WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Sen et al.

World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 6.041

Volume 5, Issue 8, 14-24

Editorial Article

ISSN 2278 – 4357

GET SLIM TO FULFILL THE DREAM Saurabh Patel and Prof. Dr. Dhrubo Jyoti Sen* Shri Sarvajanik Pharmacy College, Gujarat Technological University, Arvind Baug, Mehsana-384001, Gujarat, India.

Article Received on 28 May 2016,

ABSTRACT Obesity is a medical condition in which excess body fat has

Revised on 17 June 2016, Accepted on 07 July 2016

accumulated to the extent that it may have a negative effect on health.

DOI: 10.20959/wjpps20168-7375

People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight by the

*Corresponding Author

square of the person's height, is over 30kg/m2, with the range 25–

Prof. Dr. Dhrubo Jyoti

30kg/m2 defined as overweight. Overweight is having extra body

Sen

weight from muscle, bone, fat and/or water. Obesity is having a high

Shri Sarvajanik Pharmacy

amount of extra body fat. Body mass index (BMI) is a useful measure

College, Gujarat Technological University, Arvind Baug, Mehsana384001, Gujarat, India.

of overweight and obesity. Talk to your health care provider if you are concerned about your BMI. Many factors can contribute to a person’s weight. These factors include environment, family history and genetics, metabolism (the way your body changes food and oxygen into energy),

and behavior or habits. Energy balance is important for maintaining a healthy weight. The amount of energy or calories you get from food and drinks (energy IN) is balanced with the energy your body uses for things like breathing, digesting, and being physically active (energy OUT): The same amount of energy IN and energy OUT over time=weight stays the same (energy balance). More energy IN than OUT over time=weight gain; More energy OUT than IN over time=weight loss. To maintain a healthy weight, your energy IN and OUT don’t have to balance exactly every day. It’s the balance over time that helps you maintain a healthy weight. You can reach and maintain a healthy weight if you: Follow a healthy diet, and if you are overweight or obese, reduce your daily intake by 500calories for weight loss. Limit the time you spend being physically inactive. www.wjpps.com

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KEYWORDS: Quetelet’s index, BMI, Under weight, Normal weight, Overweight, Obese, DXA, MBD. INTRODUCTION Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity and genetic susceptibility. A few cases are caused primarily by genes, endocrine disorders, medications or mental illness. Evidence to support the view that obese people eat little yet gain weight due to a slow metabolism is not generally supported. On average, obese people have greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass. Body Mass Index (BMI) or Quetelet’s index is a person's weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness. BMI can be used to screen for weight categories that may lead to health problems but it is not diagnostic of the body fatness or health of an individual.[1,2] BMI is a person's weight in kilograms divided by the square of height in meters. The BMI is an attempt to quantify the amount of tissue mass (muscle, fat and bone) in an individual and then categorize that person as underweight, normal weight, overweight or obese based on that value. However, there is some debate about where on the BMI scale the dividing lines between categories should be placed. Commonly accepted BMI ranges are underweight: under 18.5, normal weight: 18.5-25, overweight: 25-30, obese: over 30.[3,4] BMI [m÷h2]=mass(kg)÷height2(m)=mass(lb)÷height2 (in)×703 BMI is usually expressed in kilograms per square meter, resulting when weight is measured in kilograms and height in meters. To convert from pounds per square inch multiply by 703(kg/m2)÷(lb/in2). The most commonly used definitions, established by the World Health Organization (WHO) in 1997 and published in 2000, provide the values listed in the Table-1. Some modifications to the WHO definitions have been made by particular bodies. The surgical literature breaks down "class III" obesity into further categories whose exact values are still disputed. Any BMI ≥ 35 or 40kg/m2 is severe obesity. Any BMI of ≥ 35kg/m2 and experiencing obesity-related health conditions or ≥ 40–44.9kg/m2 is morbid obesity. Any BMI of ≥ 45 or 50kg/m2 is super obesity. As Asian populations develop negative health consequences at a lower BMI than Caucasians, some nations have redefined obesity; the Japanese have defined obesity as any BMI greater than 25kg/m2 while China uses a BMI of greater than 28kg/m2.

