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In this lecture, I talked about everything concerning obesity from medical aspect.

In this lecture, I talked about everything concerning obesity from medical aspect.

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    obesity   jaber amin obesity jaber amin Presentation Transcript

    • Dr. Jaber Amin Manasia 5th year medical student Presented to Dr. Panayiota Vryonidou Al- Louzi Dr. Jaber Manasia 1
    • Define obesity Describe health consequences of obesity Evaluation & Management Obesity in adults Obesity in children Obesity in elderly Dr. Jaber Manasia 2
    • An excessive amount of body fat, which increases the risk of medical illness and premature death. Dr. Jaber Manasia 3
    • Worldwide obesity has nearly doubled since 1980. In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. 35% of adults aged 20 and over were overweight in 2008, and 11% were obese. 65% of the world's population live in countries where overweight and obesity kills more people than underweight. More than 40 million children under the age of five were overweight in 2011. Obesity is preventable. Dr. Jaber Manasia 4
    • In Jordan , 64% of both men and women are overweight. 30% of Jordanians are obese. WHO website Dr. Jaber Manasia 5
    • WHO Classification BMI Risk of Death Underweight Below 18.5 Low Healthy weight 18.5-24.9 Average Overweight (grade 1 obesity) 25.0-29.9 Mild increase Obese (grade 2 obesity) Moderate/severe 30.0-39.0 Morbid/severe obesity(grade 40.0 and above Very severe 3) World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, [1997 [3
    • • BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals. Dr. Jaber Manasia 7
    • Abdominal obesity •also known as belly fat or clinically as central obesity, is excessive abdominal fat around the stomach and abdomen. •There is a strong correlation between central obesity and cardiovascular disease. •Abdominal obesity has been linked to Alzheimer's Disease as well as other metabolic and vascular diseases. •Visceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes. 8
    • Women cm cm (80cm) = Increased risk 88< Men cm (90cm) = Increased risk 102< Lean MEJ et al. Lancet; 1998; 351:853-6
    • Abdominal obesity, given as waist circumference*† Men     Women     Triglycerides HDL cholesterol Men     Women     Blood pressure >102 cm (>40 in) >88 cm (>35 in) ≥150 mg/dL <40 mg/dL <50 mg/dL ≥130/≥85 mm Hg Dr. Jaber Manasia 10
    • The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been: an increased intake of energy-dense foods that are high in fat; and an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, Dr. Jaber Manasia marketing and education. 11
    • Raised BMI is a major risk factor for noncommunicable diseases such as: cardiovascular diseases (mainly heart disease and stroke), which were the leading cause of death in 2008; diabetes; musculoskeletal disorders (especially osteoarthritis - a highly disabling degenerative disease of the joints); some cancers (endometrial, breast, and colon). Dr. Jaber Manasia 12
    • Dr. Jaber Manasia 13
    • Common presenting problems include type 2 diabetes mellitus, hypertension, musculoskeletal complaints (particularly back, knee, hip, or foot pain), and breathing difficulties. It is important to identify the excess weight or obesity as a problem, even if that is not the presenting complaint. Dr. Jaber Manasia 14
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    • Physical Examination : To rule out signs of secondary causes of obesity: o Cushing syndrome o hypothyroidism or o other pituitary abnormalities. Measurement of the waist circumference is also important as noted above. Dr. Jaber Manasia 16
    • Many treatment modalities are available to foster weight loss. it is crucial to remember to set goals with the patient. The best practice is to prevent overweight and obesity from occurring by instilling in patients the healthy habits of good nutrition and avoiding a sedentary lifestyle. Dr. Jaber Manasia 17
    • There are critical periods in life when weight gain is more likely, these include after childbirth and menopause, so if patients can learn to anticipate these changes, it is possible that they can institute appropriate lifestyle changes to prevent weight gain. Dr. Jaber Manasia 18
    • The following modalities are used in the treatment of obesity : Counseling and behavioral interventions Medication Surgery Dr. Jaber Manasia 19
    • The National Heart, Lung, and Blood Institute (NHLBI) practice guideline suggests an initial weight loss of 10% of body weight among 6 months ; however, this may not always be practical or achievable . and even a 10-lb weight loss may ameliorate related conditions, such as hypertension and elevated blood glucose. Additional goals should include the maintenance of weight loss over time, and prevention of further weight gain. Dr. Jaber Manasia 20
