This document provides an overview of the Programi-Care holistic weight management program led by Dr. Lee Oi Wah. It defines obesity and discusses its prevalence and health consequences. The program focuses on assessment, dietary therapy including calorie counting and step I diets, physical activity goals of 30-45 minutes per week burning 1000+ calories, and behavioral strategies like journaling and goal setting. Regular medical monitoring and emphasis on health benefits are also discussed. The goal is 4-6 months of weight loss followed by maintenance.

1. PROGRAMI-CAREA HOLISTIC APPROACH TO WEIGHT MANAGEMENTBY DR LEE OI WAHPENGARAH HCM

3. OverviewDefinition, Prevalence & Consequences of ObesityHealthy LifestylesAssessment of ObesityTreatments for Obesity

4. DefinitionObesity is an abnormal accumulation of body fat, usually 20 percent or more over an individual's ideal body weight.

5. Calculating BMICalculate Body Mass Index (BMI) = weight (kg)height squared (meters) Or…weight (pounds) x 703height squared (inches)

6. Definition of Overweight & ObesityUsing BMI

7. Definition of Overweight & ObesityUsing waist circumferenceWomen > 80cm

8. Men >94cmPrevalence of ObesityChildhood and adolescent obesity increased from 5% to 16% in the last 20 yearsAdulthood obesity increased from 12% to 21% in 10 years.16 million US adults with BMI over 3560 million US obese adults (BMI > 30)

9. Factors predispose to obesityGenetic – familial tendency.

10. Sex – women more susceptible .

11. Activity – lack of physical activity.

12. Psychogenic – emotional deprivation, depression .Social class – poorer classes.

13. Alcohol – problem drinking.

14. Smoking – cessation smoking.

15. Prescribed drugs – tricyclic derivatives.Weight Gain: How Does It Happen?Energy imbalance calories consumed not equal to calories used Over a long period of timeDue to a combination of several factorsIndividual behaviorsSocial interactionsEnvironmental factorsGenetics

16. Weight Gain: Energy In3500 calories = 1 pound100 calories extra per day= 36,500 extra per year= 10.4 lbs weight gainQuestion: How much is 100 calories?Answer: Not very much!1 glass skim milk, or1 banana, or1 slice cheese, or1 tablespoon butter

17. Health Consequences of ObesityMajor cause of preventable death Increase in mortality from all causesIncrease in risk for these cancersEndometriumBreastProstateColonIncrease in risk of:HypertensionDyslipidemiaDiabetes type 2Coronary artery diseaseStrokeGallbladder diseaseOsteoarthritisSleep apnea & respiratory problems

19. Health Consequences of ObesityStill doing nothing about that extra flab? Major cause of preventable death Increase in mortality from all causesIncrease in risk for these cancersEndometriumBreastProstateColonIncrease in risk of:HypertensionDyslipidemiaDiabetes type 2Coronary artery diseaseStrokeGallbladder diseaseOsteoarthritisSleep apnea & respiratory problems

20. Rosalie Bradford-200LBSThe longtime binge-eater weighed an astounding 1,199 lb, having spent 8 years immobile in bed.She holds Guinness World Record for most weight lost by a woman.

21. I-CARE :WHAT DO WE DO?

23. Assessment Assess the patient's readiness and willingness to lose weight:Unfortunately those who are most concerned about their weights are not necessarily those who are at the highest health risk.Those who are unable or unwilling to embark on a weight reduction program, but they are willing to take steps to avoid further weight gain or perhaps to work on other risk factors such as cigarette smoking, and they should be encouraged to do so.

24. Assessment Is he overweight? Obese?What are his key health issues?

25. Assessment Measure BMIMeasure waist circumference“Apple shape” body is higher risk for DM, CVD, HTNWaist larger than 40 inches for men Waist larger than 35 inches for women

26. AssessmentAssess for other risk factors

27. Existing high risk disease:

28. coronary heart disease; other atherosclerotic diseases; type 2 diabetes; sleep apnea

29. Diseases associated with obesity

30. Gynecological problems; osteoarthritis; gallstones; stress incontinence

31. Cardiovascular risk factors (3 or more = high risk)

32. Cigarette smoking; Hypertension; LDL >130; HDL <35; fasting glucose = 110 to 125; family history of premature CHD; men age > 45; women age > 55

33. Other risk factors

34. Physical inactivity; elevated serum triglycerides

35. Medications associated with obesityTreatment ApproachA multi-faceted approach is bestDietPhysical activityBehavior change“A” Recommendation

36. Treatment ApproachAim for 4 - 6 months of weight loss effortMost people will lose 20 to 25 pounds After 6 months, weight loss is more difficultChanges in resting metabolic rateEnergy requirements decrease as weight decreasesDiet adherence waversSet goals for weight maintenance for next 6 months, then reassess.

37. Dietary TherapyWeight reduction with dietary treatment is in order for virtually all patients with a BMI 25-30 who have comorbidities and for all patients over BMI 30.Strategies of dietary therapy include teaching about calorie content of different foods, food composition (fats, carbohydrates, and proteins), reading nutrition labels, types of foods to buy, and how to prepare foods.

38. Low-Calorie Step I Diet

39. Weight Maintenance: How Much Should People Eat?Varies widelySome averages, below

40. Physical ActivityPhysical activity should be an integral part of weight loss

41. Physical activity alone is less successful than a combined diet & exercise program

42. Increased activity alone does not decrease weightSustained activity does prevent weight regainReduces risk for heart disease & diabetesPhysical ActivityStart slowlyMany obese people live sedentary livesAvoid injuryEarly changes can be activities of daily livingIncrease intensity & duration graduallyLong-term goal30 to 45 minutes or more of physical activity5 or more days per weekBurn 1000+ calories per week

43. Recommend Physical ActivityWhat does it take to burn 1000 calories per week?Gardening 5 hoursCycling 22 milesRunning 11 milesWalking 12 milesDancing 3 hours

45. Behavioral StrategiesKeep a journal of diet & activityVery powerful intervention!Set specific goals re: behaviorsEatingActivityRelated behaviorsTrack improvement Weigh & measure on a regular basis

46. Cognitive StrategiesFocus on the goals

47. Plan meals & activity

48. Develop reminder systems

49. Anticipate temptations & plan resistance

50. Reward yourself

51. Limit quantities, but do not deprive yourself

52. Have confidence in your ability to succeed

53. Do positive self-talkFollowupMonitor weight, BP, pulse at each visitMonitor waist size intermittentlyShare progress with patient; praise effortsShare lab results with patientEmphasize findings associated with weight reductionFocus on medical benefitsMost weight loss doesn’t reach individual’s ‘ideal’ (cosmetic) goal

54. Thank You and Good Luck!