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MANAGEMENT OF OBESITY
Dr. ALI JAWA MD (USA), MPH (USA), FACE (USA)Diplomate American Board of Endocrinology & Diabetes
Diplomate American Board of Internal MedicineDiplomate American Board of Physician Nutrition Specialists
Assistant Professor of Endocrinology/DiabetesAllama Iqbal Medical College, Lahore
INTRODUCTION
• Overweight=weight above the "normal" range• Assessed by body mass index (BMI)• BMI = weight (kilograms) divided by height
(meters squared) BMI (kg/m2)
Normal 18-25
Overweight 25-29.9
obesity ≥30
Severe Obesity ≥40 ≥35 kg/m2 in the presence of comorbidities
GUIDELINES
• The American Gastroenterological Association (AGA)
• American College of Physicians• NHLBI• NAASO
PREVALENCE Worldwide
Increasing
10 % (men)/11 % (women) Belgium 23 % UK 8 % (men)/13 % (women) Pakistan.
IMPORTANCE OF WEIGHT LOSS
Obesity is associated with many health risks including
• Type 2 diabetes mellitus • Hypertension • Dyslipidemia • Coronary heart disease• Obstructive Sleep Apnea
Weight Loss lowers morbidity and mortality
Maintenance of weight loss
• The reduction in energy expenditure that is induced by weight loss.
• Maintenance of body weight at 10 percent below the baseline weight in obese subjects was associated with an 8 kcal/kg decrease in energy expenditure.
• Recidivism, that is regaining of lost weight
Characteristics of those who are likely to succeed in maintaining weight loss
• Weight loss of more than 2 kg in four weeks • Frequent and regular attendance at a weight
loss program• Subject's belief that his or her weight can be
controlled. • Exercise consistently
APPROACH TO THERAPY
All treatments of obesity entail some risk• What are the risks of treatment?• Is treatment appropriate?• What is the most appropriate treatment
regimen?
What are the risks of treatment?
• Most of the currently available drugs have minor side effects that diminish with treatment
Is treatment appropriate?
• The BMI is the most practical way to evaluate the overall degree of excess weight
• The waist circumference is the most practical measure of central adiposity.
BMI (kg/m2)
Normal 18-25
Overweight 25-29.9
obesity ≥30
Severe Obesity ≥40 ≥35 kg/m2 in the presence of comorbidities
What is the most appropriate treatment?
• Treatments for obesity either decrease energy intake or increase energy expenditure.
• Those that decrease energy intake have a greater potential for causing weight loss than those that increase energy expenditure through exercise.
Behavior modification
• Behavior modification or behavior therapy is one cornerstone in the treatment for obesity. These concepts are usually included in programs conducted by psychologists or other trained personnel as well as many self-help groups.
Dietary therapy
• Approximately 22 to 25 kcal/kg is required to maintain one kilogram of body weight in a normal adult.
• woman weighing 100 kg is approximately 2200 to 2500 kcal/day.
• No adult who has been studied in a metabolic chamber has needed fewer than 1000 kcal/day for weight maintenance.
Exercise
• Increasing energy expenditure through physical activity has particular attractiveness in efforts at long-term maintenance of a lower body weight.
DRUG THERAPY
IINDICATIONS• BMI greater than 30 kg/m2, or • BMI of 27 to 30 kg/m2 if they have comorbid
conditions
Orlistat is the only FDA approved anti-obesity drug
LIPOSUCTION
• Removal of fat by aspiration after injection of physiologic saline has been used to remove and contour subcutaneous fat.
• Does not appear to improve insulin sensitivity or risk factors for coronary heart disease.
BARIATRIC SURGERY Indications (NIH Consensus 1991 Panel)
• Be well-informed and motivated• Have a BMI ≥40 kg/m2• Have acceptable risk for surgery• Have failed previous non-surgical weight loss• Adults with a BMI ≥35 kg/m2 who have
serious comorbidities such as severe diabetes, sleep apnea, or joint disease
BARIATRIC SURGERY Benefits
Complete resolution or improvement in• diabetes, • hypertension, • hyperlipidemia, and • obstructive sleep apnea
Complementary therapies
• Ephedra• Acupuncture - modest benefit of acupuncture
for weight loss
TAKE HOME MESSAGE
• Overweight (BMI ≥ 27) or obese (BMI ≥ 30) counseling on diet, lifestyle, and goals for weight loss.
• Failed to achieve weight loss goals through diet and exercise pharmacologic therapy
• BMI ≥40 kg/m2 who have failed diet and exercise (with or without drug therapy) or for patients with BMI >35 kg/m2 and obesity-related co-morbidities bariatric surgery
THANK YOU
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