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Obesity and Weight Management


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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
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
Type II Diabetes
Gallbladder and Respirtory Diseases
Complications in surgery and pregnancy
Prevelance of Obesity in Adolescence and Children
16.5% between 6- 19 overweight
15% at risk for overweight
NIH Treatment Guidelines
BMI > 25 + 2 or more risk factors
Modest Weight Loss
DIet, Excercise, behavioral therapy
Obesity Definition
Disruption in regulation of food intke and energy expenditure
Genetic and environmental factors interact.
Obesity Environmental Risk Factors
Sedentary Lifestyle
Excess energy intake
Societal "Supersize"
Excess Energy Intake
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
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
Improved glycemic control
Reduced blood pressure
Improved lipid profile
Three Basic Weight loss Principles
1. Diet
2. Excercise
3. Behavioral Therapy
Follow dietary guidelines- increase fruits, vegetables, amd whole grains, decreased saturated fat
Reduced energy intake by about 500 kcal/day

Atkins Diet
Diet consists of pure protein and fat < 20g of Carbs Daily
Atkins Biochemical Effects
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
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
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
Appetite Suppressant
- Sibutramine (Meridia)
Lipase Inhibitor
- Orlilstat (Xenical)
Meridia and Xenical
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?
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
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

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