DR.

BLYDEN : OBESITY
Dr. Blyden by Dr.Blyden Noah. Copyright : Dr.Blyden Noah , 2021
Expert on Global Health . DR. BLYDEN LIBRARY

DR. BLYDEN
BY DR.
BLYDEN NOAH
DR. Blyden
Noah is a
general
practitioner
living and
working in
Sweden. He is
the author of
the Dr.Blyden
handbooks ,
Dr.Blyden radio
podcasts ,novels
, poems ,
factbooks about
OBESITY African and
Sierra Leonean
DR. BLYDEN NOAH . E-mail : culture and
nas.deen1@gmail.com . WEBSITE : https:// traditional
religions , new
doctorblyden.jimdo.com/ or https:// games , new
independent.academia.edu/BlydenNoah inventions etc .
DR. BLYDEN LIBRARY Dr. Blyden
Noah was born
in Sierra Leone .

E-mail :
nas.deen1@gma
il.com
Dr. Blyden
Website : https://
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BlydenNoah

 OBESITY : BY WORLD HEALTH ORGANIZATION (WHO)

Overweight and obesity are defined as abnormal or excessive

fat accumulation that presents a risk to health. A body mass
index (BMI) over 25 is considered overweight, and over 30 is
obese. The issue has grown to epidemic proportions, with
over 4 million people dying each year as a result of being
overweight or obese in 2017 according to the global burden
of disease. 
Rates of overweight and obesity continue to grow in adults
and children. From 1975 to 2016, the prevalence of
overweight or obese children and adolescents aged 5–19
years increased more than four-fold from 4% to 18% globally.
Obesity is one side of the double burden of malnutrition, and
today more people are obese than underweight in every
region except sub-Saharan Africa and Asia. Once considered
a problem only in high-income countries, overweight and
obesity are now dramatically on the rise in low- and middle-
income countries, particularly in urban settings. The vast
majority of overweight or obese children live in developing
countries, where the rate of increase has been more than
30% higher than that of developed countries
Complications : Overweight and obesity are major risk
factors for a number of chronic diseases, including
cardiovascular diseases such as heart disease and stroke,
which are the leading causes of death worldwide. Being
overweight can also lead to diabetes and its associated
conditions, including blindness, limb amputations, and the
need for dialysis. Rates of diabetes have quadrupled since
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around the world since 1980. Carrying excess weight can

lead to musculoskeletal disorders including osteoarthritis.
Obesity is also associated with some cancers, including
endometrial, breast, ovarian, prostate, liver, gallbladder,
kidney and colon. The risk of these noncommunicable
diseases increases even when a person is only slightly
overweight and grows more serious as the body mass index
(BMI) climbs.
Obesity in childhood is associated with a wide range of
serious health complications and an increased risk of
premature onset of related illnesses. Studies have found that
without intervention, children and adolescents with obesity
will likely continue to be obese into adulthood.
Prevention and controll : Many of the causes of overweight
and obesity are preventable and reversable. However, no
country has yet to reverse the growth of this epidemic.
Although other factors are involved, the fundamental cause
of obesity is an imbalance of calories consumed and calories
expended. As global diets have changed in recent decades,
there has been an increase in the consumption of energy-
dense foods high in fat and free sugars. There has also been a
decrease in physical activity due to the changing nature of
many types of work, more access to transportation and
increased urbanization.
Lowering the risk of overweight and obesity includes
reducing the number of calories consumed from fats and
sugars, increasing the portion of daily intake of fruit,
vegetables, legumes, whole grains and nuts, and engaging in
regular physical activity (60 minutes per day for children and
150 minutes per week for adults). In babies, studies have

 shown that exclusive breastfeeding from birth to 6 months of

age reduces the risk of infants becoming overweight or
obese. By WHO

WHAT IS MASS ?

Mass is a body of physical substance (matter, material) which

has a form .

WHAT IS BODY MASS ?

Body mass is dividing (ratio , relationship) a person's weight
(Kg) by his/her height (meters) .

WHAT IS WEIGHT ?

Weight is the pull (force) of gravity on a mass of body .

 HUMAN ANATOMY : FAT

6
 FAT / OIL MOLECULE (TRIGLYCERIDE)

 FAT CELL (ADIPOCYTE , ADIPOSE CELL)

ADIPOSE (FAT) TISSUE MADE UP OF ADIPOCYTES

 WHAT ARE LIPIDS ?

Lipids are substances made by animals and plants which are

not soluble in water . Lipids are divided into fats and oils .
The name lipid is derived from the greek word lipos which
means fat .

WHAT IS FAT ?

Fat is an oily substance which is solid at room temperature

(25 degrees C) . Fats are divided into animal fat and
vegetable fat . Animal fats are saturated fats (solid at room
temperature ) and are stored in adipose tissue under the skin
all over the body (subcutaneous fat) , around organs in the
chest and the abdomen (visceral fat) , in muscles , in the
blood (cholesterol) , in the brain , in the bone marrow inside
bones . Yes , fat is stored almost everywhere in the human
body . Fat stored around the diaphragm muscle in the chest
causes breathing problems .
Vegetable fats are a mixture of saturated fats (in palm oil ,
cocoa butter , coconut oil etc) and unsaturated fats (liquid at
room temperature ) . Vegetable fats are derived from plants ,
usually from the seeds, fruits or other parts of plants .
Fats are made up of 3 fatty acids bound by a glycerol
molecule .

