Obesity : What as Practitioner we should know?

//Obesity : What as Practitioner we should know?

Obesity : What as Practitioner we should know?

[et_pb_section fullwidth=”on” specialty=”off”][et_pb_fullwidth_header admin_label=”Fullwidth Header” title=”Obesity : Guidelines to follow” subhead=”Overlooking the route cause of Major health Threat” background_layout=”light” text_orientation=”left” header_fullscreen=”off” header_scroll_down=”off” parallax=”off” parallax_method=”off” content_orientation=”center” image_orientation=”center” custom_button_one=”off” button_one_letter_spacing=”0″ button_one_use_icon=”default” button_one_icon_placement=”right” button_one_on_hover=”on” button_one_letter_spacing_hover=”0″ custom_button_two=”off” button_two_letter_spacing=”0″ button_two_use_icon=”default” button_two_icon_placement=”right” button_two_on_hover=”on” button_two_letter_spacing_hover=”0″] [/et_pb_fullwidth_header][/et_pb_section][et_pb_section][et_pb_row][et_pb_column type=”4_4″][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” use_border_color=”off” border_color=”#ffffff” border_style=”solid”]

OVERVIEW

Obesity is a substantial public health crisis in the United States, and internationally, with the prevalence increasing rapidly in numerous industrialized nations. In 2009-2010, the prevalence of obesity among American men and women was almost 36%. Obesity a biggest health threat and concern in Semi developed countries like India. Obesity is considered as major risk factor for most of the non communicable disease by WHO.

[/et_pb_text][et_pb_slider admin_label=”Slider” show_arrows=”on” show_pagination=”on” auto=”on” auto_speed=”4000″ auto_ignore_hover=”on” parallax=”off” parallax_method=”off” remove_inner_shadow=”off” background_position=”default” background_size=”default” hide_content_on_mobile=”off” hide_cta_on_mobile=”off” show_image_video_mobile=”off” custom_button=”off” button_letter_spacing=”0″ button_use_icon=”default” button_icon_placement=”right” button_on_hover=”on” button_letter_spacing_hover=”0″] [et_pb_slide heading=”Obesity Co morbidities” button_text=”Obesity root of many more dangereous Diseases” background_image=”http://drtapan.com/wp-content/uploads/2015/07/31609.jpg” background_position=”default” background_size=”contain” background_color=”#ffffff” alignment=”center” background_layout=”light” allow_player_pause=”off” header_font_select=”default” body_font_select=”default” custom_button=”off” button_font_select=”default” button_use_icon=”default” button_icon_placement=”right” button_on_hover=”on”] [/et_pb_slide][et_pb_slide heading=”Obesity! A simple difference of what you eat and what you spend” background_image=”http://drtapan.com/wp-content/uploads/2015/07/31610.jpg” background_position=”default” background_size=”contain” background_color=”#ffffff” alignment=”center” background_layout=”light” allow_player_pause=”off” header_font_select=”default” body_font_select=”default” custom_button=”off” button_font_select=”default” button_use_icon=”default” button_icon_placement=”right” button_on_hover=”on”] [/et_pb_slide][et_pb_slide heading=”Pathogenesis of Obesity” button_text=”How your hormones interplay to make you fat” background_image=”http://drtapan.com/wp-content/uploads/2015/07/31608.jpg” background_position=”default” background_size=”contain” background_color=”#ffffff” alignment=”center” background_layout=”light” allow_player_pause=”off” header_font_select=”default” body_font_select=”default” custom_button=”off” button_font_select=”default” button_use_icon=”default” button_icon_placement=”right” button_on_hover=”on”] [/et_pb_slide][et_pb_slide heading=”Other causes of Obesity” background_image=”http://drtapan.com/wp-content/uploads/2015/07/31611.jpg” background_position=”default” background_size=”contain” background_color=”#ffffff” alignment=”center” background_layout=”light” allow_player_pause=”off” header_font_select=”default” body_font_select=”default” custom_button=”off” button_font_select=”default” button_use_icon=”default” button_icon_placement=”right” button_on_hover=”on”] [/et_pb_slide] [/et_pb_slider][et_pb_blurb admin_label=”Blurb” title=”Guidelines on treating obesity from the Endocrine Society” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” use_border_color=”off” border_color=”#ffffff” border_style=”solid”]