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Table-1: BMI class. BMI(kg/m2) From Upto 0 18.5 18.5 25.0 25.0 30 30.0 35.0 35.0 40.0 40.0 More

Classification Underweight Normal or Healthy Weight Overweight Class I Obesity (Severe Obesity) Class II Obesity (Morbid Obesity) Class III Obesity (Super Obesity)

BMI does not measure body fat directly, but research has shown that BMI is moderately correlated with more direct measures of body fat obtained from skin fold thickness measurements, bioelectrical impedance, densitometry (underwater weighing), dual energy xray absorptiometry (DXA) and other methods. Dual-energy X-ray absorptiometry means of measuring bone mineral density (BMD). Two X-ray beams, with different energy levels, are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by bone. Dual-energy X-ray absorptiometry is the most widely used and most thoroughly studied bone density measurement technology. The DXA scan is typically used to diagnose and follow osteoporosis, as contrasted to the nuclear bone scan, which is sensitive to certain metabolic diseases of bones in which bones are attempting to heal from infections, fractures or tumors.[5,6] Furthermore, BMI appears to be as strongly correlated with various metabolic and disease outcome as are these more direct measures of body fatness. In general, BMI is an inexpensive and easy-to-perform method of screening for weight category, for example underweight, normal or healthy weight, overweight and obesity. A high BMI can be an indicator of high body fatness. BMI can be used as a screening tool but is not diagnostic of the body fatness or health of an individual. To determine if a high BMI is a health risk, a healthcare provider would need to perform further assessments. These assessments might include skin fold thickness measurements, evaluations of diet, physical activity, family history and other appropriate health screenings. BMI can be used for population assessment of overweight and obesity.

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Slim Male

Slim Female

Figure-1: Body Mass Index: The prediction for obesity. Calculation requires only height and weight; it is inexpensive and easy to use for clinicians and for the general public. BMI can be used as a screening tool for body fatness but is not diagnostic. Other methods to measure body fatness include skin fold thickness measurements (with calipers), underwater weighing, bioelectrical impedance, dual-energy x-ray absorptiometry (DXA) and isotope dilution. However, these methods are not always readily available and they are either expensive or need to be conducted by highly trained personnel. Furthermore, many of these methods can be difficult to standardize across observers or machines, complicating comparisons across studies and time periods.[7,8] For children and teens, the interpretation of BMI depends upon age and sex. BMI is interpreted differently for children and teens, even though it is calculated using the same formula as adult BMI. Children and teen's BMI need to be age and sex-specific because the amount of body fat changes with age and the amount of body fat differs between girls and boys. The CDC BMI-for-age growth charts take into account these differences and visually show BMI as a percentile ranking.

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Table-2: BMI calculation Measurement Units Kilograms and meters (or centimeters)

Pounds and inches

Formula and Calculation Formula: weight(kg)÷[height(m)]2 With the metric system, the formula for BMI is weight in kilograms divided by height in meters squared. Because height is commonly measured in centimeters, divide height in centimeters by 100 to obtain height in meters. Example: Weight=68kg Height=165cm(1.65m) Calculation: 68kg÷(1.65m)2=24.98kg/m2 Formula: weight(lb)÷[height(in)]2×703 Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by a conversion factor of 703. Example: Weight=150lbs Height=5'5"(65") Calculation: [150lb÷(65in)2]×703=24.96kg/m2

