overweight and obesity lecture
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DESCRIPTIONOverweight and Obesity Lecture
Overweight and Obesity
Maru E Combate M.D,MS,FPCP,FPCCP
Definition, Prevalence & Consequences of Obesity
Assessment of Obesity
Treatments for Obesity
Obesity is an abnormal accumulation of body fat, usually 20 percent or more over an individual's ideal body weight.
Definition of Overweight & Obesity
ITEMS BMI GRADE
UNDER WEIGHT 18.5
NORMAL 18.5 24.9
OVER WEIGHT 25.0 29.9
OBESITY 30.0 34.9 I
OBESITY 35.0 39.9 II
EXTREME OBESITY 40 III
Calculate Body Mass Index (BMI) =
weight (kg) height squared (meters)
weight (pounds) x 703
height squared (inches)
Prevalence of Obesity
Childhood and adolescent obesity increased from 5% to 16% in the last 20 years
Adulthood obesity increased from 12% to 21% in 10 years.
16 million US adults with BMI over 35
60 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 obesity
Genetic 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
Diabetes Insulin, sulfonylureas
Seizures Valproic acid, Tegretol
Hypertension Clonidine, -blockers, -blockers
Weight Gain: How Does It Happen?
calories consumed not equal to calories used
Over a long period of time
Due to a combination of several factors
Weight Gain: Energy In
3500 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, or 1 banana, or 1 slice cheese, or 1 tablespoon butter
More in and less out = weight gain
More out and less in = weight loss
control center for hunger and satiety
where are the hormones?
Protein hormone secreted by adipocytes
Levels correlate with lipid content of cells
Leptin acts on the hypothalamus to reduce hunger and to stimulate energy expenditure
Hormone secreted in the stomach
Acts on the hypothalamus to stimulate appetite
Levels peak just before meals and drop afterward
Bad News for Dieters
Leptin Dieting decreases leptin levels
Reducing metabolism, stimulating appetite
Ghrelin Levels in dieters are higher after weight loss
The body steps up ghrelin production in response to weight loss
The higher the weight loss, the higher the ghrelin levels
Health Consequences of Obesity
Major cause of preventable death
Increase in mortality from all causes
Increase in risk for these cancers
Increase in risk of:
Diabetes type 2
Coronary artery disease
Sleep apnea & respiratory problems
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
Is he overweight? Obese?
What are his key health issues?
Measure waist circumference
Apple shape body is higher risk for DM, CVD, HTN
Waist larger than 40 inches for men
Waist larger than 35 inches for women
Assess for other risk factors Existing high risk disease:
coronary heart disease; other atherosclerotic diseases; type 2 diabetes; sleep apnea
Diseases associated with obesity Gynecological problems; osteoarthritis; gallstones; stress
Cardiovascular risk factors (3 or more = high risk) Cigarette smoking; Hypertension; LDL >130; HDL 45; women age > 55
Other risk factors Physical inactivity; elevated serum triglycerides
Medications associated with obesity
A multi-faceted approach is best
Initial goal: 10% weight loss Significantly decreases risk factors
Rate of weight loss 1 to 2 pounds per week
Reduction of caloric intake 500-1000 per day
Slow weight loss is more stable Rapid weight loss is almost always followed by
Rapid weight loss increases risk for gallstones & electrolyte abnormalities
Aim for 4 - 6 months of weight loss effort
Most people will lose 20 to 25 pounds
After 6 months, weight loss is more difficult Ghrelin & Leptin are at work!
Changes in resting metabolic rate
Energy requirements decrease as weight decreases
Diet adherence wavers
Set goals for weight maintenance for next 6 months, then reassess.
Weight 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 Diet
1000 to 1200 kcal/day for women
1200 to 1600 kcal/day for men
Adjust for current weight & activity
increase kcal by 100 - 200/day
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
Nutrient Recommended intake
Calories 500 to 1000 kcal/day reduction from usual
Weight Maintenance: How Much Should People Eat?
Some averages, below
Males Age 20-49 2900 calories/day
Age 50-plus 2500 calories/day
Females Age 20-49 2300 calories/day
Age 50-plus 1900 calories/day
Physical activity should be an integral part of weight loss
Physical activity alone is less successful than a combined diet & exercise program
Increased activity alone
does not decrease weight
Sustained activity does
prevent weight regain
Reduces risk for heart disease & diabetes
Many obese people live sedentary lives
Early changes can be activities of daily living
Increase intensity & duration gradually
30 to 45 minutes or more of physical activity
5 or more days per week
Burn 1000+ calories per week
Recommend Physical Activity
What does it take to burn
1000 calories per week?
12 miles Dancing 3 hours
5 hours Cycling 22 miles
Keep a journal of diet & activity Very powerful intervention!
Set specific goals re: behaviors Eating
Track improvement Weigh & measure on a regular basis
Focus on the goals
Plan meals & activity
Develop reminder systems
Anticipate temptations & plan resistance
Limit quantities, but do not deprive yourself
Have confidence in your ability to succeed
Do positive self-talk
Pharmacotherapy for Weight Loss
Adjunct to diet & physical activity
Or, BMI 27 with other risk factors
Should not be used for cosmetic weight loss
Only for risk reduction
Use only when 6-month trial of diet & physical activity fails to achieve weight loss
Pharmacotherapy for We