OBESITY

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OBESITY

• Fighting the Battle of the Bulge

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Overview

• Energy
• Definition of obesity
• Etiology/pathogenesis
• Obesity/health hazards
• Evaluation of the obese patient
• Why is it so difficult to maintain weight loss?
• Treatment

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• 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

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Energy Expenditure

• Resting metabolic rate 70
• Thermic effect of food 15
• Physical Activity 15

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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

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Etiology

• Prenatal influences
• Breast feeding
• Women (pregnancy, menopause)
• Men (sedentary lifestyle)
• Sleep deprivation
• Cessation of smoking
• Diet
• Medications
• Socioeconomic

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Medications

• Antipsychotics
• Antidepressants
• Antiepileptics
• Diabetic
• Betablockers
• Glucocorticoids

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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

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Health Hazards

• Hypertension
• Dyslipidemia
• Cardiovascular disease
• Metabolic syndrome

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Cancer (Men)

• Liver
• Stomach
• Pancreas
• Esophagus
• Rectum
• Gallbladder
• Multiple Myeloma

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Cancer (Women)

• Uterus
• Kidney
• Cervix
• Pancreas
• Esophagus
• Gallbladder
• Breast
• Liver
• Ovary
• Colon
• Rectum

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Other Risks Related to Metabolic Effects

• Gastrointestinal
• Kidney
• Endocrine/infertility

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Other Risks Related to Increased Body Mass

• Bone and joint disease
• Pulmonary disease
• Social stigmatization

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Evaluation

• BMI
• Waist circumference
• Waist hip ratio
• Blood pressure
• Lipid panel
• Glucose

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• Why is it so difficult to lose weight and
  maintain weight loss?

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• Answer
• Our bodies defend our current weight and this
  makes both weight loss and maintenance of weight
  loss difficult.

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Treatment

• Diet
• Physical exercise
• Behavioral modification

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When These Fail

• Pharmacologic therapy
• Bariatric surgery

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Diet

• Diet composition is less important than total
  calories consumed!!!

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Diets

• Low-carbohydrate diets
• Low-fat diets
• Low-energy dense diets
• Portion controlled/very low-calorie diets
• Commercial weight-loss programs
• Alternative/natural/herbal diets

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Behavioral Modifications

• Setting realistic goals
• Self-monitoring
• Control of stimuli that activates eating
• Slowing down the eating process
• Social support

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Exercise

• 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

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Pharmacologic

• Sibutramine
• Orlistat

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Surgical (Bariatric)

• Generally reserved for BMI of 40 or above
• May consider with BMI of 35 and comorbidities

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Types

• Restrictive
• Malabsorptive

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Summary

• Caloric intake that exceeds caloric expenditure
  results in weight gain!!!