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Overweight and Obesity. Dr Mojtaba Hashemzade Obesity surgeon. Overview. Definition, Prevalence & Consequences of Obesity Healthy Lifestyles Assessment of Obesity Treatments for Obesity. Definition. - PowerPoint PPT Presentation

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  • Overweight and ObesityDr Mojtaba HashemzadeObesity surgeon

  • OverviewDefinition, Prevalence & Consequences of ObesityHealthy LifestylesAssessment of ObesityTreatments for Obesity

  • DefinitionObesity is an abnormal accumulation of body fat, usually 20 percent or more over an individual's ideal body weight.

  • Definition of Overweight & ObesityUsing BMI

    ITEMSBMIGRADEUNDER WEIGHT 18.5NORMAL18.5 24.9OVER WEIGHT25.0 29.9OBESITY30.0 34.9IOBESITY35.0 39.9IIEXTREME OBESITY 40III

  • Calculating BMICalculate Body Mass Index (BMI) =

    weight (kg)height squared (meters)

    Or

    weight (pounds) x 703height squared (inches)

  • Prevalence of ObesityChildhood and adolescent obesity increased from 5% to 16% in the last 20 yearsAdulthood obesity increased from 12% to 21% in 10 years.16 million US adults with BMI over 3560 million US obese adults (BMI > 30)

  • Prevalence of Adult Obesity, U.S.A.From CDC website: http://www.cdc.gov/nccdphp/dnpa/obesity/trend/prev_reg.htm

  • Factors predispose to obesityGenetic familial tendency.Sex women more susceptible .Activity lack of physical activity.Psychogenic emotional deprivation, depression .Social class poorer classes. Alcohol problem drinking. Smoking cessation smoking. Prescribed drugs tricyclic derivatives.

  • Weight Gain: Medications

    DiseaseExamplesDiabetesInsulin, sulfonylureasDepressionTricyclicsSeizuresValproic acid, TegretolHypertensionClonidine, -blockers, -blockersHormonesProgesterone

  • Weight Gain: How Does It Happen?Energy imbalance calories consumed not equal to calories used Over a long period of timeDue to a combination of several factorsIndividual behaviorsSocial interactionsEnvironmental factorsGenetics

  • Weight Gain: Energy In3500 calories = 1 pound

    100 calories extra per day= 36,500 extra per year= 10.4 lbs weight gain

    Question: How much is 100 calories?Answer: Not very much!1 glass skim milk, or1 banana, or1 slice cheese, or1 tablespoon butter

  • Evolving PathologyMore in and less out = weight gainMore out and less in = weight lossHypothalamus control center for hunger and satietyEndocrine disorder where are the hormones?

  • LeptinProtein hormone secreted by adipocytesLevels correlate with lipid content of cellsLeptin acts on the hypothalamus to reduce hunger and to stimulate energy expenditure

  • GhrelinHormone secreted in the stomachActs on the hypothalamus to stimulate appetiteLevels peak just before meals and drop afterward

  • Bad News for DietersLeptinDieting decreases leptin levelsReducing metabolism, stimulating appetiteGhrelinLevels in dieters are higher after weight lossThe body steps up ghrelin production in response to weight lossThe higher the weight loss, the higher the ghrelin levels

  • Health Consequences of ObesityMajor cause of preventable death Increase in mortality from all causesIncrease in risk for these cancersEndometriumBreastProstateColonIncrease in risk of:HypertensionDyslipidemiaDiabetes type 2Coronary artery diseaseStrokeGallbladder diseaseOsteoarthritisSleep apnea & respiratory problems

  • Assessment Assess the patient's readiness and willingness to lose weight :Unfortunately those who are most concerned about their weights are not necessarily those who are at the highest health risk.Those who are unable or unwilling to embark on a weight reduction program, but they are willing to take steps to avoid further weight gain or perhaps to work on other risk factors such as cigarette smoking, and they should be encouraged to do so.For those not ready to act, the issue should be deferred and brought up at the next visit

  • Assessment Is he overweight? Obese?What are his key health issues?

  • AssessmentMeasure BMIMeasure waist circumferenceApple shape body is higher risk for DM, CVD, HTNWaist larger than 40 inches for men Waist larger than 35 inches for women

  • AssessmentAssess for other risk factorsExisting high risk disease:coronary heart disease; other atherosclerotic diseases; type 2 diabetes; sleep apneaDiseases associated with obesityGynecological problems; osteoarthritis; gallstones; stress incontinenceCardiovascular risk factors (3 or more = high risk)Cigarette smoking; Hypertension; LDL >130; HDL 45; women age > 55Other risk factorsPhysical inactivity; elevated serum triglyceridesMedications associated with obesity

  • Treatment ApproachA multi-faceted approach is bestDietPhysical activityBehavior changeA Recommendation

  • Treatment ApproachInitial goal: 10% weight lossSignificantly decreases risk factorsRate of weight loss1 to 2 pounds per weekReduction of caloric intake 500-1000 per daySlow weight loss is more stableRapid weight loss is almost always followed by weight gainRapid weight loss increases risk for gallstones & electrolyte abnormalities

  • Treatment ApproachAim for 4 - 6 months of weight loss effortMost people will lose 20 to 25 pounds After 6 months, weight loss is more difficultGhrelin & Leptin are at work!Changes in resting metabolic rateEnergy requirements decrease as weight decreasesDiet adherence waversSet goals for weight maintenance for next 6 months, then reassess.

