obesity - a systematic approach
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This document provides an overview of obesity, including its definition, measurement, prevalence, causes, evaluation, treatment approaches, and a case study. It defines obesity as a BMI over 30 kg/m2 and notes the increased prevalence in the US and worldwide. The evaluation of patients with obesity involves taking a history, physical exam, assessing comorbidities, fitness, and readiness to change. Treatment options include lifestyle management, pharmacotherapy, and surgery. A case study is then presented and discussed in terms of appropriate treatment goals.
![DEFINITION AND MEASUREMENT
Obesity is a state of excess adipose tissue mass
current practical definition of obesity is determined by an assessment of
BMI. (Obesity is >30 kg/m2)
BMI is calculated by dividing a person’s weight (in kilograms) / height (in
meters squared);
alternatively, the [weight (in pounds) *704 ] /height (in inches squared)](https://image.slidesharecdn.com/presentation3-190927130026/85/obesity-a-systematic-approach-2-320.jpg)
obesity - a systematic approach
- 1. SUBJECT SEMINAR APPROACH TO PATIENTS WITH OBESITY CHAIR PERSON Dr.SantoshVastrad (M.D) STUDENT Dr.Anusha SJ
- 2. DEFINITION AND MEASUREMENT Obesity is a state of excess adipose tissue mass current practical definition of obesity is determined by an assessment of BMI. (Obesity is >30 kg/m2) BMI is calculated by dividing a person’s weight (in kilograms) / height (in meters squared); alternatively, the [weight (in pounds) *704 ] /height (in inches squared)
- 4. •PREVELANCE • BMI >30 has increased from 14.5% to 35.7% - U.S • Women – 6.6% • Men – 3.5% • more common among blacks and Hispanics. • worldwide prevalence :more than doubled in less than 35 years India
- 5. • Study Facts: • World Population: 7,505,257,673 • World Obesity Population : 774,000,000
- 6. APPROACH TO PATIENTS WITH OBESITY
- 9. EVALUATION • (1) a focused obesity-related history, • (2) a physical examination to determine the degree and type of obesity, • (3) assessment of comorbid conditions, • (4) determination of fitness level, and • (5) assessment of the patient’s readiness to adopt lifestyle changes.
- 10. The Obesity-Focused History • What factors contribute to the patient’s obesity? • How is the obesity affecting the patient’s health? • What is the patient’s level of risk from obesity?
- 11. • What does the patient find difficult about managing weight? • What are the patient’s goals and expectations? • Is the patient motivated to begin a weight management program? • What kind of help does the patient need?
- 12. Factors Affecting Body Mass Index–Related Risk • The relationship between BMI and health risk is influenced by, • body fat distribution, • age, • concomitant medical illness, • weight gain, • aerobic fitness, and • ethnicity.
- 13. •CAUSES • Role of genes Versus Environment • Genetic • Obesity is commonly seen in families, and the heritability of body weight is similar to that for height. • Environmental • viruses • sleep deprivation
- 15. •Drugs • medications for diabetes (insulin, sulfonylureas, thiazolidinediones); • steroid hormones; psychotropic agents; mood stabilizers (lithium); • antidepressants (tricyclics, monoamine oxidase inhibitors, paroxetine, mirtazapine); • antiepileptic drugs (valproate, gabapentin, carbamazepine).
- 16. • Specific Syndromes • Cushing’s syndrome • Hypothyroidism • Insulinoma • Craniopharyngioma
- 19. •Body Mass Index (BMI) and Waist Circumference • Three key anthropometric measurements are important in evaluating the degree of obesity: • weight, • height, and • waist circumference (102 in men and 88 in women).
- 20. •Physical Fitness Several prospective studies have demonstrated that physical fitness, measured by a maximal treadmill exercise test, is an important predictor of all-cause mortality rate independent of BMI and body composition.
- 21. Obesity-Associated Comorbid Conditions • symptoms, risk factors, and index of suspicion. • fasting lipid panel • fasting blood glucose level • blood pressure .
- 25. Assessing the Patient’s Readiness to Change • patient motivation and support, • stressful life events, • psychiatric status, • time availability and constraints, • and appropriateness of goals and expectations.
- 26. Readiness can be viewed as the balance of two opposing forces: • (1) motivation, or the patient’s desire to change; and • (2) resistance, or the patient’s resistance to change. • A helpful method to begin a readiness assessment is to use the motivational interviewing technique of “anchoring” the patient’s interest and confidence to change on a numerical scale.
