LMCC/Obesity
< LMCC
(Redirected from Obesity (LMCC))Body Mass Index
edit(ie. (kg/m)²)
Classification of weight in adults
editClassification | BMI |
Underweight | <18.5 |
Normal | 18.5-24.9 |
Class I Obese | 30-34.9 |
Class II Obese | 35 - 39.9 |
Class III Obese | >40 |
- waist circumference (not waist to hip ratio) can be added to increase the specificity of the BMI. Those at high risk are:
- Men > 102 cm
- Women > 88 cm
- There is a U shaped relationship between BMI and mortality, with those over and underweight showing an increase in mortality
Epidemiology
edit- Prevelence of obesity is > 14% (Canada)
- There has been a doubling of childhood obesity in North America over the last 20 years
Assessment
edit- Calculate BMI and waist circumference
- Ask about comorbidities
- Coronary artery disease
- Hypertension
- Smoking
- Lipid profile
- diabetes
- Sleep apnea
- Osteoarthritis
- Gallstones
- Assess motivation for weight loss and any surrounding support or obstacles
- Examine past attempts and assess for efficacy
- physical exam and investigations are based on specific patient complaints
Management
editWeight Loss
editIf:
- BMI>30
- BMI 25-29.9 or high waist circumference and 2 risk factors
- weight loss is not to exceed 1kg/week with an initial goal of 10% loss in 6 months.
Weight Prevention
edit- BMI 25-29.9 and less than 2 risk factors
Dietary Therapy
edit- women: 1000-1200kcal/day
- men: 1200-1600kcal/day
- reduce usual intake by:
- Obese: 500-1000kcal/day
- Overweight: 300-500kcal/day
- these reduction will result in a loss of 1kg/week
Temporary and/or drastic diets do not generally lead to long term weight loss. By reducing the caloric intake suddenly, the body will enter a "starvation mode" and losing fat will be more difficult.
What most people who are obese need is a "permanent" change in their eating habits. Progressive substitution of bad products with healthy products will help reduce the shock from a sudden change in their eating style. A reduction of calories about 10% (maximum 20%) of their original caloric intake should do.
Behavioural therapy
edit- involve patients in goal setting
- self monitor for dietary intake and exercise
- reward when goals are acheived (not with food though)
- dietary behaviour: eat slower, use smaller plates
- modify environmental cues that prompt undesired eating
Pharmacotherapy
edit- use if lifestyle changes do no work after 6 months
- appropriate if BMI > 30 or >27 with co-morbidities/risk factors
- sibutramine
- appetite suppresant
- inhibits norepinephrine and seretonin reuptake
- side effects: increased BP, tachycardia
- orlistat
- reduces GI fat absorption
- side effects: reduction in fat soluable vitamins, stool leakage diarrhea
- ezetimibe
- cholesterol absorption inhibitor
- side effects:arthralgias, back pain, diarrhea
Surgery
edit- for severe obesity
- "stomach stapling", a bariatric procedure
References
editToronto Notes 2005