  • Dietary TherapyWeight reduction with dietary treatment is in order for virtually all patients with a BMI 25-30 who have comorbidities and for all patients over BMI 30.Strategies of dietary therapy include teaching about calorie content of different foods, food composition (fats, carbohydrates, and proteins), reading nutrition labels, types of foods to buy, and how to prepare foods.

  • Low-Calorie Step I Diet1000 to 1200 kcal/day for women1200 to 1600 kcal/day for men Adjust for current weight & activityToo hungry? increase kcal by 100 - 200/dayNot losing? decrease kcal by 100 - 200/day

  • How Much is 1200 Calories?Could you stick to 1200 per day?1 Big Mac (580)1 SMALL Fries (210)1 SMALL shake (430)

  • Low-Calorie Step I Diet

    NutrientRecommended intakeCalories500 to 1000 kcal/day reduction from usualTotal fat

  • Weight Maintenance: How Much Should People Eat?Varies widelySome averages, below

    MalesAge 20-492900 calories/dayAge 50-plus2500 calories/dayFemalesAge 20-492300 calories/dayAge 50-plus1900 calories/day

  • Physical ActivityPhysical activity should be an integral part of weight lossPhysical activity alone is less successful than a combined diet & exercise programIncreased activity alone does not decrease weightSustained activity does prevent weight regainReduces risk for heart disease & diabetes

  • Physical ActivityStart slowlyMany obese people live sedentary livesAvoid injuryEarly changes can be activities of daily livingIncrease intensity & duration graduallyLong-term goal30 to 45 minutes or more of physical activity5 or more days per weekBurn 1000+ calories per week

  • Recommend Physical ActivityWhat does it take to burn 1000 calories per week?Running 11 milesWalking 12 milesDancing 3 hoursGardening 5 hoursCycling 22 miles

  • Behavioral StrategiesKeep a journal of diet & activityVery powerful intervention!Set specific goals re: behaviorsEatingActivityRelated behaviorsTrack improvement Weigh & measure on a regular basis

  • Cognitive StrategiesFocus on the goalsPlan meals & activityDevelop reminder systems Anticipate temptations & plan resistanceReward yourselfLimit quantities, but do not deprive yourselfHave confidence in your ability to succeedDo positive self-talk

  • Pharmacotherapy for Weight LossAdjunct to diet & physical activityBMI 30Or, BMI 27 with other risk factors Should not be used for cosmetic weight lossOnly for risk reductionUse only when 6-month trial of diet & physical activity fails to achieve weight loss

  • Pharmacotherapy for Weight LossThese drugs are only modestly effective2 to 10 kilogram lossMost occurs in the first 6 monthsIf patient does not lose 2 kilograms in the first 4 weeks, success is unlikelyIf the first 6 months is successful, continue medication as long asIt is effective in maintaining weight, andAdverse effects are not serious

  • Pharmacotherapy for Weight Loss

    DrugDoseActionAdverse EffectsSibutramine(Merida)5/10,/15 mg10 mg po qd to start. May be increased to 15 mg or decreased to 5 mgNor epinephrine, dopamine & serotonin reuptake inhibitorIncrease in heart rate & blood pressureOrlistat(Xenical)120 mg120 mg po tid before mealsInhibits pancreatic lipase, decreases fat absorptionDecrease in absorption of fat-soluble vitamins; soft stools and anal leakage

  • Weight Loss Surgery47,000 in 2001; 98,000 in 2003Types of Obesity Surgery: 1.Restrictive Surgery - uses bands or staples to create food intake restriction:Vertical Banded Gastroplasty (VBG) - is a pure restrictive surgery since it only involves surgically creating a stomach pouch. VBG uses bands and staples and is the most frequently performed procedure for obesity surgery.Gastric Banding involves the use of a band to create the stomach pouch. Laparoscopic Gastric Banding (Lap-Band), approved by the FDA in June 2001, is a less invasive procedure in which smaller incisions are made to apply the band. The band is inflatable and can be adjusted over time

  • Weight Loss Surgery2. Combined Restrictive and Malabsorptive Surgery - is a combination of restrictive surgery (stomach pouch) with bypass (malabsorptive surgery), in which the stomach is connected to the jejunum or ileum of the small intestine, bypassing the duodenum.Roux-en-Y Gastric Bypass (RGB) - is the most commonly performed gastric bypass procedure, and the s

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