WHAT IS OIL ?

 Oil is a oily substance which is liquid at room temperature

(25 degrees C) . Vegetable oil is obtained from plants e,g
coconut oil , palm oil , groundnut oil , mustard oil , almond
oil etc . Animal oil is obtained from animals e,g cod liver oil ,
whale oil etc .

Fats and oils are very useful to animals and plants , they are
a source of food and energy , they provide warmth and
protect against cold temperatures , they transport fat-soluble
vitamins through the blood .

WHAT IS BODY MASS INDEX (BMI) ?

10

BMI is a person's weight in kilograms divided by his/her

height x height in meters . For example a person who weighs
75 Kg , height 1.80 meters , BMI is 75/1.80 x 1.80 = 23 or
23 Kg/m2 .
BMI is a measure of a person's health and longevity . People
with normal BMI are healthier and have low risks for
diseases plus longevity . People with very low or very high
BMI are less healthy and have high risks for diseases and a
shorter life span .

BMI (body mass index) information :

BMI < 19 (< 18,5) = Underweight
BMI 20-24 (18,5-24,9) = Normal weight
BMI 25-29 (25-29,9) = Overweight

BMI > 30 = Obesity

The Classes of Obesity :

Class 1 Obesity : BMI 30-34,9
Class 2 Obesity : BMI 35-39,9
Class 3 Obesity (Extreme Obesity) : BMI > 40

ADIPOCYTES (FAT CELLS) , ADIPOSE TISSUE

AND OBESITY

11

 FAT CELL (ADIPOCYTE , ADIPOSE CELL)

12

 13

The story of obesity cannot be told without adipocytes (fat

cells) and adipose tissue . Our human ancestors (hunter-
gatherers) had to travel long distances and for many days in
search of food . Sometimes they could find food in
abundance e.g during the rainy season . During the dry
season food was scarce and they would walk for long periods
, sometimes a day or two without food . How could they
survive and continue walking for a day or two with little or
no food ? The answer is FASTING and ADIPOCYTES . When
food was in abundance they would eat large volumes of high
energy foods such as meat , fish, fatty foods , sweet berries
etc so that their fat cells (adipocytes) would convert them to
fat and store them as food (energy) source for times when
food was scarce . During periods when little or no food was
available, they would fast for many hours and up to 2 days
knowing well that their adipocytes and adipose tissue would
be providing their bodies with the food and energy they need
during this tough period .
Adipose tissue is made up of a collection of fat cells
(adipocytes) . The main function of fat cells and adipose
tissue is to store fat which the body can use as energy or
nutrients during times of low food intake , exercise etc .
Adipocyte (fat cell) store fat (triglyceride) as a tiny droplet
inside the cell (see picture above) . Adipocytes can convert
sugar into tryglycerides (fats) . The stored fat is released to
the body as fatty acids which the cells of the body can use as
energy or nutrient in time of need . Lipolysis (Fat burning) is
the process in which fat is broken down into fatty acids
which the cells can use as nutrients or energy . The body uses

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fatty acids as a source of energy , to absorb fat soluble

vitamins (A , D E) and to make phospholipids which are an
important part of cell membranes . The body obtains fatty
acids from lipolysis and from dietary fat .
Fats (triglycerides) , dietary and stored , provide a lot of
energy (calories) which the body (cells) needs to function . A
calorie is a unit of energy . The amount of energy stored in
fats and other foods is measured by heating them until they
burn , the amount of heat released is the same as the amount
of calories contained in the substance .
There are two types of adipose tissue:

1/ White adipose tissue

2/ Brown adipose tissue

The main function of white adipose tissue is to store fat

when food is abundant and then release fat (lipolysis) which
the cells can use when food is scarce . White adipose tissue
also act as a mechanical cushion (buffer) and insulator of
heat .
The main function of brown adipose tissue is to generate
heat via chemical reactions in it's cells .

Fat distribution in males and females :

Males : Apple shaped fat distribution : In males fat
deposits are concentrated in the chest , shoulders , abdomen
, back and buttocks creating an apple shape .
Females : Pear shaped fat distribution : In females fat
deposits are concentrated in the hips, waist , breasts, and
buttocks creating a pear shape .