Obesity among 2-19 year olds is defined as a BMI at or above the 95th percentile of children of the same age and sex in this 1963-1994 reference population. For example, a 10year old boy of average height (56inches) who weighs 102pounds would have a BMI of 22.9kg/m2. This would place the boy in the 95th percentile for BMI - meaning that his BMI is greater than that of 95% of similarly aged boys in this reference population - and he would be considered to have obesity. BMI is calculated the same way for both adults and children. How is BMI interpreted for adults? For adults 20years old and older, BMI is interpreted using standard weight status categories. These categories are the same for men and women of all body types and ages. The standard weight status categories associated with BMI ranges for adults are shown in the following table.[9,10] For example, here are the weight ranges, the corresponding BMI ranges and the weight status categories for a person who is 5'9". Table-3: BMI interpretation Height Weight Range 5' 9" (175.3cm) 124lbs (56kg) or less 125lbs (57kg) to 168lbs (76kg) 169lbs (77kg) to 202lbs (92kg) 203lbs (92kg) or more

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BMI (kg/m2) Below 18.5 18.5-24.9 25.0-29.9 30 or higher

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Weight Status Underweight Normal or Healthy Weight Overweight Obese

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The correlation between the BMI and body fatness is fairly strong, but even if 2 people have the same BMI, their level of body fatness may differ. In general, 

At the same BMI, women tend to have more body fat than men.



At the same BMI, Blacks have less body fat than do Whites and Asians have more body fat than do Whites.



At the same BMI, older people, on average, tend to have more body fat than younger adults.



At the same BMI, athletes have less body fat than do non-athletes.[11,12]

The accuracy of BMI as an indicator of body fatness also appears to be higher in persons with higher levels of BMI and body fatness. While, a person with a very high BMI (e.g., 35kg/m 2) is very likely to have high body fat, a relatively high BMI can be the results of either high body fat or high lean body mass (muscle and bone). A trained healthcare provider should perform appropriate health assessments in order to evaluate an individual's health status and risks.[13,14] According to the BMI weight status categories, anyone with a BMI between 25-30 would be classified as overweight and anyone with a BMI over 30 would be classified as obese. However, athletes may have a high BMI because of increased muscularity rather than increased body fatness. In general, a person who has a high BMI is likely to have body fatness and would be considered to be overweight or obese, but this may not apply to athletes. A trained healthcare provider should perform appropriate health assessments in order to evaluate an individual's health status and risks.

Figure-2: Obese man and woman before and after. www.wjpps.com

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People who are obese are at increased risk for many diseases and health conditions, including the following: All-causes of death (mortality), High blood pressure (Hypertension), High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia), Type 2 diabetes, Coronary heart disease, Stroke, Gallbladder disease, Osteoarthritis (a breakdown of cartilage and bone within a joint), Sleep apnea and breathing problems, Chronic inflammation and increased oxidative stress, Some cancers (endometrial, breast, colon, kidney, gallbladder and liver), Low quality of life, Mental illness such as clinical depression, anxiety and other mental disorders, Body pain and difficulty with physical functioning.[15,16]

CONCLUSION BMI (body mass index) is a common measurement used to determine whether you are at an appropriate weight. It is calculated using your height and weight. The Centers for Disease Control and Prevention reports that a BMI of 18.5-24.9 is healthy. A BMI between 25 and 29.9 is considered overweight and over 30 is obese. Reducing BMI requires losing weight through a healthy diet and exercise. While quick weight loss is possible, it's not recommended: It can slow your metabolism and compromise your health. Health experts recommend a weight loss of 1-2lbs/week. Diet to Lower BMI Step 1: Reduce your calories. Eating more food than your body needs leads to weight gain and a higher BMI. The more calories you cut, the faster you'll lose weight; however, don't go on a strict diet. Too few calories can slow your metabolism and prevent weight loss. Women should have at least 1,200 calories and men 1,500 calories a day.

