Transcript Evaluation of obesity

Evaluation of Obesity
Associate Prof. Dr. Memet IŞIK
Ataturk University Medical Faculty
Department of Family Medicine
[email protected]
http://aile.atauni.edu.tr/profil=doc.-dr.-memet-isik
1
EVALUATION OF OBESITY
•
Major health concern in postindustrial
societies
•
60% of Americans older than 20
•
Long term risk of becoming
overweight: 50%
•
Social cost: 100 billion annual
OBESITY PROMOTE
•
•
metabolic
syndrome,
•
Type 2 DM
•
Dyslipidemia
•
Hypertension
•
Increase risk of :
•
Hearth failure
•
Cancer
•
Premature death
Metabolic syndrome is not a disease in itself. Instead, it’s
a group of risk factors — high blood pressure, high blood
sugar, unhealthy cholesterol levels, and abdominal fat.
Increased
risks of :
•
Impaired pulmonary function
•
Osteoarthritis
•
Gallbladder diseases
•
Surgical complications
EVALUATION OF OBESITY
CONDITION ASSOCIATED WITH OBESITY
THAT USUALLY WORSENS AS THE
DEGREE OF OBESITY INCREASES
Hypertension
Cardiovascular disease
Dyslipidemia
Type 2 diabetes
Sleep apnea / obesity
hypoventilation syndrome
Osteoarthritis
Lower extremity venous stasis
disease
Gastro-esophageal reflux
Urinary stress incontinence
 Identify
etiologic factors
 Assess
weight status and fat
distribution as risk factors for major
diseases
TASKS FOR PRIMARY CARE
PHYSICIAN
DEFINITIONS
 Obesity
is a medical condition in which excess body fat
has accumulated to the extent that it may have an
adverse effect on health, leading to reduced life
expectancy and/or increased health problems[1].
 Overweight:
BMI of 25-29.9 kg/ m2
 Obese:
BMI greater than 30 kg/ m2
 Morbit
obese: BMI greater than 40 kg/ m2
Body Mass Index: Body Wight( Kg)/ Height2 (meter)
1: WHO 2000 p.6
DISTRIBUTION OF BODY FAT

a. Often characterized as centrally vs. peripherally located fat
distribution

b. Central obesity is characterized by an "android" or "apple" shape
• Central obesity is more common in men and is a strong risk
factor for several diseases
• Ratio of waist (umbilicus) to hip (pubic syphilis) >0.85 is a risk
factor (central form)
• This ratio also correlates (r=0.4) with elevated serum triglyceride
and low HDL

c. Peripherally distributed ("gynoecia" or "pair" shape) is more
common in women
• Although not completely benign, peripheral (non-central)
obesity appears to be less of a risk factor for cardiovascular disease
than central obesity
HISTORY
INITIAL ENCOUNTER
1. Duration of obesity
2. Eating habits
3. Activity habits
4. Hour dietary recall
5. Previous weight loss attempts
6. Assess patient readiness
7. Weight loss expectations
8. Family history of obesity
9. Presence of comorbid conditions
FOLLOW-UP
 Eating
and activity habits
1. Measure Body Mass Index (BMI)..
2. General physical examination
including: Waist circumference and
body habitus
DIAGNOSTIC CONSIDERATIONS

1. Determine the BMI-related health risk
2. Perform needed tests to rule out
obesity related illnesses
T3, T4 – if suspect hypothyroidism
FBS – if suspect diabetes
Serum cholesterol
Dexamethasone suppression test – if
suspect Cushing’s syndrome
DIAGNOSTIC CONSIDERATIONS
MANAGEMENT STEPS
1.
Select weight reduction treatment option based on
the determined health risk
MANAGEMENT STEPS
2. Determine weight reduction exclusion: Pregnancy, lactation,
osteoporosis, anorexia nervosa, unstable medical condition or
terminal illness
3. Together with the patient, select a target BMI that the patient is
willing to maintain
4. Create an energy balance between the energy consumed in
food and daily physical activity
5. Establish permanent life style change strategies
a. Eating Behavior Modification is essential but probably not
sufficient
i. Reduce total caloric intake by 500 Kcal per day to lose 1 kg
per week
ii. Keep records of food intake
iii. Eat regular meals
b. Exercise is necessary in all cases
MANAGEMENT STEPS

6. Medication: Some medications are temporarily helpful as
adjunct to reduced calorie diet especially in patients with BMI
above 30 or 27 with other cardiovascular risk factors.

a. Sibutramine (Reductyl, Meridia): a mixed neurotransmitter
reuptake inhibitor which helps curb appetite. Start at 10 mg once
daily then increase to 15 mg daily in 4 weeks.

b. Selective Serotonin Reuptake Inhibitors - Fluoxetine (Prozac) at
20 mg daily – decreases appetite

c. Certain stimulant compounds including Methylphenidate
(Ritalin) – decreases appetite

d. Orlistat (Xenical): Lipase inhibitor - decreases fat absorption..
120 mg capsule taken during or up to 1 hour after each of 3 daily
meals. If a meal contains no fat, medication is skipped.

7. Re-evaluate weight
Desired outcomes

Weight not more than 20% greater than norm for height reduction
need and progress periodically
WHEN TO REFER
 1)
Refer all to registered dietician for
implementation of prescribed diet
 2)
Refer to “obesity treatment center” or
endocrinologist if uncertain about diagnosis
or patient desires multidisciplinary treatment
or if BMI > 40 or BMI > 35 with significant comorbidity
PATIENT EDUCATION
 1)
Explain the cause of obesity
 2)
Explain the prognosis
 3)
Advise about the complications
of obesity
 4)
Advise to avoid fad diets
 5)
Advise to avoid self prescribed
diet pills
 6)
Advise about the exercise
program