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Keto Diet Guide to Weight Gain and Loss
- 1. KETO DIET
- 2. Introduction Weight isgenerally stable Food intake = Energy expenditure Coordinated control of the hypothalamus “Feeding”center “Satiety” center Food intake Availabilityof food Attractiveness of food Emotional factors
- 3. Introduction (Cont’d) Energyexpenditure Basal metabolism – 50% Physical activity – 40 - 50% Voluntary change in weight – not worrisome Involuntary change in weight – may indicate disease
- 4. Weight Gain
- 5. Mechanisms of weight gain Excess muscle – exercise Excess fat – food intake > energy expenditure Excess water – fluid retention, over hydration
- 6. Nature vs Narture Genes Fuel homeostasis Energy expenditure Hunger/satiety Environment Physical inactivity Food Sciocultural factors Intrauterine programming
- 7. Environment Increased intake Increased portionsizes energy dense foods High glycaemic index foods Softdrinks Added sugar Easyaccess to foods Marketing Decreased expenditure Reduced exercise Increased automation Vehicles Sedentary schools Sedentaryworkplace Elevators/Escalators TV/Computer
- 8. Other causes of Weight Gain Aging – slowed metabolism Pregnancy Endocrine & Other Medical Disorders Cushing’s Syndrome Hypothyroidism Polycystic ovary syndrome Hypogonadism Some inherited diseases/genetic syndromes
- 9. Causes of Weight Gain (Cont’d) Drugs Corticosteroids Lithium Tranquilizers Antidepressants Emotional factors Anxiety Depression Guilt
- 10. Lifestyle Factors Overeating Physical inactivity
- 11. Classification of BMI (in Kg/m2) Underweight --BMI <18.5 Normal weight -- BMI ≥18.5 to 24.9 Overweight — BMI ≥25.0 to 29.9 Obesity — BMI ≥30 Obesity Class I — BMI of 30.0 to 34.9 Obesity Class II — BMI of 35.0 to 39.9 Obesity Class III — BMI ≥40
- 12. Prevalence of overweight, 2008 Source:WHO
- 13. Prevalence of CVD risk factors in A.A Risk Factor Prevalence (%) Males Females Overweight 20 38 Obese 2 10 Low level of Total Physical Activity 17 31 High BP (> 140/90 mmHg) 32 29 Fikru et al., BMC Cardiovascular Disorders 2009, 9:39
- 14. Pear Shaped Fatness in Women Excess Fat Deposited Hips Buttocks Thighs
- 15. Apple Type Fatness in Males Excess Fat Deposited Abdomen (Beer Bellies)
- 16. Health Risks of Obesity Increased Morbidity Type 2 Diabetes Hypertension Dyslipidemia Coronary Heart Disease Stroke
- 17. Health Risks of Obesity (Cont’d) • Increased Morbidity Cancer (endometrial, breast, colon) Poor Qualityof Life Psychosocial Dysfunction Sleep Apnea Osteoarthritis Increased Mortality
- 18. Work up History Amountof gained weight Duration of weightgain Recent changes in diet orappetite Rateof weight gain Rapid weightgain – f luid retention
- 19. Work up (Cont’d) History Alcohol & Drugs Intake Exercise Habit Psychosocial Problems Anyothersymptoms
- 20. Examination Height, weight, BMI, waistcm Neck size, BP, PR Featuresof Insulin resistance Goitre Liveredge Oedema
- 21. Laboratory tests Glucosestudies, lipids, renal & liver function Sleepstudies Abdominal US, Echo Secondarycauses Geneticcause/suspicionof?
- 24. Waist Circumference Males – 102 (94) cm Females – 88 (80) cm
- 26. WEIGHT LOSS
- 27. Introduction Always ask aboutweightchange Changeof 5% over 6 months is significant Relative change is also important Significantweight loss – markerof serious illness Persistence & periodicevaluation to identify thecause - important
- 28. Mechanisms of weight loss Increased energyexpenditure Increased energy loss Decreased food intake
- 29. Causes of weight loss I. Involuntary with increased appetite A. Increased energy expenditure Hyperthyroidism Pheochromocytoma Extensiveexercise B. Increased energy loss Diabetes Mellitus Malabsorptionsyndromes Chronicpancreatitis Ulcerative colitis Chrohn’sdisease Celiac sprue
- 30. Causes of weight loss (Cont’d) II. Involuntary with decreased appetite A. Medical disorders Cancer Infections: HIV, TB, Endocarditis, lung abscess, hepatitis, chronic helminth infection Chronic illnesses CHF, CLD, COPD, CKD Endocrine diseases Adrenal insufficiency Hypercalcemia GI Diseases PUD Strictures Dysphagia Diabetic gasteroparesis Compressive mass Infiltrating cancer Hyperemesis gravidarum B. Psychiatric Disorders Depression C. Chronic drug use Alcohol Metformin Anti cancers ART
- 31. Causes of weight loss (Cont’d) III. Voluntary Weight Loss • Diet and exercise • Treatment of Obesity • Anorexia Nervosa, Bulimia
- 32. Evaluation • Ask About Appetite • Food Intake • Weight History • Maximum Weight • Usual Weight • Current Weight • Patients Underestimate/Overestimate • Ask Family Members
- 33. Evaluation (cont’d) • Voluntary or Involuntary • Duration, rapidity & amount of Weight Loss • Nutritional Status
- 34. Evaluation (cont’d) General Appearance Vital Signs HEENT : Hair Changes Pallor Mouth changes GLANDS : Lymph Nodes Thyroid
- 35. Evaluation (cont’d) RESPIRATORY SYSTEM : Cough Dyspnea Chest Findings CVS : Dyspnea Orthopnea Oedema Cardiac Findings
- 36. Evaluation (cont’d) • GIS : Vomiting – Gastric Outlet Obstruction Diarrhea Malabsorption Chronic Liver Disease Organomegaly • GUS : Polyuria Chronic Renal Failure • CNS : Paraplegia Malignancy Motor Neurone Disease
- 38. FIRST PHASE TESTS – For Every Patient • CBC/ESR • Urinalysis • Blood Chemistry Tests • Fasting blood sugar • Calcium • Urea & Creatinine – Chronic renal failure • Liver function tests – Chronic liver disease • Electrolytes
- 39. FIRST PHASE TESTS – For Every Patient (Cont’d) • TSH – Thyrotoxicosis • HIV test • Chest x- ray • Stool for occult blood
- 40. SECOND PHASE TESTS • CT scans – Abdomen, chest, brain • Mammography • Parathyroid hormone level (if calcium level is elevated) • Endoscopy • Colonoscopy
- 41. SECOND PHASE TESTS (Cont’d) • Blood Cultures • 72 h stool fat • Bone marrow biopsy • Vitamin B12 level • MRI of the spine
- 42. Conclusion Gain & Loss in weightare importantclinical problems Involuntarychange is a markerof serious underlying disease Alwaysask aboutappetite Obesity is a seriousworld wide problemwith increased morbidity & mortality Persistenceand periodicevaluation is important to reach at the underlying cause forweight loss
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- 44. Thank you