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obesity, weight loss and management

lecture on obesity sponsored by lesofat. bmi, health risks, management
by

lourdes anne villoso

on 19 November 2012

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Transcript of obesity, weight loss and management

Lourdes Anne Villoso, MD
Physical Medicine and Rehabilitation Obesity: Weight Loss and Management Quick formula
weight (lbs) / height (in)2 x 703 Overweight- excess body weight for height
Obesity - excess stored body fat Overweight and Obesity
Health risks of Overweight and Obesity
Weight loss and management
Exercise, medical and surgical Outline 7th National Nutrition and Health Survey (NNHeS) 2008
FNRI, DOST
Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults
www.nhlbi.nih.gov
WHO Library Cataloguing-in-Publication Data. "Global Recommendations on Physical Activity and Health"
American Heart Association
American College of Sports Medicine
American Academy of Physical Medicine and Rehabilitation Significant health issue in the US and in industrialized countries
Philippines is catching up*
7th NNHes Obesity Per Capita Total Food Consumption in Grams: Phil 1978-2008 Per Capita Total Food Consumption in Kcal: Phil 1978-2008 (FNRI, NNHeS) Overweight and Obesity BMI (kg/m2) for Adults
weight for height
BMI = weight (kg) / height (m)2


US Asians
underweight <18.5 <18.5
normal 18.5 - 24.9 18.5 - 22.9
overweight 25.0 - 34.9 23.0 - 24.9
obesity (class I) 30.0 - 34.9 >25.0
(class II) 35.0 - 39.9
extreme obesity (III) 40.0 and up BMI Health Risk
<18.5 nutritional deficiency
normal low
overweight moderate
obese high BMI 30 -~ 35 to 45 lbs overweight
186 lb in 5ft 6in
153 lb in 5ft BMI measures body mass

high in persons with greater musculature

low or normal in elderly Percentage Body Fat

Waist circumference

Skin fold thickness

Body fat distribution (CT scan/ MRI) High risk
F > 31 in
M >35 in Incresed Health Risk Cardiometabolic syndrome
Type 2 diabetes
Hypertension
Dyslipidemia
Coronary artery disease
Osteoarthritis
Stroke
Gall bladder disease
Obstructive Sleep Apnea
GERD
CA (endometrial, breast, colon) Etiology

multifactorial

balance between energy intake and output Factors to be considered in the development of obesity include the following:

Metabolic factors

Genetic factors

Level of activity

Behavior

Endocrine factors

Race, sex, and age factors Socioeconomic status

Dietary habits

Smoking cessation

Pregnancy and menopause

Psychologic factors Goals of Weight loss and management
- prevent further weight gain
- to reduce body weight
- to maintain lower body weight long term Weight loss
- 10% BW in 6 mos
- 1 lb a week Strategies for Weight loss and Maintenance
- dietary therapy
-Exercise and physical activity
- behavior therapy/counseling
-pharmacotherapy
-surgery Individualized eating plan

quality and quantity

500kcal deficit

low sat fat, total fat calories 30% Exercise and Physical Activity

- AHA and ACSM recommendations

- Physical Activity Readiness Questionnaire (PAR-Q) Pharmacotherapy

- centrally acting: impair food intake (appetite suppressant)
- peripherally : food absorption
- increase energy expenditure appetite suppressant

phentermine/+topiramate
lorcaserine
ephedrine For severe obesity, BMI 40 and above or
BMI 35 with comorbid conditions peripheral

Lesofat - gastrointestinal lipase inhibitor

Carb blockers- blocks alpha amylase (breakdown of carbohydrates) bariatric surgery
Roux en Y gastric bypass
andjustable gastric banding
vertical sleeve gastrectomy
gastroplasty fat burners

caffeine
ephedrine Long Term drug pharmacotherapy for Obesity and Overweight

Padwal. Cochrane Summaries. Jan 2009

Background:

Obesity is a highly and increasingly prevalent chronic condition for which drugs are commonly prescribed to improve health.



Objectives:

To assess the long-term effects of approved anti-obesity medications in clinical trials of at least one-year duration.



Search strategy:

MEDLINE, EMBASE, The Cochrane Library, the Current Science Meta-register of Controlled Trials and reference lists were searched. Drug manufacturers and two obesity experts were contacted.



Selection criteria:

Double-blind, randomised placebo-controlled trials of approved anti-obesity agents that 1) included patients over 18 years, 2) used an intention-to-treat analysis, and 3) had follow-up of one year or more. Both weight loss and weight maintenance trials were included. Abstracts, pseudo-randomised trials, head-to-head trials and open-label studies were excluded.



Data collection and analysis:

Two reviewers independently assessed all potentially relevant reports for inclusion and methodological quality. Data were extracted using double data entry. The primary outcome measure was weight loss.



Main results:

Sixteen orlistat (n = 10,631), 10 sibutramine (n = 2623) and four rimonabant trials (n = 6365) met inclusion criteria. Attrition rates averaged 30% to 40%. Compared to placebo, orlistat reduced weight by 2.9 kg (95% confidence interval (CI) 2.5 to 3.2 kg), sibutramine by 4.2 kg (95% CI 3.6 to 4.7 kg), and rimonabant by 4.7 kg (95% CI 4.1 to 5.3 kg). Patients on active drug therapy were significantly more likely to achieve 5% and 10% weight loss thresholds. Placebo-controlled weight losses were consistently lower in patients with diabetes. Orlistat reduced diabetes incidence, improved total cholesterol, LDL-cholesterol, blood pressure, and glycaemic control in patients with diabetes but increased rates of gastrointestinal side effects and slightly lowered HDL levels. Sibutramine improved HDL and triglyceride levels but raised blood pressure and pulse rate. Rimonabant improved HDL-cholesterol, triglyceride and blood pressure levels and glycaemic control in patients with diabetes but increased the risk of mood disorders. triad:
Aerobic
Strength
Flexibility Precautions

Low impact, isotonic exercises
walking, cycling, water exercises
switch up for boredom
comorbids/ injuries- just move Physical Medicine and Rehabilitation focuses on restoration of
FUNCTION
and
REINTEGRATION
into the community
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