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 16

 FOODS AND FAT/CALORIE STORAGE

The human diet is mostly made up of carbohydrates (sugar) ,

fats, proteins, and water . The other components are fibers ,
minerals and vitamins . The optimal diet for human beings is
a combination of all these nutrients consumed in moderate
amounts daily . All excess amounts of carbohydrates (sugar) ,
fats and proteins are stored as fat in adipose tissue by the
body for future use .
Obesity is excessive storage of fat (calories) contained in food
consumed . Excessive consumption of calorie-rich foods such
as carbohydrates (sugar) , fats and proteins greatly increase
the risk for obesity .
GLUCOSE creates the shortest pathway to fat storage and
obesity . The cells in the brain and body yearn for glucose
when they are hungry so there is a tendency for humans to
consume excessive amounts of glucose. LIMITING GLUCOSE
CONSUMPTION is therefore the best way to prevent , treat
and controll obesity .
Adipose tissue and the liver : convert glucose to fat (fatty
acids + glycerol)
The liver converts : carbohydrates to glucose and then to
fatty acids (fat)
The liver converts : proteins to glucose and then to fatty
acids (fat)
So you can see that glucose is a short distance from food to
fat and humans consume a lot more glucose (carbohydrates ,
sugar) than proteins or fats daily .

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Calorie rich foods :

100 gram glucose (sugar) contains 400 calories

100 gram fat contains 900 thousand calories

100 gram carbohydrates contains 400 thousand calories
(Kcal)
100 gram proteins contains 400 thousand calories

Calorie poor foods :

100 gram water contains 0 calories

100 grams banana contains 89 calories

100 grams apple contains 52 calories
100 grams orange contains 47 calories
100 grams tomato contains 18 calories
100 gram lettuce contains 15 calories
100 gram carrots contains 41 calories
100 grams pear contains 57 calories

SWEETENERS (NON-/LOW-SUGAR PRODUCTS)

& OBESITY

Natural sweeteners (e.g honey /fructose/ , dates , agave

nectar , brown rice syrup etc) and artificial (human
engineered ) sweeteners (saccharine, sucralose (sucrose) ,
aspartame) raise blood glucose levels which are easily
converted to fat . So excessive intake of sweeteners (natural
and artificial) lead to excessive fat storage and to obesity .

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 World's Most Obese Man 2017 , 32 year old Juan Pedro

Franco From Mexico : Juan Pedro Franco, weighed 595
kg in 2017 . See even cover photo .

From : thehindu.com , 24 September 2020

Coronavirus | Former ‘world’s heaviest man’ defeats
COVID-19

A quarter of the more than 74,000 Mexicans who have

died after catching the virus were overweight.

Mexican who was once the world’s heaviest man has beaten
the coronavirus, helped -- he believes -- by several years of

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dieting, exercise and stomach-reduction surgery that saw him

shed hundreds of kilos.
Juan Pedro Franco used to weigh 595 kilos (1,310 pounds)
— more than the average male polar bear and enough to be
certified by Guinness World Records in 2017.
The 36-year-old now weighs around 208 kilos, but his history
of diabetes, high blood pressure and chronic obstructive
pulmonary disease made his battle against the virus
particularly gruelling.
It’s a very aggressive disease. I had a headache, body ache,
breathing difficulty, a fever. I was a very high-risk person,”
Franco told AFP from his home in the central state of
Aguascalientes.
Mexico, which has the world’s fourth-highest Covid-19 death
toll, has the highest obesity rate on the planet among
children and the second-highest among adults.
A quarter of the more than 74,000 Mexicans who have died
after catching the virus were overweight.
Many of the dead suffered from at least one underlying
condition such as hypertension, diabetes and obesity, often
associated with a poor diet and lack of exercise.
“Patients who are diabetic, have hypertension and heart
disease are more susceptible to serious complications” from
the virus, said Jose Antonio Castaneda, the doctor who
headed the team that treated Franco’s obesity.
“Their chances of pulling through are very slim,” he added.
His patient, who was once too heavy to get out of bed, was
an exception.
Franco, who lost his 66-year-old mother to Covid-19, believes
that his weight loss treatment — including three operations

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— helped him to survive because his diabetes and

hypertension are now under control.

WHAT IS OBESITY

According to WHO obesity is abnormal or excessive fat

accumulation that presents a risk to health. A body mass
index (BMI) over 30 is obesity .

THE CAUSES & RISK FACTORS OF OBESITY

1/ Consuming too much of calorie rich foods such as soft

drinks (glucose) , fat , carbohydrates and proteins and too
little of calorie poor foods such as water , vegetables and
fruits daily .

2/ Sedentary lifestyle and inactivity : The body breaks

down fat (fat burning) into fatty acids which the muscles use
as energy during exercise . Fats which are not burned due to
lack of exercise are stored in the body causing overweight
and obesity.

3/ Family history / Genetic factors : Studies show that in

children with obesity, one or both parents very often have
obesity. The risk of developing obesity is 10-15 times higher
if one of the parents has obesity, compared with children of
normal-weight parents . Studies have shown that there are a
number of genes that predispose to obesity by influencing

21

 metabolism (chemical reactions in cells that convert food

into energy) , nutrient uptake , physical activity etc .

4/ Enviromental factors /Lifestyle habits :

Studies have shown that the rate (frequency) of obesity in
communities , cultures and countries that consume mostly
calorie rich foods plus have a sedentary lifestyle is higher
than in communities etc who exercise regularly and consume
a healthy diet . Unhealthy lifestyle and eating habits of
individuals , groups and communities also lead a high rate of
obesity .

