Updates on obesity managment including basics and recent updates of 5 As of Canadian Obesity network If any one needs this presentation you can email me Tarek1.mohamed@mu.edu.eg

1. Dr
Tarek Al Areeny , MD.
Obesity Medicine Consultant

4. Busy Practitioner Assessment of clients
presenting with excess weight:
 when dealing with obese patients, it is
important for health professionals to
fully assess all relevant aspects of
mental, physical and socioeconomic
health to fully evaluate contributing
factors, health consequences and
potential barriers to treatment.

5.  Given the wide range of problems
potentially leading to or affected by excess
body weight, it may be helpful to think of
the complications and barriers in specific
categories, which Dr Sharma* have
denoted the four Ms or ‘M, M, M, & M’ .
The four Ms stand for Mental,
Mechanical, Metabolic and Monetory,
respectively (*Sharma, 2010)

6.  The category ‘Mental’ includes all
complications, co-morbidities and
barriers to treatment related to
mental health, such as disorders
affecting
mood, eating, anxiety, personality, at
tention, sleep, addictions or
cognition, all of which are common
in patients seeking treatment for
obesity

7.  Failure to recognize, acknowledge
and address mental health issues in
patients seeking obesity treatment, as
with other chronic disorders, is likely
to result in poor compliance and
adherence as well as high rates of
Recidivism.

8.  The category ‘Mechanical’ includes
disorders related to the mechanical
consequences of excess body
weight/size such as musculoskeletal
disorders or obstructive sleep apnea
but also gastro-esophageal reflux
disease, urinary
incontinence, intertrigo or
pseudotumour cerebri.

9.  Because of their substantial influence
on quality of life and mobility, such
mechanical problems are not only
important indications for obesity
treatments but can also pose important
barriers to increasing physical
activity, an important component of
long-term weight management.

10.  The category ‘Metabolic’ includes not only
endocrine and homeostatic disorders like
type 2 diabetes
mellitus, dyslipidemia, hypertension
(sodium
metabolism), gout, cholelithiasis, polycystic
ovary syndrome
(PCOS), infertility, hypothyroidism or
Cushing’s syndrome, but also obesity-
related cancers like breast, cervical and
colon cancers

11.  Metabolic consequences like type II
diabetes mellitus ,dyslipidemia or
PCOS can be highly sensitive to weight
loss, with remarkable improvements
seen with a rather minor 5%
reduction in body weight. On the other
hand, endocrine disorders like
hypothyroidism may be important
barriers to obesity treatment.

12.  The category ‘Monetory’ refers to
issues related to the impact of obesity
on income, promotion, getting life or
medical insurance, getting married
and other aspects of socioeconomic
health including the ability to afford a
healthy diet, medical or surgical
treatment.

13.  For most clinical outcomes of weight
management, a target of
5-10% loss
has been adopted in clinical guidelines.
It can be achieved by many methods
in community settings and many
medical complications of obesity are
greatly improved.

16. Limitations of those methods
 too costly
 Complicated
 time consuming for routine clinical use
 can be used only in clinical and
epidemiological research

17.  Yet,weight alone is not an adequate
measure of adiposity so the
calculation of the body mass index
(BMI), which is weight (kg) divided
by the height (metres) squared, gives a
reasonable approximation of adiposity
and this is widely used in both clinical
practice and research.

20. Limitations of BMI
 It is not as useful in children, the aged, or the very fit
and muscular
 As it was developed for those of European
origin, the cutoff points given may not be
appropriate for other racial groups. For
example, for those of Asian origin the desirable
range may be a BMI of 18.5–22.9, whilst for
Polynesians the BMI seems to overestimate the
degree of adiposity.
 Recently The 'Obesity Paradox,' Wherein Being
Overweight Appears to Help lowered mortality of
obese populations with chronic diseases

21. Waist Circumference
Level of
Men Women
Risk
Level 1 > 94cm > 80cm
Level 2 > 102cm > 88cm

22. 5As Framework for
Obesity Management
Arya M. Sharma, MD/PhD, FRCPC
Scientific Director & CEO
Canadian Obesity Network

36. Pearls
* As regards scales you can
use commercial scales and
avoid buying very
expensive medical scales
* On measuring blood
pressure you can use a well
calibrated automated BP
instrument with a wrist