Transcript Obestiy

APPROACH TO OBESE
PATIENT
FAHAD ALRASHED
ABDUALLH ALSULAIM
SULIMAN ALOBAID
TARIQ ALMESNED
OBJECTIVE :
-
Define obesity and classify the degree of obesity (BMI, Waist
circumference And Waist to Hip ratio).
-
Explore the prevalence of obesity in Saudi Arabia.
-
Discuss how to prevent obesity in the community.
-
Identify the common causes of obesity in the community
-
Define the common health problems due to obesity.
-
Apply the evidence based approach to decrease weight (Exercise,
Dieting, Drug treatment, and Bariatric Surgical Intervention like gastric
banding, Sleeve gastrectomy and gastric bypass.
-
Identify the role of health team and school health in dealing with
obesity in the community
DEFINITION :
WHAT ARE OVERWEIGHT AND
OBESITY?
Overweight and obesity are defined as abnormal or excessive
fat accumulation that may impair health . (WHO)
KEY FACTS AND FIGURES :
Most overweight adults and children who are obese have exogenous
obesity.
Which tends to imply that ‘they ate too much’, but the problem is more
complex than relative food input. Physical activity and environmental and
genetic influences must also be taken into account.
The cause of exogenous obesity is multifactorial.
Abdominal obesity gives a higher cardiovascular risk at any weight.
The onset of obesity can occur at any age.
KEY FACTS AND FIGURES :
Secondary or pathologic causes are rare.
Less than 1% of obese patients have an identifiable secondary cause of
obesity.
Two conditions causing unexplained weight gain that can be diagnosed by
the physical examination are Cushing syndrome and hypothyroidism.
Even small weight losses are effective in preventing diabetes and
improving the cardiovascular risk profile.
DIAGNOSIS AND CLASSIFICATION :
The easiest and possibly most accurate
assessment of obesity is the Body Mass
Index (BMI) .
BMI = weight (kg) / height (M2).
BMI : ‘healthy’ range is between 20 and
25.
in the table you can see a simple
classification of the BMI associated with
the relative degree of risk increase and
suggested therapy
DIAGNOSIS AND CLASSIFICATION :
Waist circumference:
in men > 94cm.
in women > 80 cm.
The waist hip circumference ratio is regarded as a useful predictor of
cardiac disease .
Recommended waist/hip ratios are:
• males <0.9
• females <0.8
THE PREVALENCE OF OBESITY IN SAUDI ARABIA
COMMON CAUSES OF OBESITY :
THERE ARE TWO MAIN CAUSES
EXOGENOUS
OBESITY :
Overweight caused by consuming more food than the
person's activity level warrants, leading to increased fat
storage.
COMMON CAUSES OF OBESITY :
ENDOGENOUS OBESITY:
Overweight caused by malfunction of the hormonal or
metabolic system such as:
Liver failure.
Nephrotic syndrome.
Pregnancy.
Endocrine disorders: hypothyroidism, Cushing syndrome, acromegaly ,
hypogonadism, hyperprolactinaemia , polycystic ovarian disease.
Depression.
Diabetes.
Drugs: antidepressant, corticosteroids .
OBESITY PREVENTION :
COMMUNITY LEVEL :
PROMOTE THE AVAILABILITY OF AFFORDABLE
HEALTHY FOOD AND BEVERAGES.
ENCOURAGE BREASTFEEDING.
ENCOURAGE PHYSICAL ACTIVITY OR LIMIT
SEDENTARY ACTIVITY AMONG CHILDREN AND YOUTH.
OBESITY PREVENTION :
INDIVIDUALS :

Exercise regularly.

Follow a healthy eating plan.

Know and avoid the food traps that cause you to eat.

