|Remember Assess any environmental, social, and family factors, including family history of overweight or obesity and comorbidities
Assessment of weight and obesity
|Think Limitations of BMI on:
|Young children (centile charts)
|Risk of morbidities
|Side note An adult’s waist circumference is measured halfway between the inferior margin of the last rib and the crest of the ilium in the mid-axillary plane. The measurement is taken at the end of normal expiration.
|Remember Investigate comorbidities and other factors to an appropriate level, depending on the person, timing of assessment, degree of overweight or obesity, and previous assessments
|Side note Expenditure - Base Metabolic Rate (70%), thermogenesis (20%), exercise (10%). Base metabolic rate Approximately 1800 calories a day for 70kg man.
|Facts about obesity
|Genetics factors play a big role, but heritability is not destiny. Life-style modification (environmental change) can promote weight loss as much as pharmaceutical agents available
|Trying to go on a diet is effective in losing weight but generally does not work well in the long-term
|Exercise increases health regardless of body weight or weight lost
|Physical activity or exercise in a sufficient dose aids in long-term weight maintenance
|Continuing doing things that promote weight loss helps maintain weight loss
|Programs that involve overweight children and their parents help promote greater weight loss or maintenance
|Meal replacement products help promote greater weight loss
|Pharmaceutical medication can help with weight loss and maintenance as long as the agents continue to be used.
|In appropriate patients, bariatric surgery results in long-term weight loss and reductions in the rate of incident diabetes and mortality
Significant benefit (a reduction in mortality and morbidity) can be obtained with moderate weight loss (5-10%). Energy Balance is key!
Medications can have an adverse effect on weight by influencing either food intake (hunger) or energy expenditure. Medication should be considered in people who have a BMI >25
The most effective treatment for the morbidly obese
|Indications for Bariatric Surgery
|Other approaches were unsuccessful
|Understands surgery and risks
|No uncontrolled psychological conditions
|Dedicated to life-style change and follow-up
|Metabolic Syndrome is a cluster of risk factors comprising of excess abdominal weight, lipid abnormalities, hypertension and elevated glucose levels.