NUTRITION AND OBESITY: A FAMILY MEDICINE APPROACH

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NUTRITION AND OBESITY A FAMILY MEDICINE APPROACH
NUTRITION AND OBESITY A FAMILY MEDICINE APPROACH

• Spring Family Medicine Conference 2012
• Catherine McKenna RD MD CCFP

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EPIDEMIOLOGY

• Canadians
• 34 overweight
• 18 obese

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DEFINITIONS

• Underweight lt18.5
• Normal Weight 18.5-24.9
• Overweight 25-29.9
• Obesity
• Class 1 30-34.9
• Class 2 35-39.9
• Class 3 gt40

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WAIST CIRCUMFERENCE

• 88cm women
• 102cm men

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COMORBIDITIES

• Diabetes
• Osteoarthritis
• Hypertension
• Gout
• Coronary artery disease
• Stroke
• Cancer
• Liver disease

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INDICATIONS FOR TREATMENT

• Personal choice
• Weight related comorbidity
• Improved quality of life

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WEIGHT LOSS AND MORTALITY
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FATS

• Food
• Portions
• Eating out options
• Hidden fats

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FATS

• Activity
• 30 minutes a day
• benefits of increased physical activity are
  independent of weight loss

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FATS

• Therapeutics
• 5 reduction in weight weight loss drug
• Orlistat

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FATS

• Surgery-Bariatric
• BMIgt35 w comorbidities or gt40
• Motivated
• Acceptable surgical risk
• Failed non surgical weight loss

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BARIATRIC SURGERY

• Overall mortality 1/500 (less with lap bands)
• Risk of death/year
• Obese with end organ damage 1/40
• Obese without complications 1/400

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BARIATRIC SURGERY

• Weight loss of 20-30 of original weight
• 16 reduction at 10 years vs 1.5 increase in
  medical patients
• No long term data on mortality reduction
• Lower incidence of DM/HTN at 10y compared with
  medical patients

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WHAT TO DO

• Prevention in the young
• Promote physical activity
• Teach basic nutrition

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CASE 1 BART

• 49M
• BMI 32
• WC 90cm
• TAG 4
• HTN
• FBS 5.8

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BART

• Foods
• Eggs, toast, juice, coffee
• 12 sub, coke, chips
• Steak, veggies, bread
• tea, cookies

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BART

• Activity
• Walks to work

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BART

• Therapeutics
• Tried diet drugs in the 70s

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BART

• Surgery
• Not really interested except would like some
  Plastics if he has loose skin

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GETTING THEM STARTED

• 10 reduction is medical success
• Pick one food group and get started
• Move a body part during commercials

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SUMMARY

• Is it a problem
• FATS
• Support