5/ Medicines :
Classes of medicines which can cause overweight and
obesity :
a/ Antidepressants (e.g SSRI , tricyclic antidepressants)
b/ Corticosteroids (e.g prednisolone, betamethasone)
c/ Antipsychotic medicines a.k.a neuroleptics (e.g clozapine,
olanzapine and risperidone )
d/ Antiepileptic medicines (e.g valproate and gabapentin)

6/ Diseases :
Diseases which can cause overweight and obesity :
a/ Hypothyroidism
b/ Cushing syndrome
c/ Down syndrome

THE CLASSES OF OBESITY

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 The Classes of Obesity :

Class 1 Obesity : BMI 30-34,9
Class 2 Obesity : BMI 35-39,9
Class 3 Obesity (Extreme Obesity) : BMI > 40

THE SYMPTOMS ASSOCIATED WITH OBESITY

1/ Egg-shaped build (Not slim build)

2/ Wide waistline (circular line just above the navel)
3/ Difficulties moving around
4/ Breathing difficulties (Due to fat around diaphragm - the
breathing muscle)
5/ Pain in the joints (Due to osteoarthritis)
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6/ Back pain (Due to heavy fat tissue straining the spine)

7/ Tiredness and fatigue
8/ Sleep apnea (pause in breathing during sleep)
9/ Infections in skin folds
10/ Increased neck circumference / Neck fat folds and
double chin
11/ Increased sweating
12/ Physical inactivity

NECK FAT FOLDS & DOUBLE CHIN

24

 MEASUREMENTS OF OBESITY WITH

HIGH HEALTH RISKS

25

 1/ Body Mass Index (BMI) : BMI is a good indicator of the

health risk of obesity . The higher the BMI the higher the
health risk . BMI > 30 significantly increases the risk for
metabolic syndrome , Type 2 diabetes mellitus , breathing
difficulties , sleep apnea , physical inactivity etc .

WAIST CIRCUMFERENCE

26

 2/ Waist circumference : The waist is the circular segment

of the human body that lies between the lowest rib and the
navel (umbilicus , belly button) . Waist circumference is the
circular measurement of the waist, and this is done just
below the lowest rib . Waist circumference is a good indicator
of the health risk of obesity .
Waist circumference measurement : Waist circumference is
a good measure of abdominal obesity . Abdominal obesity
is a waist circumference of > 88 cm (35 inches) for women
and > 102 cm (40 inches) for men . Waist circumference is
measured standing , after exhalation , with a tape measure
(measuring tape) . The health risks of abdominal obesity
are metabolic syndrome , type 2 diabetes mellitus ,

27

 cardiovascular disease (eg heart attack , stroke) ,

hypertension , hyperlipidemia (high cholesterol levels) ,
breathing difficulties etc .

3/ Waist-hip ratio :

WAIST-HIP RATIO

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 Waist-hip ratio : A ratio means to divide something by

something . Measure your waist circumference with a a tape ,
just below your lowest rib . Measure your hip circumferene
with a tape measure at the widest part of your buttocks .
Divide your waist circumference by your hip circumference to
get your waist-hip ratio .
Waist-hip ratio is a good measure of abdominal obesity .
Abdominal obesity is a waist-hip ratio of > 0.85 for females
and > 0.90 for males according to WHO . See the health
risks of abdominal obesity above .

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WAIST-HEIGHT RATIO

30

 4/ Waist-height ratio : Measure your waist circumference

with a a tape measure below your lowest rib . Measure your
height with a stadiometer . Divide your waist circumference
by your height to get your waist-height ratio . Waist-height
ratio is a good measure of abdominal obesity . See the
health risks of abdominal obesity above . A waist-height ratio
of > 0.5 in males and females is associated with increased
health risk .

INVESTIGATION & ASSESSMENT OF BODY FAT

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 1/ SKINFOLD CALIPERS :

Skinfold calipers : This is a skin pinching instrument used

to measure the size of subcutaneous fat .

2/ Computed tomography (CT scan) : Can be used to

measure the size , type , percentage and distribution of fat
deposits all over the body .

3/ Magnetic Resonance Imaging (MRI scan) : Can be used

to measure the size , type , percentage and distribution of fat
deposits all over the body .