- 27. TREATMENT • THE GOAL OF THERAPY • The primary goals of treatment are to improve obesity-related comorbid conditions and to reduce the risk of developing future comorbidities. • Target: 8–10% over 6 months
- 28. • LIFESTYLE MANAGEMENT (3–5 kg) • Diet Therapy • Physical Activity • Behavioural Therapy
- 29. • Mediterranean diet : low-carbohydrate, low-fat • very low-calorie diets
- 30. Physical Activity Therapy moderate intensity vigorous-intensity Behavioral Therapy
- 31. •PHARMACOTHERAPY •INDICATIONS •Sympathomimetic adrenergic agents •Peripherally acting agents .
- 32. MEDICAL 1. Phentermine/Topiramate 2. Lorcaserin 3. Bupropion and naltrexone (ContraveTM) 4. Liraglutide 5. Sibutramine 6. Orlistat (XenicalTM) Centrally acting agents Peripherally acting agent
- 33. SURGERY INDICATIONS • restrictive, • restrictive malabsorptive, and • malabsorptive
- 34. Restrictive surgeries. • Prototype - Laparoscopic adjustable gastric banding i. LAP-BAND, ii. REALIZE band, Malabsorptive • laparoscopic sleeve gastrectomy,
- 35. Restrictive-malabsorptive bypass procedure • Roux-en-Y gastric bypass, • biliopancreatic diversion, and • biliopancreatic diversion with duodenal switch
- 38. Harrison’s Principles of Internal Medicine
- 39. Case Presentation • A 45-year-old white woman presents with difficulty losing weight despite her diet and exercises program. • She feels she is a setup for T2DM, which her mother developed when she was the patient’s age. • She states she was never very thin, but she has been gradually gaining weight over the last 10 years.
- 40. • She attributes her weight gain to decreased physical activity and stress- induced eating. • She has lost 15 to 20lb on several occasions on various diet programs, but she stops following the diet when she does not see continued progress and then she regains her weight. • The heaviest she ever weighed was 210lb. • Her primary physician started her on amlodipine10mg o.d for her HTN this past year, but she is otherwise in good health.
- 41. • GPE, • B.P :130/85mm Hg. • Weight : 200lb • Height : 5’4”. • W.C : 38’ • HC : 40” • She did not have any striae, bruising, or significant hirsutism. • She had a normal cervical fat pad for her weight. • Her abdomen was obese with weight distribution more typical of an android body shape
- 42. • Laboratory findings • FPG : 105mg/dL, • HbA1c : 5.5%. • Total cholesterol -198mg/dL, • HDL -39mg/dL, • triglycerides -200mg/dL, • LDL - 110mg/dL. • TSH - 1.6IU/mL, • 24-hoururine free cortisol- 50g/24 hours. • The patient wants to know what she can do to lose weight and reduce her risk of developing diabetes.
- 43. • BMI = 34.3 • Determine the appropriate risk of metabolic syndrome WC or waist-to-hip ratio provides the measure of central obesity • Weight management therapy one step further beyond the initial 5% to 10%, • To set an appropriate goal for weight to reduce the risk of metabolic syndrome, physicians must inform patients of where they stand on the cardiovascular disease risk curve and what they need to do to reduce the risk to where it is more comparable to someone without significant obesity . • This is accomplished by reducing this patient’s BMI from her initial 34 down to 27 or 28
- 44. • Setting the ideal body weight range as the appropriate goal is not realistic for someone with significant obesity. • An over aggressive goal only leads to weight management failure. • Many weight loss attempts fail because people do not transition well from the weight loss phase to the weight maintenance phase. • caloric restriction and exercises to increase their energy expenditure in order to maintain the weight loss.
- 45. REFERENCES • HARRISON’S PRINCIPLES OF INTERNAL MEDICINE 19TH EDITION. • WILLIAM TEXTBOOK OF ENDOCRINOLOGY 13TH EDITION • API TEXTBOOK OF MEDICINE . EDITOR-IN-CHIEF YASH PAL MUNJ 9th EDITION • A CASE-BASED GUIDE TO CLINICAL ENDOCRINOLOGY TERRY F. DAVIES, MD, FRCP, FACE
- 46. • CROSS REFERENCES • Management of Obesity .Anoop Misra, Lokesh Khurana • European Guidelines for Obesity Management in Adults .Volkan Yumuk Constantine Tsigos Martin Fried et.al • Update on Treatment Strategies for Obesity.Holly R. Wyatt • Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for Asian Indians and Recommendations for Physical Activity, Medical and Surgical Management A Misra*, P Chowbey**, BM Makkar***, • Obesity: Current Treatment andFuture Horizons.Article in Mini Reviews in Medicinal Chemistry · January 2017 • Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance
- 47. THANK YOU