Phenotype of Obese 1. Family is more likely to be overweight. 2. Poorer fitness than the lean, and lesser tendency to exercise. 3. Age group at onset: infant, teen, or adult 4. Immigrants or those becoming westernized in their own natural surroundings tend to become overweight. 5. Many efforts and failures to lose weight. Many excuses for not being able to change habits or weight. 6. Overeating (binge eating) typically under stress.
Medical History and physical Ekg, blood chemistry panel, waist and hip circumferences
Behavioral Mood, social support, psychopathology Patient readiness, stress, time availability
Treatment Decision and Selection BMI Category Health Risked based on BMI <25 Minimal 25>27 Low 27<30 Moderate 30<35 High 35<40 Very High >40 Extremely High Presence of a co-morbid condition or other risk factor jumps patient to next level of risk based on BMI. Shapeup America
Treatment Decision and Selection Health Risk Treatment Options Minimal & Low Healthful eating &/or moderate deficit diet, Increased physical activity Lifestyle change Moderate All of above plus low calorie diet High & Very High All of above plus pharmacotherapy or very low calorie diet (VLCD) Extremely High All of above plus surgical intervention
Goal Setting Dream Weight What you would like to weigh. Happy Weight A weight you would be happy with. Acceptable Weight Less than above but “OK” Disappointed Less than current, but more than Weight above.
Goal Setting 60 women mean age 40 years, BMI of 36.3 Current Weight 99.1 kg Dream Weight 61.4 kg (-38%) Happy Weight 68 kg (-31%) Acceptable Weight 74 kg (-25%) Disappointed Weight 82 kg (-17%)
Reassess: Understanding and compliance with diet. physical activity, and drug regimen Accuracy of weight recordings Possible Fluid retention (salt intake, etc) Changes in medical condition Motivation for change Social and personal stress Is the provider of health care the root of the problem ?
For Those Who Don’t Lose Weight and There is no Cause Except Noncompliance with Diet & Exercise
Consider changing medication
consider referral to: Dietitian Behavioral counselor Exercise professional Weight Watchers
Reconsider goal: i.e. simple maintenance or a rest from weight loss efforts
Discuss surgical options if medically or psychologically indicated