In January, 2015, the Endocrine Society released new guidelines on the treatment of obesity to include the following:[2, 3]

  • Diet, exercise, and behavioral modification should be included in all obesity management approaches for body mass index (BMI) of 25 kg/m 2 or higher. Other tools, such as pharmacotherapy for BMI of 27 kg/m 2 or higher with comorbidity or BMI over 30 kg/m2 and bariatric surgery for BMI of 35 kg/m 2 with comorbidity or BMI over 40 kg/m 2, should be used as adjuncts to behavioral modification to reduce food intake and increase physical activity when this is possible.
  • Drugs may amplify adherence to behavior change and may improve physical functioning such that increased physical activity is easier in those who cannot exercise initially. Patients who have a history of being unable to successfully lose and maintain weight and who meet label indications are candidates for weight loss medications.
  • To promote long-term weight maintenance, the use of approved weight loss medication (over no pharmacological therapy) is suggested to ameliorate comorbidities and amplify adherence to behavior changes, which may improve physical functioning and allow for greater physical activity in individuals with a BMI of 30 kg/m 2 or higher or in individuals with a BME of 27 kg/m 2 and at least one associated comorbid medical condition (eg, hypertension, dyslipidemia, type 2 diabetes mellitus, and obstructive sleep apnea).
  • If a patient’s response to a weight loss medication is deemed effective (weight loss of 5% or more of body weight at 3 mo) and safe, it is recommended that the medication be continued. If deemed ineffective (weight loss less than 5% at 3 mo) or if there are safety or tolerability issues at any time, it is recommended that the medication be discontinued and alternative medications or referral for alternative treatment approaches be considered.
  • In patients with type 2 diabetes mellitus who are overweight or obese, antidiabetic medications that have additional actions to promote weight loss (such as glucagon-like peptide-1 [GLP-1] analogs or sodium-glucose-linked transporter-2 [SGLT-2] inhibitors) are suggested, in addition to the first-line agent for type 2 diabetes mellitus and obesity, metformin.
  • In obese patients with type 2 diabetes mellitus who require insulin therapy, at least one of the following is suggested: metformin, pramlintide, or GLP-1 agonists to mitigate associated weight gain due to insulin. The first-line insulin for this type of patient should be basal insulin. This is preferable to using either insulin alone or insulin with sulfonylurea.
  • Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers, rather than beta-adrenergic blockers, should be considered as first-line therapy for hypertension in patients with type 2 diabetes mellitus who are obese.
  • In women with BMI of more than 27 kg/m 2 with comorbidities or BMI of more than 30 kg/m 2 seeking contraception, oral contraceptives are suggested over injectable medications because of weight gain with injectables, provided that women are well informed about risks and benefits (ie, oral contraceptives are not contraindicated).

[/et_pb_blurb][et_pb_tabs admin_label=”Tabs” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [et_pb_tab title=”Signs and symptoms” tab_font_select=”default” body_font_select=”default”]

 

Although several classifications and definitions for degrees of obesity are accepted, the most widely accepted classifications are those from the World Health Organization (WHO), based on body mass index (BMI). The WHO designations are as follows:

  • Grade 1 overweight (commonly and simply called overweight) – BMI of 25-29.9 kg/m 2
  • Grade 2 overweight (commonly called obesity) – BMI of 30-39.9 kg/m 2
  • Grade 3 overweight (commonly called severe or morbid obesity) – BMI ≥40 kg/m 2

Some authorities advocate a definition of obesity based on percentage of body fat, as follows:

  • Men – Percentage of body fat greater than 25%, with 21-25% being borderline
  • Women – Percentage of body fat great than 33%, with 31-33% being borderline