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Step 2: Cut sugar and processed foods from your diet. These foods have little to no nutritional value and can add weight even if you keep your calories low, according to the National Institute of Health. Step 3: Eat fresh, whole foods, recommends a diet of lean proteins, low-fat dairy, fresh vegetables and fruit and whole grains. Exercise to Lower BMI Step 1: Exercise 60 minutes five days a week. The Centers for Disease Control reports that 30 minutes of aerobic exercise is acceptable for health, but 60 minutes is best for weight loss and lowering BMI. Choose activities you enjoy that increase your heart rate such as bicycling, tennis or aerobic dance. Step 2: Perform resistance training twice a week. Resistance training builds muscle, which helps you burn more calories and speeds up your metabolism. Perform exercises that target the major muscle groups including the legs, glutes, abs, back and arms. Step 3: Increase your activity throughout your day. Taking the stairs instead of the elevator and parking away from your destination to walk farther will burn calories to help you lose weight and lower your BMI. Other ways to fit activity in your day include standing instead of sitting and going for a walk instead of watching television. Table-4: Body Mass Index of B.Pharm. Sem-III batch of Shri Sarvajanik Pharmacy College, Mehsana Boys Name Body weight (kgs) Height (m) BMI (kg/m2) Conclusion Saurabh Patel 53 1.68 18.77 Normal Ravi Mena 55 1.68 19.5 Normal Tanjil Bhoraniya 78 1.85 22.8 Normal Debojyoti Basu 80 1.70 27.68 Overweight Jimi Modi 49 1.60 19.14 Normal Vipul Darji 56 1.68 19.85 Normal Raj Patel 68 1.57 27.64 Overweight Jay Purohit 45 1.49 20.27 Normal Kashyap Prajapati 70 1.74 23.17 Normal Nirav Patel 52 1.67 18.70 Normal Divyesh Sharma 54 1.55 21.66 Normal Mit Vaidya 50 1.63 21.36 Normal Pratik Rami 48 1.68 17.02 Underweight Jinendra Shah 49 1.60 19.14 Normal Chirag Rathod 49 1.55 20.41 Normal Rohit Patel 40 1.50 17.77 Underweight Cherish Patel 51 1.53 21.79 Normal Karan Chaudhary 41 1.55 17.08 Underweight www.wjpps.com

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Name Noopur Rami Riya Patel Krupa Patel Priya Shah Krupa Desai Krisha Ambani Shreya Patel Janvi Patel Jyoti Patel Dinkal Modi Dharti Nayi Chandani Bhavsar Prima Patel Likina Patel Mansi Sharma Manasi Prajapati Army Patel Fiza Memon

World Journal of Pharmacy and Pharmaceutical Sciences

Girls Body weight (kgs) Height (m) 45 1.32 48 1.57 43 1.51 38 1.42 47 1.46 50 1.70 55 1.64 42 1.62 42 1.52 46 1.65 73 1.65 41 1.67 59 1.54 59 1.56 39 1.57 35 1.59 47 1.48 53 1.55

BMI (kg/m2) 25.28 19.51 18.85 18.90 22.06 17.30 20.52 16.03 18.18 16.91 26.83 14.74 24.89 24.27 15.85 13.88 21.46 22.08

Conclusion Overweight Normal Normal Normal Normal Underweight Normal Underweight Underweight Underweight Overweight Underweight Normal Normal Underweight Underweight Normal Normal

BMI Histogram (Boys)

