Obesity and Weight Management
Terms
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Body Mass Index Calculation
Limitations & Advantages -
Weight in Kilograms/ Height in Meters squared
Limitations: does not distinguish between fat and lean tissue, does not indicate fat distributions
Advantages: Easy, large data sets, standard for interpretation. - BMI Range Underweight
- < 18.5
- BMI Range Normal
- 18.5 - 24.9
- BMI Range Overweight
- 25.0 - 29.9
- BMI Range Obese
- 30.0 - 34.9
- BMI Range Class II Obesity
- 35.0 - 39.9 (Very High Risk)
- BMI Range Morbidly Obese
- > 40.0 (Extremely High Risk)
- Waist Circumference
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Positively Correlated with Abdominal Fat
Abdominal fat is an independant predictor of morbidity - Waist Circumference Male
- > 102cm or 40" at a greater risk of developing obesity related morbidity
- Waist Circumference Female
- < 88cm or 35" at a greater risk of developing obesity related morbidity
- Obesity Related Morbidities
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Type II Diabetes
HTN
Dyslipidemia
Cancers
Gallbladder and Respirtory Diseases
Osteoarthritis
Complications in surgery and pregnancy - Prevelance of Obesity in Adolescence and Children
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16.5% between 6- 19 overweight
15% at risk for overweight - NIH Treatment Guidelines
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BMI > 25 + 2 or more risk factors
Modest Weight Loss
DIet, Excercise, behavioral therapy - Obesity Definition
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Disruption in regulation of food intke and energy expenditure
Genetic and environmental factors interact. - Obesity Environmental Risk Factors
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Sedentary Lifestyle
Excess energy intake
Societal "Supersize" - Excess Energy Intake
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Increased Portion Size
Increased frequency of eating outside the home
Fat-free food perceived at low calorie or calorie free
Increased food consumption
Increased 300 calories per day for 1970 to 2000 - Goals of Treatment Weight Loss
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Modest weight loss (5-10%)
Rate: 1 pound per week
Lose weight over 6 months
After 6 months focus of preventing weight regain - Weight loss Benefits in HTN, TII DM, and dsylipidemia
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Improved glycemic control
Reduced blood pressure
Improved lipid profile - Three Basic Weight loss Principles
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1. Diet
2. Excercise
3. Behavioral Therapy - Diet
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Follow dietary guidelines- increase fruits, vegetables, amd whole grains, decreased saturated fat
Reduced energy intake by about 500 kcal/day
BODY FAT IS LOST WHEN ENERGY USE EXCEEDS ENERGY INTAKE - Atkins Diet
- Diet consists of pure protein and fat < 20g of Carbs Daily
- Atkins Biochemical Effects
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Insulin Levels Decrease
Fatty oxidation and gluconeogenesis for energy
Goal: Achieve ketosis/lipolysis
High Protein is needed to preserve lean body mass, Protein synthesis is low due to low IG ration - Atkins Metabolic Effects
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Reduction in calorie intake
Reduction in B vitamins and fiber intake
Increased ketone formation.
High saturated fat shown to increase LDL and risk of CVD
No Long term studies - Excercise
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Moderate intenisty, 30 Minutes minimum most days
Imporves health and associated with maintenance of weight loss. - Behavioral Therapy
- Making permanent changes in eating and exercise patterns
- Pharmacotherapy
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Appetite Suppressant
- Sibutramine (Meridia)
Lipase Inhibitor
- Orlilstat (Xenical) - Meridia and Xenical
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Approved for long term use
Few studies over one year
Weight loss 2-10kg with much variable
Weight loss seen in first 6 months
Not meant for sole treatment - Meridia Who?
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BMI > 30 or 27 with risk factors
5-15mg daily
Not for used with SSRI's
Not for patients with poorly controlled HTN, CAD, CHF, and stroke - Orlistat Mechanism of Action
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Occurs in the stomach and small intestine
Inhibits gastric and pancreatic lipases
30% of ingested fat not absorbed
Low fat diet (<30%) to minimize side effects