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Prevention of Obesity in Adult
- 2. OBESITY
- 3. Definitions Weight that is higher than what is considered as a healthy weight for a given height is described as overweight or obese. Body Mass Index (BMI) is used as a screening tool for overweight or obesity. divide weight in kilograms (kg) by height in metres (m) then divide the answer by height again to get your BMI.
- 4. Body Mass Index (BMI)
- 5. More than one-third (36.5%) of U.S. adults have obesity Obesity is common, serious & costly!
- 6. Health consequences of obesity
- 7. Health consequences of obesity All-causes of death High Cholesterol Coronary heart disease Stroke Cancers (Endometrial, breast, colon, kidney, gallbladder, and liver) Low quality of life Mental illness such as clinical depression and anxiety Body pain and difficulty with physical functioning
- 8. •Overweight & Obesity: Should be managed as a long-term chronic disease •Medically meaningful weight loss: • 5-10 % weight loss •SUCCESS!!!: Low calorie meal plan + Exercise +Pharmaceutical therapy Prevention and treatment
- 10. Burns calories (even while not exercising) and helps with weight loss while maintain muscle Decreases the risk of dying from heart disease Moderate- vigorous exercise increase survival in both men and women at age 50 (1.3-3.7 years) Lowers blood pressure (jogging 2 miles decreases systolic BP 5-15 mmHg) Helps control of blood sugar and delay the onset of diabetes Improves the blood fats by decreasing triglyceride levels and raising good cholesterol levels
- 11. Reduces stress, tension, depression, and anxiety Improves cognitive function in both young and older adults Helps to prevent osteoporosis May protect against breast and prostate cancer Helps quitting smoking
- 12. Exercise types Aerobic Exercise: Running, walking, swimming which increases heart rate. Resistance training: Increase muscle strength includes exercise bands, weights. Recommended at least twice a week with at least 48 hours rest between sessions. Stretching exercise: Improves flexibility and prevents joint/muscle injuries.
- 13. How to exercise? Warm up: 5-10 minutes (slow walk or stretching). It allows gradual increase of heart rate Work out: Mix of aerobic, resistance and/or stretching Cool down: Prevents muscle cramps. Light exercise or stretches for 5 minutes At least 30 minutes a day, on 5 or more days of the week
- 14. How often exercise? Moderate-intensity aerobic exercise (e.g. brisk walk) At least 30 minutes a day, on 5 or more days of the week. You should be able to carry on conversation during moderate intensity exercise Vigorous- intensity exercise (e.g. jogging) 20 minutes a day on 3 days of week
- 15. Washing windows/ floors for 45-60 minutes Playing volleyball for 45 minutes Gardening for 30-45 minutes Bicycling 5 miles in 30 minutes Walking 2 miles in 30 minutes Water aerobics in 30 minutes Jumping rope for 15 minutes Running 1.5 miles in 15 minutes Stair walking for 15 minutes Moderate physical activity Less vigorous, more time More vigorous, less time
- 16. Exercise safely! Most people do not need any special test before starting an exercise program but it is better to discuss with health care provider. Seek for help if you develop chest pain, shortness of breath, heart racing, syncope, excessive tiredness during or after your exercise. Remember to stay well hydrated. Wear comfortable, well-fitting shoes during the exercise.
- 18. Energy intake from different categories
- 19. Let’s talk about the basics
- 20. Calorie restriction Low calorie meal: Deficit of 500-1000 kcal/day (daily calorie intake <1200 kcal/day), weight loss up to 1-2 pound/week. Very low calorie meal: Daily calorie intake <800 kcal/day, weight loss up to 1.5-2.5kg/week, 12- 16kg in 12-16 weeks. Especially recommended for patients who has BMI >30 kg/m2+comorbidities.
- 21. Medical and surgical treatment options Medical treatment + BehaviorModifications Surgical treatment+ BehaviorModifications (BehaviorModifications= diet +exercise) Diet and exercise should be continued with medical treatment or surgery.