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 THE HEALTH RISKS & COMPLICATIONS OF OBESITY

1/ Insulin resistance and type 2 diabetes : Obesity causes

insulin to become less effective in breaking down glucose in
the cells . This leads to high levels of glucose in the blood
and eventually to type 2 diabetes .
2/ Breathing difficulties : Fat deposits around the breathing
muscles (diaphragm) put an enormous strain on the
diaphragm leading to breathing difficulties.
3/ Hypertension : The body's mass in overweight and obese
people is greatly increased . The heart uses more force to
pump blood to the large body mass . This causes an increase
in blood pressure . Overweight and obese people tend to be
less active which can also play a roll in the increase in blood
pressure . It is important to note that not all overweight and
obese people have high blood pressure .
4/ Hyperlipidemia : Hyperlipidemia means high levels of
lipids (fats) in the blood . In hyperlipidemia there are high
levels of total cholesterol , triglycerides and low-density
lipoprotein (LDL , bad cholesterol) but low levels of high-
density lipoprotein (HDL , good cholesterol) . High
cholesterol levels can lead to the covering of the inner
surface of blood vessels with fat and blood debris creating
plaques . The plaques can cause cardiovascular diseases such
as high blood pressure , angina pectoris , TIA attack , heart
attack , stroke and dementia . Reducing cholesterol levels in
the blood can significantly reduce the risk for these diseases

33

 CHOLESTEROL PLAQUES ON BLOOD VESSEL WALLS

5/ Cardiovascular disease : High blood fat levels can lead

to the covering of the inner surface of blood vessels with fat
and blood debris creating plaques . The fat deposits and
other blood deposits can pile up causing the plaques to
thicken . The thick plaques clog the blood vessels and even
make them become less elastic , this causes obstruction to
blood flow . This obstruction makes the heart pumps with
more force thus increasing blood pressure and even causing
cardiovascular diseases such as stroke , atrial fibrillation ,
heart failure , TIA attack , angina pectoris etc.

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 METABOLIC SYNDROME

METABOLISM :
Metabolism is a chemical (via chemistry) process in which
food molecules (carbohydrates , fats and proteins) are
combined with oxygen in cells to provide energy and heat
which the body needs for it’s normal functions such as
breathing , temperature regulation , bowel movements and
digestion, pumping blood around the body , making new
cells etc .
Metabolism is divided into anabolism and catabolism .

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Anabolism is the building up process of metabolism , food

molecules are chemically combined to produce energy-rich
compounds such as glycogen and triglycerides which the
body can later use as energy for it's normal functions .

Catabolism is the breaking down process of metabolism , the

energy-rich compounds are combined with oxygen to
produce energy and heat .

6/ Metabolic syndrome :
Metabolic syndrome is a group of health risks that is
associated with obesity . Metabolic syndrome consists of four
components but only 3 components need to be present to
diagnose metabolic syndrome.
The four components of metabolic syndrome are :

a/ : Abdominal obesity : Abdominal obesity is a waist

circumference of > 88 cm (35 inches) for women and >
102 cm (40 inches) for men or a waist-hip ratio of > 0.85
for females and > 0.90 for males

b/ High blood pressure (hypertension)

c/ Diabetes mellitus or high blood glucose levels

d/ Hyperlipidemia (High blood cholesterol levels)

7/ Snoring , Sleeping difficulties & Sleep apnea : Fat

deposits around the neck , throat , mouth and diaphragm

36

cause narrowing of the upper respiratory tract which lead to

snoring, sleeping difficulties and sleep apnea . Snoring is the
sound produced when air is forced out of these narrowed
tubes of the upper respiratory tract . Sleep apnea is a
temporary stop in breathing whilst asleep . A breathing stop
of > 10 seconds + > 5 breathing stops under one hour
confirms the diagnosis of sleep apnea . Sleep apnea lead to
breathing difficulties , low levels of oxygen in the blood and
tiredness during the day . Sleep apnea is treated in special
clinics with a CPAP (Continuous positive airway pressure)
mask and CPAP machine .

8/ Osteoarthritis :
Fat is heavy . The heavy , fatty , adipose tissues in obesity put
an enormous strain on the joints of the knees and hips . This
leads to the wearing out and inflammation of these joints .
The wearing out and inflammation is called osteoarthritis .
The treatment of osteoarthritis is rest , pain killers ,
physiotherapy and if necessary a surgical operation
(replacing the joint with an artificial joint a.k.a prothesis) .

9/ Infertility in women : There are 2 ovaries and 2 Fallopian

tubes (oviducts) in females . The eggs are produced in the
ovaries and they travel through the Fallopian tubes to
uterus . Sperms travel through the vagina to the uterus to
meet the egg and fertilize it . The large quantities of
subcutaneous and visceral fat in the lower abdomen in obese
women can block the Fallopian tube, preventing the egg from
reaching the uterus . This leads to infertility .

37

 10/ Cancer : Examples of cancers which have been

associated with obesity are breast cancer , pancreas cancer ,
endometrial cancer and colon cancer .

11/ Low back pain : The excessive accumulation of fat on

the body associated with obesity causes a strain on the
muscles around the lumbar spine which leads to low back
pain .

12/ Reduced ability to move around : It is difficult to move

around with a large , obese body . Movements is usually
greatly reduced causing a sedentary (sitting & lying) lifestyle.

13/ Low quality of life : The physical and mental health of

obese people is diminished leading to a low quality of life .

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 14 / Gynecomastia in males : Gynecomastia is enlargement

of the breasts in men or boys . Gynecomastia due to obesity
is caused by excessive deposits of fat in breast tissue.