The clinician should also determine whether the patient has had any of the comorbidities related to obesity, including the following[4] :

  • Respiratory – Obstructive sleep apnea, [5] greater predisposition to respiratory infections, increased incidence of bronchial asthma, and Pickwickian syndrome (obesity hypoventilation syndrome)
  • Malignant – Association with endometrial, prostate, colon, breast, gall bladder, and possibly lung cancer [6]
  • Psychological – Social stigmatization and depression
  • Cardiovascular – Coronary artery disease, [7] essential hypertension, left ventricular hypertrophy, cor pulmonale, obesity-associated cardiomyopathy, accelerated atherosclerosis, and pulmonary hypertension of obesity
  • Central nervous system (CNS) – Stroke, idiopathic intracranial hypertension, and meralgia paresthetica
  • Obstetric and perinatal – Pregnancy-related hypertension, fetal macrosomia, and pelvic dystocia [8]
  • Surgical – Increased surgical risk and postoperative complications, including wound infection, postoperative pneumonia, deep venous thrombosis, and pulmonary embolism
  • Pelvic – Stress incontinence
  • Gastrointestinal (GI) – Gall bladder disease (cholecystitis, cholelithiasis), nonalcoholic steatohepatitis (NASH), fatty liver infiltration, and reflux esophagitis
  • Orthopedic – Osteoarthritis, coxa vera, slipped capital femoral epiphyses, Blount disease and Legg-Calvé-Perthes disease, and chronic lumbago
  • Metabolic – Type 2 diabetes mellitus, prediabetes, metabolic syndrome, and dyslipidemia
  • Reproductive (in women) – Anovulation, early puberty, infertility, hyperandrogenism, and polycystic ovaries
  • Reproductive (in men) – Hypogonadotropic hypogonadism
  • Cutaneous – Intertrigo (bacterial and/or fungal), acanthosis nigricans, hirsutism, and increased risk for cellulitis and carbuncles
  • Extremity – Venous varicosities, lower extremity venous and/or lymphatic edema
  • Miscellaneous – Reduced mobility and difficulty maintaining personal hygiene

[/et_pb_tab][et_pb_tab title=”Diagnosis” tab_font_select=”default” body_font_select=”default”]

Laboratory studies

  • Fasting lipid panel
  • Liver function studies
  • Thyroid function tests
  • Fasting glucose and hemoglobin A1c (HbA1c)

Evaluation of degree of body fat

BMI calculation, waist circumference, and waist/hip ratio are the common measures of the degree of body fat used in routine clinical practice. Other procedures that are used in few clinical centers include the following:

  • Caliper-derived measurements of skin-fold thickness
  • Dual-energy radiographic absorptiometry (DEXA)
  • Bioelectrical impedance analysis
  • Ultrasonography to determine fat thickness
  • Underwater weighing

 

[/et_pb_tab][et_pb_tab title=”Management” tab_font_select=”default” body_font_select=”default”]

Treatment of obesity starts with comprehensive lifestyle management (ie, diet, physical activity, behavior modification).[9] The 3 major phases of any successful weight-loss program are as follows:

  • Preinclusion screening phase
  • Weight-loss phase
  • Maintenance phase – This can conceivably last for the rest of the patient’s life but ideally lasts for at least 1 year after the weight-loss program has been completed

Medications

Currently, the 3 major groups of drugs used to manage obesity are as follows:

  • Centrally acting medications that impair dietary intake
  • Medications that act peripherally to impair dietary absorption
  • Medications that increase energy expenditure

Surgery

Among the standard bariatric procedures are the following:

  • Roux-en-Y gastric bypass
  • Adjustable gastric banding
  • Gastric sleeve surgery
  • Vertical sleeve gastrectomy
  • Horizontal gastroplasty
  • Vertical-banded gastroplasty
  • Duodenal-switch procedures
  • Biliopancreatic bypass
  • Biliopancreatic diversion

 

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By | 2018-01-15T22:31:46+00:00 July 25th, 2015|Healthcare Informations|0 Comments

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