    • Modification of other cardiovascular risk factors, such as smoking, hypertension, elevated cholesterol, and physical inactivity, and recognition and treatment of diabetes deserve equal emphasis in the management of overweight or obese patients. Note that as patients quit smoking, they are likely to gain weight, so anticipatory guidance about this is essential. Patients should not expect to be able to quit smoking and lose weight at the same time. Dr. Jaber Manasia 21
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    • A healthy eating plan gives your body the nutrients it needs every day. It has enough calories for good health, but not so many that you gain weight. A healthy eating plan is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar. Following a healthy eating plan will lower your risk for heart disease and other conditions. Dr. Jaber Manasia 24
    • Healthy foods include: Fat-free and low-fat dairy products, such as low-fat yogurt, cheese, and milk. Protein foods, such as lean meat, fish, poultry without skin, beans, and peas. Whole-grain foods, such as whole-wheat bread, oatmeal, and brown rice. Other grain foods include pasta, cereal, bagels, bread, tortillas, couscous, and crackers. Fruits, which can be fresh, canned, frozen, or dried. Vegetables, which can be fresh, canned (without salt), frozen, or dried. Canola and olive oils, and soft margarines made from these oils, are heart healthy. However, you should use them in small amounts because they're high in calories. Dr. Jaber Manasia 25
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    • Weight-loss medicines approved by the Food and Drug Administration (FDA) might be an option for some people. If you're not successful at losing 1 pound a week after 6 months of using lifestyle changes, medicines may help. You should only use medicines as part of a program that includes diet, physical activity, and behavioral changes. Weight-loss medicines might be suitable for adults who are obese (a BMI of 30 or greater). People who have BMIs of 27 or greater, and who are at risk for heart disease and other health conditions, also may benefit from weight-loss medicines. Dr. Jaber Manasia 28
    • Sibutramine (Meridia®) As of October 2010, the weight-loss medicine sibutramine (Meridia®) was taken off the market in the United States. Research showed that the medicine may raise the risk of heart attack and stroke. Dr. Jaber Manasia 29
    • Table 18.11 Drugs Commonly Used for Weight Loss Drug Sibutramine (Meridia) Dose FDA Approval Action Adverse Effects 5, 10, 15 mg 10 mg orally Long-term use Norepinephrine Increase in heart rate and daily to start, may be (controlled , dopamine, blood pressure; drug increased to 15 mg or substance C- and serotonin interactions with CNS active decreased to 5 mg IV) reuptake drugs, including MAOIs and inhibitor seratonergic medications Orlistat 120 mg Long-term use Inhibits Decrease in absorption of (Xenical) 120 mg orally three pancreatic fat-soluble vitamins; soft times daily before fatlipase, stools and anal leakage containing meals decreases fat absorption Phentermine 8, 15, 18.75, 30, 37.5 mg Short-term use Appetite Abuse, hypertension, (Adipex-P, 8 mg three times daily (controlled suppressant tachycardia, restlessness, Fastin, Oby30 minutes before substance Cinsomnia trim, Pro-fast, meals, or 15–37.5 mg IV) Zantryl) daily before breakfast Dietylpropion (Tenuate, Tenuate Dospan, generic available) 25 mg, 75 mg SR 25 mg three times daily, 1 hour before meals, or 75 mg SR once daily in the midmorning Short-term use Appetite (controlled suppressant substance CIV) Pulmonary hypertension, arrhythmias, psychosis, dry mouth, restlessness CNS, central nervous system; FDA, US Food and Drug Administration; MAOIs, monoamine oxidase Dr. Jaber Manasia inhibitors. 30
    • A recent meta-analysis demonstrated that such medications can lead to a weight loss of about 5 kg after 1 year, with little evidence for long-term sustained weight loss. A general guideline is that if a patient taking a weight loss medication has not lost at least 2 kg after 4 weeks, the medication should be discontinued Dr. Jaber Manasia 31
    • Surgical procedures for weight loss should be reserved for patients in whom medical weight loss treatment has failed, and who are suffering from complications of extreme obesity. Bariatric surgery can be considered an option for patients with : • BMI >= 40 kg/m2 • BMI >= 35 kg/m2, if cardiovascular risk factors are present. Dr. Jaber Manasia 32
    • Available procedures include : • placing a restrictive band around the stomach to reduce the capacity (gastric banding). • ligating off part of the stomach (gastroplasty) • bypassing the stomach altogether (gastric bypass). Gastric bypass has been shown to be more effective than gastric banding for weight loss and requires fewer surgeries for revision, but has more side effects. Dr. Jaber Manasia 33
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    • Also known as insulin resistance syndrome or “Syndrome X.” characterized by abdominal obesity, dyslipidemia, elevated blood pressure, and impaired fasting glucose. Represents a compilation of traits associated with insulin resistance and an ↑ risk of type 2 DM. Dr. Jaber Manasia 35