GYNECOMASTIA

39

 CELLULITE

15 / Cellulite : The large amount of subcutaneous fat in

obesity lead to fat bumps under the skin . The bumps have a
soft texture . This creates an uneven surface of the skin and is
called cellulite or adiposis edematosa . Cellulite is usually
found in the buttocks , hips and thighs . Cellulite can lead to
lymph stasis (lymph edema) . The treatment of cellulite is
lymph massage by masseurs or liposuction in private clinics .

40

 HOW TO PREVENT OBESITY

The best and most effective way to prevent obesity is by

having healthy eating habits and regular exercise .
'You are what you eat'

1/ HEALTHY EATING HABITS WHICH CAN PREVENT

OBESITY :

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 2+2 DIET (DR. BLYDEN DIET)

According to Dr. Blyden Noah
Fruits and vegetables are rich in fiber and liquid content and
low in calories . Eat whatever you want until you are
satisfied at breakfast , lunch and dinner . Drink only water ,
no sugary (soft) or sweetened drinks are allowed . No
alcoholic drinks are allowed . No sweets or chocolates
(confectionery) , potato chips etc are allowed . Eat only fresh
vegetables and fruits between the main meals of breakfast ,
lunch and dinner .

The details of the 2+2 diet :

BREAKFAST :
42

Eat whatever you want until you are satisfied . Don't

overeat .
No sugary (soft) or sweetened drinks are allowed . No
alcoholic drinks are allowed . You can drink milk . You can
use sugar or honey in your tea or coffee at breakfast . No
sweets , chocolates , cakes , potato chips etc are allowed .
Drink 2 glasses of water .

BETWEEN BREAKFAST & LUNCH :

Eat 2 fruits + 2 fruits , e.g :
2 bananas + 2 apples
or 2 bananas + 2 oranges
or 2 bananas and 2 pears etc .
No sugary (soft) or sweetened drinks are allowed .
No alcoholic drinks are allowed .
No sweets , chocolates , cakes , potato chips or other snacks
are allowed .

LUNCH :
Eat whatever you want but not a heavy meal . Don't
overeat . Eat until you are satisfied .
No sugary (soft) or sweetened drinks are allowed .
No alcoholic drinks are allowed .
No sweets , chocolates , cakes or potato chips etc allowed .
Drink 2 glasses of water .

BETWEEN LUNCH & DINNER :

Eat 2 fruits + 2 fruits , e.g :

2 bananas + 2 apples

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or 2 bananas + 2 oranges
or 2 bananas and 2 pears etc .
No sugary or sweetened drinks are allowed .
No alcoholic drinks are allowed .
No sweets , chocolates , cakes , potato chips or other snacks
are allowed .

DINNER :
Eat whatever you want until you are satisfied . Don't
overeat .
No sugary (soft) or sweetened drinks are allowed .
No alcoholic drinks are allowed .
No sweets , chocolates ,cakes or potato chips etc are
allowed .
Drink 2 glasses of water .
Eat a bowl of fresh vegetables salad made up of :
2 leaves of lettuce
2 medium-sized tomatoes.
2 carrots
2 small-sized cucumbers

BETWEEN DINNER & SUPPER :

Eat a bowl of fresh vegetables salad made up of :
2 leaves of lettuce
2 medium-sized tomatoes
2 carrots
2 small-sized cucumbers

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 SUPPER :
Eat 2 light , bread sandwiches containing meat (sausage) ,
fish , cheese or with whatever you want .
Drink 2 glasses of water .

2/ EXERCISES WHICH CAN PREVENT OBESITY :

Exercises which produce muscular effort plus increase the

pulse rate (heart rate) burn fat the most and thus prevent
obesity .
These exercises require the the use of the large muscle
groups of the legs and arms and the muscles of the abdomen,
the diaphragm and the heart .
These exercises should be done five times a week , 30-60
minutes at a time .
The exercises are :

a/ WALKING

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 You can walk at a slow pace or brisk pace , combine slow and
brisk pace or just choose any method that suits you .
Walking for 30 minutes burn ca 200 calories .

b/ RUNNING

Running for 30 minutes burns ca 500 calories ! That is a lot

of fat removed from your body in just 30 minutes !

c/ RUNNING & JUMPING

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 Running and jumping for 30 minutes burns ca 700 calories !

That is a lot of fat removed from your body in just 30
minutes !

d/ CYCLING

Cycling for 30 minutes burns ca 300 calories , according to

Harvard University .

e/ ROWING

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 Rowing for 30 minutes burns ca 255 calories , according to

Harvard University .

f/ KICKBOXING

Kickboxing for 30 minutes burns ca 300 calories , according

to Harvard University .

g/ FOOTBALL / SOCCER

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 Playing football for 30 minutes burns ca 400 calories .

h/ TENNIS

Playing tennis for 30 minutes burns ca 240 calories .

i/ BADMINTON

Playing badminton for 30 minutes burns ca 300 calories .

