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Obesity

 

Prevalence

  • WHO projected in 2015, approximately 2.3 billion adults will be overweight and more than 700 million were obese.
  • At least 20 million children under the age of 5 years were overweight globally

 

Is Obesity a Disease?

  • Obesity is a heterogeneous complex disorder of multiple etiologies characterized by excess body fat that threatens or affects socioeconomic, mental or physical health
     

 

Table 1 Classification of Overweight and Obesity by Body Mass Index (BMI),Waist Circumference, and Associated Disease Risk
BMI (kg/m²)Obesity ClassDisease Risk (Relative to Normal Weight and Waist Circumference)*
Men: ≤40 inches (≤102 cm) Women: ≤35 in (≤88 cm) > 40 inches (>102 cm) > 35 inches (>88 cm)
Underweight< 18.5
Normal weight18.5–24.9
Overweight25.0–29.9IncreasedHigh
Obesity30.0–34.9IHighVery high
35.0–39.9IIVery highVery high
Extreme obesity≥ 40IIIExtremely highExtremely high
* Disease risk for type-2 diabetes, hypertension, and cardiovascular disease. ‡ Increased waist circumference can also be a marker for increased risk even in persons of normal weight. Adapted from Obesity: Preventing and Managing the Global Epidemic. WHO, 1997.3

 

Obesity-related organ systems review

          Cardiovascular

    • Hypertension
    • Congestive heart failure
    • Cor pulmonale
    • Varicose veins
    • Pulmonary embolism
    • Coronary artery disease

          Respiratory

    • Dyspnea
    • Obstructive sleep apnea
    • Hypoventilation syndrome
    • Pickwickian syndrome
    • Asthma

          Endocrine

    • Metabolic syndrome
    • Type 2 diabetes
    • Dyslipidemia
    • Polycystic ovarian syndrome/angrogenicity
    • Amenorrhea/infertility/menstrual disorders

 

 

 

 

 

 

 

 

          Gastrointestinal

    • Gastroesophageal reflux disease
    • Non-alcoholic fatty liver disease
    • Cholelithiasis
    • Hernias
    • Colon cancer

          Musculoskeletal

    • Hyperuricemia and gout
    • Immobility
    • Osteoarthritis (knees and hips)
    • Low back pain

          Genitourinary

    • Urinary stress incontinence
    • Obesity-related glomerulopathy
    • Chronic kidney disease
    • Hypogonadism (male)
    • Breast and uterine cancer
    • Pregnancy complications

 

 

 

 

 

 

 

 

          Psychologic

    • Depression/low self esteem
    • Body image disturbance
    • Reduced quality of life

          Neurologic

    • Stroke
    • Idiopathic intracranial hypertension
    • Meralgia paresthetica

          Integument

    • Striae distensae (stretch marks)
    • Stasis pigmentation of legs
    • Lymphedema
    • Cellulitis
    • Intertrigo, carbuncles
    • Acanthosis nigricans/skin tags

 

 

 

 

 

 

 

Is there any cure for Obesity?

 

Lifestyle Management

  • Diet therapy
  • Physical Activity therapy
  • Behavioral change

 

Results in a modest (typically 3–5 kg) weight loss compared with no treatment or usual care

 

Diet Therapy

Reduce overall consumption of calories

    • Smaller portion sizes
    • Eating more fruits and vegetables
    • Consuming more whole grain cereals
    • Selecting leaner cuts of meat and skimmed dairy

products

    • Reducing fried foods and other added fats and oils
    • Drinking water instead of caloric beverages

 

Low-carbohydrate diets:

Institute of Medicine ►45% to 65% calories from carbohydrates

Lower-carbohydrate diets    ► 40% to 46%

Atkins diet ► 5% to 15% carbohydrate

Meal Replacements:

  • Shakes, Meal bars, or  Selected frozen meals.
  • Provides 200 – 400 calories
  • Helps to reduce calories from the total day and provide a nutritionally balance meal when combined with a side of vegetables and fruits (provides adequate fiber and antioxidants).
  • Convenient and Reasonably Priced.
  • Effective and healthy option for busy people who make poor food choices.

Energy density:

Number of calories (energy) a food contains per unit of weight

  • People tend to ingest a constant volume of food, regardless of caloric or macronutrient content.
  • Diets containing low energy dense foods control hunger and result in decreased caloric intake and weight loss.
  • Examples : soups, fruits, vegetables, oatmeal, and lean meats.
  • Dry foods and high-fat foods, such as pretzels, cheese, egg yolks, potato chips, and red meat, have a high energy density.

Very-low-calorie diets

  • A form of more aggressive dietary therapy.
  • Promotes a rapid and significant (13–23 kg) short-term weight loss over a 3- to 6-month period.
  • These are usually prescribed by physicians specializing in obesity care because of the need for close metabolic monitoring.

Concerns have been raised that diets focusing long term on eating mostly protein with small amounts of carbohydrate may increase the risk of osteoporosis and kidney stones????

Physical Activity Therapy

Focusing on simple ways to add physical activity into the normal daily routine through leisure activities, travel, and domestic work should be suggested.

Examples:

    • Walking
    • Using the stairs
    • Doing home and yard work
    • Engaging in sport activities

 

Physical Activity Therapy

The Dietary Guidelines for Americans 2005 found compelling evidence that  At least 60 to 90 minutes of daily moderate-intensity  physical activity  (420–630 min/wk) is needed to sustain weight loss.

Behavioral Therapy

  • Motivational Interviewing
  • Cognitive behavioral therapy
  • Self Monitoring
  • Identifying internal triggers for eating
  • Creation of coping strategies
  • Prompts or reminders can help to build better habits
  • Stress management
  • Stimulus Control
  • Social Support
  • Problem Solving

Examples of commonly used Behavioral modification Techniques

Pharmacotherapy

  • Centrally Acting Anorexiant Medications

    • Sibutramine, Phentermine
  • Peripherally Acting Medication