    • Guidelines from the 2001 National Cholesterol Education Program (Adult Treatment Panel [ATP] III) suggest that the clinical identification of the metabolic syndrome should be based upon the presence of any three of the following traits: Abdominal obesity (waist circumference > 102 cm in men, > 88 cm in women). TG ≥ 150 mg/dL. HDL < 40 mg/dL in men and < 50 mg/dL in women. BP ≥ 130/85. Fasting glucose ≥ 110 mg/dL. Dr. Jaber Manasia 36
    • TREATMENT : Directed toward preventing the development of type 2 DM and coronary vascular disease. Includes lifestyle modifications (diet, weight loss, exercise) and even treatment of insulin resistance with medications. Dr. Jaber Manasia 37
    • Through the last decades, the average weights of children have increased. In 2011, more than 40 million children under the age of five were overweight. According to NHANES 2009–2010, about 1 in 6 American children ages 2–19 are obese. The survey also suggests that overweight and obesity are having a greater effect on minority groups, including Blacks and Hispanics. Dr. Jaber Manasia 38
    • The definition of overweight and obesity in children is based on comparison to children of the same age and sex as follows: BMI-for-Age Percentile Less than 5th percentile 5th percentile to less than the 85th percentile 85th percentile to less than the 95th percentile 95th percentile or greater Dr. Jaber Manasia Underweight Healthy weight Overweight Obese 39
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    • The United States Preventive Services Task Force (USPSTF) recommends that clinicians screen children age 6–18 years for overweight and obesity and offer them comprehensive behavioral intervention to improve weight status. Dr. Jaber Manasia 42
    • Appropiate, weight specific questions include those about diet, activity level, and hours of television viewing, breast versus formula feeding as an infant, as well as presence of family history of obesity, and conditions frequently comorbid with obesity, such as type 2 diabetes, hypertension, and lipid disorders. Dr. Jaber Manasia 43
    • There is a long-standing body of evidence supporting the theory that consumption of sweet drinks (fruit juices and soft drinks) is associated with overweight in children. However, a recent publication on the study called Project Eating Among Teens (Project EAT) did not show any association between sugar-sweetened beverages, juice consumption, and weight gain among teenagers over a 5-year period. Dr. Jaber Manasia 44
    • measurement of waist circumference is not helpful in screening or diagnosis. look for secondary causes of obesity (for example, purple striae may suggest hypercortisolism) Fasting lipidglucose profiles in presence of family hx. In a child with normal growth in stature, it is unlikely that overweight or obesity is caused by an underlying metabolic or genetic form of overweight . Dr. Jaber Manasia 45
    • Overweight children with the highest risk for adverse health outcome include those with current weight related comorbidities, high risk of developing weightrelated comorbidities in the future, or significant negative psychosocial ramifications of their overweight status. Dr. Jaber Manasia 46
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    • It is important to note that when older adults lose weight, a relatively high percentage of the weight lost is lean body mass. The BMR decreases with age, and this may lead to weight gain despite consistency in diet and exercise patterns. In spite of this, the trend is for weight to decrease in older age. Peak weights for men occur on average at 55 years of age and for women at 65 years. Dr. Jaber Manasia 48
    • Generally, its similar to adult guidelines,which consider water intake, increased calcium, and selected vitamin supplements. The study also recommended weight loss, the improved dietary content and physical activity seemed as important as caloric reduction. Dr. Jaber Manasia 49
    •  Should not compromise nutritional status, meet nutritional requirements, and contribute to a healthy, sustained declined in weight  Should result in small changes and focus on reduction in fat intake  Increase HDL, decrease cholesterol, and triglycerides  Better functioning in patients with OA  Decrease glucose intolerance  Should not be a low carbohydrate diet, protein liquid diet, or a high fat diet
    •  Weight loss programs for older adults should focus on maintaining adequate intake of essential nutrients, while reducing caloric intake by controlling dietary fat intake  The DASH (Dietary Approaches to Stop Hypertension) diet is an option for older adults  Rich in fruits/vegetables  High in lean meats, poultry, and fish  Low fat diary products  Whole-grain breads and cereals  At least six 8-oz glasses of fluid  Older adults are encouraged to seek help of nutrition professionals such as registered dietitians for advice on how to modify their diets
    • http://www.nhlbi.nih.gov http://www.ncbi.nlm.nih.gov http://www.who.int Essential of Family Medicine 2012 Dr. Jaber Manasia 52