).
  • Treat comorbidities.

Surgical Management

  • Bariatric Surgery: Considered for severe refractory obesity (BMI >=40 or >=35+comorbidities). Specialist.

Monitoring

Monitor weight/BMI/waist. Monitor BP/glucose/lipids. Assess lifestyle changes. Provide ongoing support.

Complications

  • Cardiovascular disease (HTN, HD, Stroke).
  • Type 2 Diabetes.
  • Dyslipidemia.
  • Osteoarthritis.
  • Certain Cancers.
  • Obstructive Sleep Apnoea.
  • NAFLD/NASH.
  • Gallstones.
  • Infertility/PCOS.
  • Psychosocial problems.

Prevention

  • Promote healthy diet from early life.
  • Encourage regular physical activity.
  • Supportive environments.
  • Healthy food policies.
  • Early ID of weight gain trends.

Patient education

  • Explanation of overweight/obesity and health risks.
  • Realistic weight loss goals.
  • Healthy eating principles.
  • Physical activity importance.
  • Behavioural strategies.
  • Long-term management.
  • Avoiding fad diets.
  • Managing associated conditions.

Uganda-specific notes

Increasing prevalence ('double burden'). Linked to dietary transition/reduced activity. Focus on lifestyle counseling with local examples.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 19, Section 19.2.4

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