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BMI Histogram (Girls) Tips: Get at least six but no more than eight hours of sleep every night. The National Institute of Health reports that people who got less than six hours or more than eight hours of sleep were more likely to gain weight. Body mass is developed by bones, muscles and fat. Entire body is structured on the framework on bones (skeleton), muscles (various organs) and fat (adipose tissues) and body weight and height depends on all three factors. BMI∞mass and BMI∞1÷height2; so BMI is directly proportional to body mass and inversely proportional to height2. OBESITY & SLIMFIT both have seven letters in each which gives indication to enjoy another word VIBGYOR of seven letters to enjoy colorful life. ACKNOWLEDGEMENT The authors Saurabh Patel (B.Pharm. Sem-III) and Prof. Dr. Dhrubo Jyoti Sen are thankful to BPharm.-III batch students (Boys: Saurabh Patel, Ravi Mena, Tanjil Bhoraniya, Debojyoti Basu, Jimi Modi, Vipul Darji, Raj Patel, Jay Purohit, Kashyap Prajapati, Nirav Patel, Divyesh Sharma, Mit Vaidya, Pratik Rami, Jinendra Shah, Chirag Rathod, Rohit Patel, Cherish Patel, Karan Chaudhary; Girls: Noopur Rami, Riya Patel, Krupa Patel, Priya Shah, Krupa Desai, Krisha Ambani, Shreya Patel, Janvi Patel, Jyoti Patel, Dinkal Modi, Dharti Nayi, Chandani Bhavsar, Prima Patel, Likina Patel, Mansi Sharma, Manasi Prajapati, Army Patel, Fiza Memon) of Shri Sarvajanik Pharmacy College, Mehsana for providing the datas of body weight and height for calculation of BMI to interpret the category of body fitness.

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REFERENCES 1. Garrow J.S. & Webster J. Quetelet’s index (W/H2) as a measure of fatness. Int. J. Obes., 1985; 9(2): 147–153. 2. Freedman D.S., Horlick M. & Berenson G.S. A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children. Am. J. Clin. Nutr., 2013; 98(6): 1417–1424. 3. Wohlfahrt-Veje C. et al. Body fat throughout childhood in 2647 healthy Danish children: agreement of BMI, waist circumference, skinfolds with dual X-ray absorptiometry. Eur. J. Clin. Nutr., 2014; 68(6): 664–670. 4. Steinberger J. et al. Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents. Int. J. Obes., 2005; 29(11): 1346–1352. 5. Sun Q. et al. Comparison of dual-energy x-ray absorptiometric and anthropometric measures of adiposity in relation to adiposity-related biologic factors. Am. J. Epidemiol., 2010; 172(12): 1442– 1454. 6. Flegal K.M. & Graubard B.I. Estimates of excess deaths associated with body mass index and other anthropometric variables. Am. J. Clin. Nutr., 2009; 89(4): 1213–1219. 7. Freedman D.S. et al. Relation of body mass index and skinfold thicknesses to cardiovascular disease risk factors in children: the Bogalusa Heart Study. Am. J. Clin. Nutr., 2009; 90(1): 210–216. 8. Willett K. et al. Comparison of bioelectrical impedance and BMI in predicting obesity-related medical conditions. Obes. (Silver Spring), 2006; 14(3): 480–490. 9. Prentice A.M. & Jebb, S.A. Beyond body mass index. Obes. Rev., 2001; 2(3): 141–7. 10. Wagner D.R. & Heyward V.H. Measures of body composition in blacks and whites: a comparative review. Am. J. Clin. Nutr., 2000; 71(6): 1392–1402. 11. Flegal K.M. et al. High adiposity and high body mass index-for-age in US children and adolescents overall and by race-ethnic group. Am. J. Clin. Nutr., 2010; 91(4): 1020–1026. 12. Barba C. et al. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 2004; 363(9403): 157–163. 13. Marseglia L, Manti S, D’Angelo G, Nicotera A, Parisi E, DiRosa G, Gitto E, Arrigo T. Oxidative stress in obesity: a critical component in human diseases. International Journal of Molecular Sciences, 2014; 16(1): 378-400. 14. Kasen Stephanie, et al. Obesity and psychopathology in women: a three decade prospective study. International Journal of Obesity., 2008; 32(3): 558-566. 15. Luppino Floriana S., et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of general psychiatry., 2010; 67(3): 220-229. 16. Han T. S., et al. Quality of life in relation to overweight and body fat distribution. American Journal of Public Health., 1998; 88(12): 1814-1820.

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