Transcript Notes

OBESITY
Fighting the Battle of the Bulge
Overview
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Energy
Definition of obesity
Etiology/pathogenesis
Obesity/health hazards
Evaluation of the obese patient
Why is it so difficult to maintain weight loss?
Treatment
A 50 year old patient has gained 60 pounds since
the age of 30. What has been the daily average
excess calorie intake in excess of average calories
used?
A. 30
B. 100
C. 150
D. 250
E. 500
Energy Expenditure
Resting metabolic rate
70%
Thermic effect of food
15%
Physical Activity
15%
Caloric intake equals caloric expenditure
Weight stable
Caloric intake greater than caloric expenditure Weight gain
Caloric intake less than caloric expenditure
Weight loss
Definition of Obesity
 Body Mass Index (BMI) of 30 or more in
adults
 BMI = weight in kilograms/height squared in
meters
 Children BMI 95th percentile or above for
age and sex
Etiology
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Prenatal influences
Breast feeding
Women (pregnancy, menopause)
Men (sedentary lifestyle)
Sleep deprivation
Cessation of smoking
Diet
Medications
Socioeconomic
Medications
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Antipsychotics
Antidepressants
Antiepileptics
Diabetic
Beta–blockers
Glucocorticoids
Genetics
 Prader-Willi (Chromosome 15 q11-13)
 Several other single gene mutations have
been identified
 FTO gene (fat mass and obesity associated)
Chromosome 16
 Genes encoding the melanocortin -4
receptor (MC4R)
 ? “thrift” gene
Health Hazards
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Hypertension
Dyslipidemia
Cardiovascular disease
“Metabolic syndrome”
Cancer (Men)
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Liver
Stomach
Pancreas
Esophagus
Rectum
Gallbladder
Multiple Myeloma
Cancer (Women)
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Uterus
Kidney
Cervix
Pancreas
Esophagus
Gallbladder
Breast
Liver
Ovary
Colon
Rectum
Other Risks Related to Metabolic
Effects
 Gastrointestinal
 Kidney
 Endocrine/infertility
Other Risks Related to Increased
Body Mass
 Bone and joint disease
 Pulmonary disease
 Social stigmatization
Evaluation
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BMI
Waist circumference
Waist : hip ratio
Blood pressure
Lipid panel
Glucose
Why is it so difficult to lose weight and
maintain weight loss?
Answer:
Our bodies defend our current weight and
this makes both weight loss and
maintenance of weight loss difficult.
Treatment
 Diet
 Physical exercise
 Behavioral modification
When These Fail
 Pharmacologic therapy
 Bariatric surgery
Diet
 Diet composition is less important than total
calories consumed!!!
Diets
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Low-carbohydrate diets
Low-fat diets
Low-energy dense diets
Portion controlled/very low-calorie diets
Commercial weight-loss programs
Alternative/natural/herbal diets
Behavioral Modifications
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Setting realistic goals
Self-monitoring
Control of stimuli that activates eating
Slowing down the eating process
Social support
Exercise
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May benefit glycemic control
Beneficial effects on cholesterol
Beneficial effects on blood pressure
Good modality in weight maintenance and
as a component of weight loss
Pharmacologic
 Sibutramine
 Orlistat
Surgical (Bariatric)
 Generally reserved for BMI of 40 or above
 May consider with BMI of 35 and
comorbidities
Types
 Restrictive
 Malabsorptive
Summary
 Caloric intake that exceeds caloric
expenditure results in weight gain!!!