Diagnosis and management of obesity By Dr Wafaa Ahmed Fahmi Assistant professor of community medicine and nutrition
ObesityObesity is a medical condition in which excess •body fat has accumulated to the extent that itmay have an adverse effect on health, leadingto reduced life expectancy and/or increasedhealth problems
Obesity causesObesity is most commonly caused by a •combination of excessive dietary calories, lackof physical activity, and geneticsusceptibility, although a few cases are causedprimarily by genes, endocrinedisorders, medications or psychiatric illness.
Maintaining weightYour weight will stay the same when the calories you eat and drink equal the calories you burn.
Losing weightYou will lose weight when the calories you eat and drink are less than the calories you burn.
Gaining weight You will gain weight when the •calories you eat and drink are greater than the calories you burn.
AssessmentBody mass index (BMI), a measurement which •compares weight and height, defines peopleas overweight (pre-obese) if their BMI isbetween 25 kg/m2 and 30 kg/m2, and obesewhen it is greater than 30 kg/m2
Obesity RisksObesity increases the likelihood of variousdiseases, particularly heart disease, type 2diabetes, breathing difficulties duringsleep, certain types of cancer, andosteoarthritis.[
Treatment for ObesityDieting and physical exercise are the mainstaysof treatment for obesity. To supplementthis, or in case of failure, anti-obesity drugsmay be taken to reduce appetite or inhibit fatabsorption. In severe cases, surgery isperformed or an intragastric balloon is placedto reduce stomach volume and/or bowellength, leading to earlier satiation andreduced ability to absorb nutrients from food.
Dieting• Diets to promote weight loss are generally divided into four categories: low-fat, low- carbohydrate, low-calorie, and very low calorie.[A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram (4.4–8.8 lb) weight loss in all studiesAt two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized.
DietingVery low calorie diets provide 200– •800 kcal/day, maintaining protein intake butlimiting calories from both fat and carbohydrates.They subject the body to starvation and producean average weekly weight loss of 1.5–2.5 kilograms (3.3–5.5 lb). These diets are notrecommended for general use as they areassociated with adverse side effects such as lossof lean muscle mass, increased risks of gout, andelectrolyte imbalances. People attempting thesediets must be monitored closely by a physician toprevent complications.
ExerciseWith use, muscles consume energy derived fromboth fat and glycogen. Due to the large size of legmuscles, walking, running, and cycling are themost effective means of exercise to reduce bodyfat.Exercise affects macronutrient balance. Duringmoderate exercise, equivalent to a briskwalk, there is a shift to greater use of fat as a fuel. To maintain health the American Heart Associationrecommends a minimum of 30 minutes ofmoderate exercise at least 5 days a week.[
ExerciseA meta-analysis of 43 randomized controlledtrials by the Cochrane Collaboration foundthat exercising alone led to limited weightloss. In combination with diet, however, itresulted in a 1 kilogram weight loss overdieting alone. A 1.5 kilogram (3.3 lb) loss wasobserved with a greater degree of exercise.