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 j/ WORKING OUT AT THE GYM

Working out at the gym for 30 minutes burns ca 150

calories .

k/ SPORTS WHICH INVOLVE RUNNING , WALKING

AND JUMPING

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 Sports which involve running , walking and jumping can

burn 300-500 calories in 30 minutes .

EXERCISES WHICH BURN ABDOMINAL (BELLY) FAT

a/ SIT-UPS

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 b/ SQUATTING

c/ PRESS UPS (PUSH-UPS)

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 d/ ROWING : See above

e/ CYCLING : See above

f/ KICKBOXING : See above

HOW OBESITY IS TREATED

1/ Acquire and maintain healthy eating habits : See

healthy eating habits which prevent obesity above .

2/ Regular exercises which produce muscular effort plus

increase the pulse rate (heart rate) : See exercises which
prevent obesity above .

3/ Weight-loss medications :

a/ Xenical (Orlistat) , 120 mg capsules

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 b/Mysimba (Bupropion-naltrexone) , 8 mg/90 mg

prolonged-release tablets .
c/ Saxenda (Liraglutide) , injection pen

4/ Weight-loss surgery:

a/ GASTRIC BYPASS SURGERY

Gastric bypass operation : A large part of the stomach and

part of the small intestine are bypassed (disconnected) . See
illustration above .

b/ Sleeve Gastrectomy : A large part of the stomach is cut

off and removed from the body . This operation is the most
common .

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 c/ DUODENAL SWITCH
Gastric reduction duodenal switch (GRDS)

Duodenal switch : A large part of the stomach and the small

intestine is cut off and removed from the body .
This method is used for extreme obesity (BMI > 40) .

WHAT YOU CAN DO YOURSELF TO PREVENT AND

TREAT OBESITY

See how to prevent and treat obesity above .

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 WHAT GOVERNMENTS CAN DO TO PREVENT & REDUCE

THE INCIDENCE OF OBESITY

a/ Local and national governments should promote and

facilitate healthy eating habits in communities all over the
country .

b/ Local and national governments should create facilities for

outdoor recreational activities such as free outdoor gyms ,
recreational parks , forest parks , walking- and jogging paths
etc in villages , towns and cities all over the country.

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 c/ Obesity awareness campaigns :

Local , national governments and community leaders should
run obesity awareness campaigns countrywide now and
then . These campaigns should comprise radio , TV and
internet ads , posters , SMS , e-mail ads , booklets etc so that
the majority of the populace would be reached by them . The
ads should emphasize the health risks of obesity and that
obesity is a preventable and treatable disease .

d/ Equip and staff Health Centers and regional

hospitals :
Local and national governments should make sure that
Health Centers and regional hospitals are well staffed (with
nurses , doctors , laboratory technicians etc) and well
equipped (with diagnostic and curative tools and machines
etc) so that obesity can be diagnosed early , treated and
prevented .

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 WHAT THE WHO CAN DO TO PREVENT & REDUCE

THE INCIDENCE OF OBESITY WORLDWIDE

a/ The World Health Organization (WHO) should promote

and recommend healthy eating habits in all countries all over
the world .

b/ The World Health Organization (WHO) should lobby

governments all over the world to create facilities for outdoor
recreational activities such as free outdoor gyms ,
recreational parks , forest parks , walking- and jogging paths
etc in villages , towns and cities in their countries.

c/ Obesity awareness campaigns worldwide :

The World Health Organization (WHO) should run obesity
awareness campaigns worldwide now and then . These
campaigns should comprise radio , TV and internet ads ,
posters , SMS , e-mail ads , booklets etc so that the majority
of the populace would be reached by them . The ads should
emphasize the health risks of obesity and that obesity is a
preventable and treatable disease .

d/ Equip and staff Health Centers and regional hospitals

worldwide :
The World Health Organization (WHO) should lobby
governments in all countries in the world to establish well
staffed and well equipped Health Centers and regional
hospitals (with nurses , doctors , laboratory technicians ,

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 diagnostic and curative tools and machines etc) in all

communities in their countries so that obesity can be
diagnosed early , treated and prevented .

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 CASE STUDY : OBESITY

22 year old woman comes to the Health Center . She says she
is suffering from obesity since she was 4 years old . She has
tried to lose weight many times with diet and exercise
without success . She has recently being diagnosed with type
2 diabetes . She has frequent fungal infections (candidiasis)
under her breasts and excessive skin folds . She has even
high blood pressure . She is suffering from back pain and has
difficulties carrying out her work due to her condition .
She says her biggest problem is infertility . She has been
trying to get pregnant for 2 years without success . She wants
an effective treatment for her obesity so that she can lose
considerable weight which will hopefully help her become
pregnant and have children . She is on medication for high
cholesterol levels .