Monitor your weight regularly.
COMMON HEALTH
PROBLEMS
RELATED TO
OBESITY :
COMMON HEALTH PROBLEMS RELATED TO OBESITY ;
DIABETES
:
More than 80 percent of cases of type 2 diabetes can be
attributed to obesity.
At a BMI greater than 35 kg/m2, the relative risk for
diabetes adjusted for age increased to 61.
Weight gain after age 18 years in women and after age 20
years in men also increases the risk of type 2 diabetes.
COMMON HEALTH PROBLEMS RELATED TO OBESITY ;
HYPERTE
NSION
The risk of hypertension is greatest in those subjects with
upper body and abdominal obesity.
Persistent obesity makes the hypertension more difficult to
control by interfering with the efficacy of antihypertensive
drugs.
COMMON HEALTH PROBLEMS RELATED TO OBESITY ;
DYSLIPID
EMIA
The prevalence of obesity-associated dyslipidemia may be
decreasing.
Unfavorable obesity-related effects include: high (LDL),
(VLDL)and triglycerides.
Reduction in serum (HDL) cholesterol of about 5 percent .
COMMON HEALTH PROBLEMS RELATED TO OBESITY ;
HEART
DISEASE :
1. Coronary disease.
2. Heart failure.
3. Myocardial Steatosis.
4. Atrial fibrillation/flutter.
COMMON HEALTH PROBLEMS RELATED TO OBESITY ;
SKIN CHANGES :
1.
Stretch marks (striae). are common and
reflect the tension on the skin from
expanding subcutaneous deposits of fat.
2.
Acanthosis nigricans (Hyperpigmentation).
3.
Hirsutism
COMMON HEALTH PROBLEMS RELATED TO OBESITY ;
COLON CANCER
Obesity has been linked to cancer of the colon in men and
women, cancer of the rectum and prostate in men, and
cancer of the gallbladder and uterus in women.
Obesity may also be associated with breast cancer,
particularly in postmenopausal women.
COMMON HEALTH PROBLEMS RELATED TO OBESITY ;
APPROACH TO
WEIGHT LOSS
APPROACH TO WEIGHT LOSS
how to approach Weight loss ?
LIFESTYLE
MODEFICATION
DRUG THYRAPY
SURGERY
APPROACH TO WEIGHT LOSS
LIFESTYLE MODIFICATION :
1- DIET:
low-calorie diet, eat 500 to 1,000 fewer calories
each day.
Reduce intake of foods that are high in energy
(e.g.fats, sugar)
Include more fruits and veggies
Limit salt and sugar intake
Drink plenty of water
APPROACH TO WEIGHT LOSS
LIFESTYLE MODIFICATION:
2-ECERCISE :
You'll probably need to do at least 30 minutes of physical activity on most days.
The goal is to use about 2,000 extra calories a week.
Running
11 meites
Gardening
5 hours
Cycling 22 miles
APPROACH TO WEIGHT LOSS
DRUG THERAPY :
Its indicate in :
1. fail to achieve weight loss by diet and exercise + BMI > 30
kg/m2.
2. BMI range (27-29.9 kg/m2) associated with co-morbidities.
APPROACH TO WEIGHT LOSS
Drug
Action
Side Effects
Diethylpropion (Tenuate)
Decreases appetite,
increases feeling of fullness
Increased blood pressure
and heart rate, insomnia,
dizziness
Lorcaserin (Belviq)
Decreases appetite,
increases feeling of fullness
Headache, dizziness,
fatigue, nausea, dry mouth,
constipation
Phentermine (Adipex)
Decreases appetite,
increases feeling of fullness
Increased blood pressure
and heart rate, insomnia,
dizziness
Orlistat (Xenical)
Blocks absorption of fat
Intestinal cramps, gas,
diarrhea, oily spotting
Decreases appetite,
increases feeling of fullness
Increased heart rate, birth
defects, tingling of hands
and feet, insomnia,
dizziness, constipation, dry
mouth
Phentermine and extendedrelease topiramate (Qsymia)
APPROACH TO WEIGHT LOSS
BARIATRIC SURGERY :
For patients with BMI ≥40 kg/m2 who have failed diet,
exercise, and drug therapy, we suggest bariatric surgery.
individual with >35 kg/m2 and co-morbidities .
APPROACH TO WEIGHT LOSS
WHAT'S THE ROLE OF SCHOOL
HEALTH AND HEALTH TEAM IN
THE COMMUNITY?
THE ROLE OF SCHOOL HEALTH AND HEALTH TEAM IN THE COMMUNITY :
THE ROLE OF SCHOOL HEALTH AND
HEALTH TEAM IN THE COMMUNITY :
The physical activity and eating behaviors that affect weight
are influenced by many sectors of society, including families,
community organizations, health care providers, faith-based
institutions, businesses, government agencies, the media, and
schools. The involvement of all of these sectors will be needed
to reverse the epidemic.
THE ROLE OF SCHOOL HEALTH AND HEALTH TEAM IN THE COMMUNITY :
ROLE OF SCHOOLS :
Schools cannot solve the obesity epidemic on their own, but it
is unlikely to be halted without strong school-based policies
and programs. Schools play an especially important role
because:
• Research has shown that well-designed, well-implemented
school programs can effectively promote physical
activity, healthy eating, and reductions in television viewing
time.
• most of young people are enrolled in schools.
THE ROLE OF SCHOOL HEALTH AND HEALTH TEAM IN THE COMMUNITY :
WHAT CAN
SCHOOLS DO?
Most important, schools can help
students adopt and maintain
healthy eating and physical
activity behaviors through healthful
school meals and foods, physical
education programs and recess,
classroom health education, and
school health services.
THE ROLE OF SCHOOL HEALTH AND HEALTH TEAM IN THE COMMUNITY :
HEALTH TEAM ROLE
health professionals have an important role in promoting
preventive measures and encouraging positive lifestyle behaviors.
also have a role in counseling patients about safe and effective
weight loss and weight maintenance programs.
TAKE HOME MASSAGE
Obesity is defined as abnormal or excessive fat accumulation that
may impair health.
The easiest and possibly most accurate assessment of obesity is
the BMI.
The cause of exogenous obesity is multifactorial, the end result
being increased body fatness.
endogenous obesity caused by malfunction of the hormonal or
metabolic system.
obesity is associated with an increased risk of other disease like :
DM , HTN , dyslipidemia , hart disease , skin changes and colon
cancer.
TAKE HOME MASSAGE
obesity is treated first with life style modifications then drug thereby
then surgical intervention .
sugary is indicated for patients with BMI ≥40 kg/m2 who have failed
diet, exercise, and drug therapy Or patients with BMI more than 35
and other co-morbidities.
health care providers and schools can influence the level of physical
activity and eating behaviors that can reduce weight.
ROLE PLAY
REFERENCE :
WHO | Obesity and overweight. 2013.
Murtagh’s General Practice, 5th Edition.
pubmed .
wikipedia.
The Role of Schools in Obesity Prevention by Mary Story, Karen M.
Kaphingst, and Simone French.
Childhood obesity by Howell Wechsler, Mary L. McKenna, Sarah M. Lee,
and William H. Dietz.
Our colleges previous presentations.
THANK YOU FOR
LISTENING