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![OBESITY
OBESITY PREVALENCE MAPS
▸Adult obesity prevalence by state and territory using self-reported information from the Behavioral
Risk Factor Surveillance System.
▸Obesity is common, serious, and costly
▸The prevalence of obesity was 39.8% and affected about 93.3 million of US adults in 2015~2016.
▸Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of
cancer that are some of the leading causes of preventable, premature death. [Read
guidelinesExternal
]
▸The estimated annual medical cost of obesity in the United States was $147 billion in 2008 US
dollars; the medical cost for people who have obesity was $1,429 higher than those of normal
weight
CDC National Center for Health Statistics (NCHS) data briefCdc-pdf
PDF-603KB](https://image.slidesharecdn.com/mansilla-obesidad-191017185601/85/Obesity-6-320.jpg)
![TEXT
BEHAVIOR THERAPY
▸Cognitive restructuring: cognitive behavioral therapy],
motivational interviewing](https://image.slidesharecdn.com/mansilla-obesidad-191017185601/85/Obesity-40-320.jpg)
Uploaded byGregorio Cortes-Maisonet, MD, CHCP
Obesity
This document discusses obesity, including its definitions, classifications, prevalence, physiology, and management. It provides guidelines for clinicians on their role in weight loss, including counseling strategies to promote behavior change. New guidelines for obesity management are presented, along with selecting appropriate medications based on a patient's comorbidities. Surgical and non-surgical procedures for obesity are outlined, along with expected weight loss and vitamin deficiencies. The role of nutrition, physical activity, behavior therapy, and medical therapy in obesity treatment is also examined.
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More from Gregorio Cortes-Maisonet, MD, CHCP
Obesity
- 1. OBESITPAOLA MANSILLA LETELIER,MD ENDOCRINOLOGIST THYROID AND ENDOCRINE CENTER
- 2. TEXT LEARNING OBJECTIVES ▸Apply counselingstrategies to promote behavior change in patients with obesity ▸Learn about new guidelines for management of Obesity ▸Select adequate obesity medications taking into account patient’s Comorbidities
- 3. CLINICIAN ROLE INWEIGHT LOSS
- 4. OBESITY DEFINITIONS ▸Obesity: Body MassIndex (BMI) of 30 kg/m2 or higher. ▸Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, calculated by using the adult’s weight in kilograms divided by the square of his or her height in meters.
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- 6. OBESITY OBESITY PREVALENCE MAPS ▸Adultobesity prevalence by state and territory using self-reported information from the Behavioral Risk Factor Surveillance System. ▸Obesity is common, serious, and costly ▸The prevalence of obesity was 39.8% and affected about 93.3 million of US adults in 2015~2016. ▸Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death. [Read guidelinesExternal ] ▸The estimated annual medical cost of obesity in the United States was $147 billion in 2008 US dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight CDC National Center for Health Statistics (NCHS) data briefCdc-pdf PDF-603KB
- 7. TEXT OBESITY ▸Hispanics (47.0%) andnon-Hispanic blacks (46.8%) had the highest age-adjusted prevalence of obesity, followed by non- Hispanic whites (37.9%) and non-Hispanic Asians (12.7%). ▸The prevalence of obesity was 35.7% among young adults aged 20 to 39 years, 42.8% among middle-aged adults aged 40 to 59 years, and 41.0% among older adults aged 60 and older.
- 8. Prevalence¶ of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2011 *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%. ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
- 9. Prevalence¶ of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2012 *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%. ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
- 10. Prevalence¶ of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2013 *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%. ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
- 11. Prevalence¶ of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2014 *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%. ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
- 12. Prevalence¶ of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2015 *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%. ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
- 13. Prevalence¶ of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2016 *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%. ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
- 14. Prevalence¶ of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2017 ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.
- 15. Prevalence¶ of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2018 ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.