1/ General condition : Extremely obese . Dyspnea

(shortness of breath) at rest .
- Respiratory rate : 20/min (8-25/min)
- Oxygen saturation in pulse oximeter : 92 % (95-100 %)

Weight : 150 Kg
Height : 1.71 meters (171 cm)
BMI (Body Mass Index) : 51.30 (Class 3 obesity)
Waist circumference : 110 cm (Abdominal obesity)
Hip circumference : 122 cm
Waist-hip ratio : 0.9
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 Waist-height ratio : 0.64 (110 /171 cm)

2/ SKIN :
a/ Excessive skin folds : She has a large , hanging belly fold
(apron belly) .

b/ Fungal (yeast) infections : She has a rash under her

breasts and under her apron belly fold . The symptoms of the
rash are redness , itching and swelling . The cause is usually
the fungus called candida albicans.
c/ Cellulite : She has fat bumps (adiposis edematosa ,
cellulite) under the skin on her buttocks , hips and thighs .

3/ Heart auscultation : Normal rhythm and sounds.

4/ Lung auscultation : Normal lung sounds .
5/ Blood pressure : 140/87
6/ Abdominal examination : Soft . Excessive subcutaneous
adipose ( fat) tissue . Non tender . Liver is not palpable . No
masses palpable .

6/ Lab tests :
CRP : <5 mg/L (<5 mg/L)

Non-fasting blood sugar : 8.5 mmol/L (4.2 - 7.7 mmol/L)

Long term blood sugar (hemoglobin A1c) : 36 mmol/mol

(27-42 mmol/mol )

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Total cholesterol : 5.2 (2.9-6.1) mmol/L

LDL cholesterol (low density lipoprotein) : 3.8 (1.2-4.3)

mmol/L

HDL cholesterol (High density lipoprotein) : 0.8 (1.0-2.7)

mmol/L

Fasting plasma triglycerides : 3.75 (0.45-2.6) mmol/L

Complete blood count :

- Hemoglobin count (Hb) : 145 (117 - 153) g/L

- White Blood Cells count (WBCs , Leukocytes ) : 7.1 (3.5 -
8.8) 10 9/L
- Red Blood Cells count (RBCs , Erythrocytes ) : 5.3 (3.94 -
5.16) 10 12/L .
- Thrombocytes count (Blood platelets count) : 201 (165 -
387) 10 9/L

- Hematocrit (Percentage of red blood cells in blood) : 43

(35 - 46 %) .
- Mean cell (corpuscular) volume of erythrocytes (MCV ,
size of RBCs) : 83 (82 - 98 femtoliter or fL)
- Mean Cell (Corpuscular) Hemoglobin Concentration
(MCHC ) , how much hemoglobin RBCs contain : 333 (317 -
357) g/L .

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Alanine transaminase (ALT) : 2.45 mikrokatal units/L or

ukat/L (0.15 - 0.75 ukat/L) .

Creatinine : 53 (45-90 umol/L) .

Plasma potassium : 3.8 mmol/L (3.5 - 4.4) mmol/L

Thyroxine : 20 (10-22) pmol/L

Thyroid-stimulating hormone (TSH , thyrotropin) : 3.0

(0.4-4.0) mIE/L

The patient's medications : Candesartan 8 mg tablets , 1

tablet daily for blood pressure . Amlodipin 5 mg tablets , 1
tablet daily for blood pressure . Metformin 500 mg tablets ,
1 tablet twice daily for diabetes mellitus . Atorvastatin 20
mg tablets , 1 tablet twice daily for high cholesterol levels
Econazole powder , applied twice daily for 4 weeks for
fungal infections.

ASSESSMENT

The patient is suffering from metabolic syndrome

(abdominal obesity + high blood pressure + diabetes
mellitus + high cholesterol levels) which can lead to
cardiovascular diseases such as heart attack , stroke , atrial
fibrillation , heart failure and early death . The patient is
even suffering from other complications of obesity such as

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diabetes mellitus , back pain , infertility , reduced ability to

move around and a low quality of life .
The patient's condition warrants a referral to the obesity
surgery clinic at the hospital for surgical treatment.

DIAGNOSIS AND TREATMENT

The patient has class 3 obesity (Extreme Obesity) . She was

referred to the obesity surgery clinic at the hospital where
she underwent gastric bypass surgery with good results . She
lost 60 kilos after the operation . She now weighs 90 kilos
and she is now living a happy an active life. She has a lot of
friends . She became pregnant one year after the operation
and gave birth to a daughter . She says the operation was the
best thing that happened to her and that it changed her life
completely .

KNOCK FOUR TIMES FOR OBESITY WITH HIGH RISK

FOR CARDIOVASCULAR DISEASE AND EARLY DEATH :
According to Dr. Blyden Noah .

KNOCK 1 : Male or female > 20 years of age

KNOCK 2 : BMI > 30

KNOCK 3 : Waist circumference of > 102 cm (40 inches)

for men and > 88 cm (35 inches) for women .

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KNOCK 4 : Metabolic syndrome

DIAGNOSIS : Obesity with high risk for cardiovascular

disease and early death .

DR. BLYDEN NOAH . E-mail : nas.deen1@gmail.com .

WEBSITE : https://doctorblyden.jimdo.com/ or https://
independent.academia.edu/BlydenNoah

DR. BLYDEN LIBRARY

DR. BLYDEN : OBESITY ON SCRIBD

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