obesity

1. APPROACH TO PATIENT WITH OBESITY:

2. ASEM MUSTAFA SHADID
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3. UNINTENTIONAL WEIGHT GAIN - RED FLAG
SYMPTOMS
• The patient may be unaware of weight gain so
previous weight data can frame the consultation
and your concerns.

4. UNINTENTIONAL WEIGHT GAIN

5. RED FLAG SYMPTOMS

10. SUMMARY

11. STAGES OF CHANGE MODEL TO ASSESS
READINESS TO LOSE WEIGH
https://www.moh.gov.sa/OCP

12. APPLYING THE STAGES OF CHANGE MODEL TO
ASSESS READINESS TO LOSE WEIGHT
https://www.moh.gov.sa/OCP

13. REFERRAL FOR SPECIALIST SUPPORT:

14. MOST COMMON MEDICATIONS USED IN
TREATING OBESITY
• Currently there is a list of medications used for pharmacological treatment , however, there is
no enough evidence regarding the efficacy of different drugs, the benefit of combination
therapy, weight regain after withdrawal of medications or the benefits of continuing treatment
beyond 1 year.
However, the following are recommended
Consider adding pharmacologic agent with lifestyle interventions on an individual case basis after assessment of
risks and benefits:
- In obese adults (BMI ≥30 kg/m2) who failed to achieve or maintain weight loss with lifestyle modification program.
- In obese or overweight individuals (BMI ≥28 kg/m2 with co-morbidities) to assist in reducing obesity-related co-
morbidities, like type 2 diabetes, impaired glucose tolerance or the risk factors for type 2 diabetes .
- In pre-pubertal obese children Pharmacological therapy is generally not recommended, however, it can be
considered only (treatment with Orlistat) under supervision of specialized team, if severe co-morbidities are
present, e.g. orthopedic problems, sleep apnea, severe psychological disease or within the context of a supervised
clinical trial

15. PHARMACOLOGICAL TREATMENT:
• • Discuss with the patient the potential benefits, limitations, drug’s side effects, and the
temporary nature of the weight loss achieved with medications before initiating therapy
• • Discontinue use if the drug is ineffective, or if there are serious adverse effects

16. PHARMACOLOGICAL TREATMENT:
https://www.moh.gov.sa/OCP

17. 1. saxenda (liraglutide ) in FHx of thyroid
cancer or multiple endocrine neoplasia
2. Xenical (orlistat) in cholestasis and chronic
malabsorption syndrome
3. belviq (lorcaserin)
https://www.aafp.org

18. BARIATRIC SURGERY
• Consider Bariatric surgery as part of an overall clinical pathway for adult weight management.
• Consider bariatric surgery on an individual case basis after assessing the risks and benefits .
• • Consider bariatric surgery:
• - In adults with clinically severe obesity (BMI > 40 kg/m2 ). It is the most effective treatment for
morbid obesity, it leads to durable weight loss and improvement of co-morbidities
• - In adults with BMI > 35 kg/m2 and severe co-morbidities .
http://www.sages.org/publications/guidelines/guidelines-for-clinical-application-of-laparoscopic-bariatric-surgery/
Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ April 10, 2007 vol. 176 no. 8 doi: 10.1503/ cmaj.061409
Scottish Intercollegiate Guidelines Network (SIGN). Management of obesity: A national clinical guideline. Edinburgh: SIGN; 2010. http://www.sign.ac.uk/pdf/sign115.pdf.

19. BARIATRIC SURGERY
• • Consider bariatric surgery:
• - In adults with BMI > 30 kg/m2 who have poorly controlled type 2 diabetes and are at increased
cardiovascular risk .
• - In post pubertal adolescents with very severe to extreme obesity and severe co-morbidities .
Scottish Intercollegiate Guidelines Network (SIGN). Management of obesity: A national clinical guideline. Edinburgh: SIGN; 2010. http://www.sign.ac.uk/pdf/sign115.pdf.
Australian Government: Department of Health and Aging. Clinical Practice Guidelines for the Management of overweight and obesity in adults, adolescents and children in Australia
http://www.healthyactive.gov.au/internet/main/publishing.nsf/Content/obesityguidelines-guidelines-adults.htm .

20. COMMON TYPES OF BARIATRIC
SURGERY
Sleeve Gastrectomy
Laparoscopic adjustable
gastric banding
‫بالمنظار‬ ‫للتعديل‬ ‫قابل‬ ‫المعدة‬ ‫ربط‬
‫المعدة‬ ‫تكميم‬
Gastric bypass
‫المعدة‬ ‫تجاوز‬
https://www.moh.gov.sa/OCP

22. IMPLEMENT FAMILY MEDICINE CONSIDERATION
• Follow-up
• Regularly every 3 months
Relapse control

23. REFERENCE :
• https://www.moh.gov.sa/OCP
• https://www.aafp.org
• Scottish Intercollegiate Guidelines Network (SIGN).
Management of obesity: A national clinical guideline.
• Australian Government: Department of Health and
Aging. Clinical Practice Guidelines for the Management
of overweight and obesity in adults, adolescents and
children in Australia
• sages - guidelines-for-clinical-application-of-
laparoscopic-bariatric-surgery
• Canadian clinical practice guidelines on the
management and prevention of obesity in adults and
children.

24. THANK YOU