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- 20. OBESITY BRAIN REGIONS ANDFOOD INTAKE RREGULATION
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- 23. Signaling in thebrain of adolescents in response to glucose or fructose: schematic representation of changes in the periphery and brain after the ingestion of glucose or fructose. George A. Bray Diabetes 2016;65:1797-1799 ©2016 by American Diabetes Association
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- 31. OBESITY NUTRITION ▸Reduced-calorie meal planand macronutrient composition.Reducing total energy (caloric) intake should be the main component of any weight-loss intervention. ▸Modifying macronutrient composition may be considered to optimize adherence, eating patterns, weight loss, metabolic profiles, risk factor reduction, and/or clinical outcomes
- 32. OBESITY INTERMITTENT FASTING ANDTHEIR EFFICACY FOR WEIGHT LOSS
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- 35. OBESITY PHYSICAL ACTIVITY ▸Aerobic physicalactivity training should be prescribed to patients with overweight or obesity as a component of lifestyle intervention; the ultimate goal should be ≥150 min/week of moderate exercise performed during 3 to 5 daily sessions per week ▸Behavioral lifestyle intervention and support should be intensified if patients do not achieve a 2.5% weight loss in the first month of treatment, as early weight reduction is a key predictor of long- term weight-loss success ▸Promote fat loss while preserving fat-free mass; the goal should be resistance training 2 to 3 times per week consisting of single-set exercises that use the major muscle groups ▸Behavioral lifestyle intervention should be tailored to a patient’s ethnic, cultural, socioeconomic, and educational background ▸Reduce sedentary behavior AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY W. Timothy Garvey, Jeffrey I. Mechanick, Elise M. Brett, Alan J. Garber, Daniel L. Hurley, Ania M. Jastreboff, Karl Nadolsky, Rachel Pessah-Pollack, Raymond Plodkowski, and Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. Endocrine Practice 2016 22:Supplement 3, 1-203
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- 39. OBESITY BEHAVIOR THERAPY ▸Self-monitoring ofweight, food intake, and physical activity ▸Clear and reasonable goal-setting ▸Education pertaining to obesity, nutrition, and physical activity ▸Face-to-face and group meetings ▸Stimulus control ▸Systematic approaches for problem solving ▸Stress reduction
- 40. TEXT BEHAVIOR THERAPY ▸Cognitive restructuring:cognitive behavioral therapy], motivational interviewing
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- 43. OBESITY EXPECTED WEIGHT LOSSASSOCIATED WITH DIFFERENT BARIATRIC SURGICAL PROCEDURES
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- 51. OBESITY WEIGHT LOSS MEDICATIONSAND THEIR RESPONSE Goal : About 4-5 % weight at 12-16 weeks
- 52. OBESITY WEIGHT LOSS MEDICATIONSAND THEIR EFFECTS
- 53. OBESITY MEDICATION EFFECTS ONWEIGHT Apovian CM et al. J clin Endocrinol Metab. 2015; 100:342-362
- 54. OBESITY Apovian CM etal. J clin Endocrinol Metab. 2015; 100:342-362
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- 56. OBESITY HCG - 500KCAL DIET ▸ HCG is a hormone that is produced by the human placenta during pregnancy. ▸ Products that claim to contain HCG are typically marketed in connection with a very low calorie diet, usually one that limits calories to 500 per day. ▸ “reset your metabolism,” ▸ change “abnormal eating patterns”
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- 60. OBESITY WEIGHT LOSS ANDGLYCEMIC CONTROL
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- 64. OBESITY OBESITY + CARDIOVASCULARDISEASE Use agents without cardiovascular signals (increased blood pressure and pulse): ▸Orlistat ▸ Lorcaserin • Lower risk of increased blood pressure than phentermine/topiramate
- 65. OBESITY SUMMARY ▸ First guidelinethat specifically names anti-obesity medications and recommended doses Patient selection criteria: ▸ BMI >27 kg/m2 with one comorbidity ▸ BMI >30 kg/m2 with no comorbidities ▸ Diet, exercise and behavior modification is the foundation of any weight management plan ▸ Provides a blueprint on medications that cause weight gain and their alternatives ▸ New paradigm: treat weight first, then comorbid condition(s
- 66. OBESITY SUMMARY ▸Medications can driveweight gain and they can also help patients lose weight and keep it off ▸Before prescribing, review current medications and try to d/c those causing gain ▸KNOW drug profiles - prescribe the right medication for the right patient ▸Always encourage patient to follow lifestyle changes ▸Evaluate response at ~ 12 weeks on drug and change or increase if weight loss is < 5% ▸MOTIVATE your patient ▸BE AN EXAMPLE
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Editor's Notes
- #24 Signaling in the brain of adolescents in response to glucose or fructose: schematic representation of changes in the periphery and brain after the ingestion of glucose or fructose. Subjective responses using variable analog scales (VAS) are shown in the lower-left corner for hunger, fullness, and satiety where differences were detected. Both glucose and fructose are absorbed, but fructose is largely cleared in the liver, where it stimulates de novo lipogenesis. Glucose is taken up by many tissues and stimulates insulin release from the pancreas more so in the adolescents with obesity than in lean adolescents. Both monosaccharides reduce circulating acyl-ghrelin concentrations. Effects of glucose and fructose on cerebral blood flow relative to baseline are shown by arrows in major regions of the brain: the prefrontal cortex, which has major executive functions; the hypothalamus, which modulates appetite; and the limbic system and striatum-thalamus, which encompass the reward feature of food. Solid lines represent neural connections and dashed lines circulating connections. ‡Adjusted for acyl-ghrelin and insulin. ACC, anterior cingulate cortex; F, fructose; Fru, fructose; G, glucose; GLP-1, glucagon like peptide 1; L, lean adolescents; N. accumbens, nucleus accumbens; Ob, adolescents with obesity; OXM, oxyntomodulin; PP, pancreatic polypeptide; PYY, polypeptide YY; TG, triglyceride.