- 22. Medical Treatment FDA approved medications: • Phentermine products (Adipex-P® or Suprenza®) • Naltrexone HCI AND Bupropion HCI (CONTRAVE®) • Phentermine-Topiramate ER (Qsymia®) • Orlistat (Xenical® or Alli®) • Lorcaserin HCI (Belviq®) • Liraglutide injection (Saxenda®)
- 23. Medications How it works The average weight loss after one-year Phentermine products (Adipex-P® or Suprenza®) Decreases appetite and also has a mild stimulant component 4-5 % Orlistat (Xenical® or alli®) *Available OTC. Decreases the amount of fat your body absorbs 5% Lorcaserin HCI (Belviq®) It works by helping you feel full while eating less, and it works on the chemicals in your brain to help decrease your appetite. 7% Naltrexone HCI and bupropion HCI (CONTRAVE®) Decreases appetite and control eating. 5-10% Phentermine- topiramate ER (Qsymia®) Increases your energy and decreases your appetite. 14.4 % Liraglutide injection (Saxenda®) Increases our natural production of insulin.It slows down the emptying of the stomach. Lastly, it works in the brain to reduce the amount of food consumed. 5-10% Medical Treatment
- 24. Medical Treatment Many potential side effects; treatment needs to be individualized for each patient: • Decreases appetite • Stimulates energy • Decreases the amount of fat body absorption • Slows down the emptying of the stomach
- 25. Surgical treatment- bariatric surgery and devices It is an effective treatment option for those affected by severe obesity Causes weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Indications: BMI >40, Severe obesity (or weighing more than 100 pounds over ideal body weight) BMI 35-40 with significant obesity-related conditions (type 2 diabetes, high blood pressure, sleep apnea or high cholesterol)
- 26. Bariatric procedures: Adjustable Gastric Banding-LAP-BAND® Sleeve Gastrectomy Roux en-Y Gastric Bypass Biliopancreatic Diversion with Duodenal Switch Neuromodulation (VBLOC®) Bariatric devices: ORBERA™ Intragastric Balloon ReShape™ Dual Balloon. Surgical treatment
- 27. Surgical treatment Sleeve gastrectomy is currently the most common bariatric procedure, however a medical treatment, surgical treatment needs to be individualized based on comorbid conditions and other multiple factors.
- 28. Surgical treatment- bariatric surgery and devices There are risks involved with bariatric surgery, as well as any other surgical procedure. Most common complication is vitamin and mineral deficiencies
- 29. References Uptodate The benefits and risks of exercise Uptodate Patient education: Exercise (The Basics) Uptodate Patient education: Exercise (Beyond the Basics) http://www.obesityaction.org/
- 30. Thank you
Editor's Notes
- Moderate levels of physical activity appear to confer a significant health benefit, although greater amounts of activity afford greater protection from premature death (figure 3) [36]. Progressing from lower to higher levels of physical activity has been shown to reduce overall mortality [33,35,37,39]. Vigorous exercise (at least 20 minutes three times a week) combined with regular exercise (at least 30 minutes of moderate activity most days of the week) was associated with a 50 percent decreased mortality risk in an observational study involving over 250,000 men and women aged 50 to 71 years [35]. Data from the Framingham Heart Study show that moderate and high, compared with low, physical activity levels increase life expectancy for men at age 50 by 1.3 and 3.7 years, respectively; results were similar for women (1.5 and 3.5 years) The risk of dying is decreased in those who exercise regularly. As an example, one study found that men who engaged in moderately vigorous sports had a 23 percent lower risk of death than men who were less active [2]. Exercise also helps to lower the risk of death in men with coronary artery disease (figure 1) [3]. ●Exercise is an essential component of weight management programs. Exercise burns calories and may help to burn calories even while not exercising. Dieting can lead to loss of muscle, but exercise can help maintain muscle mass while dieting. (See &quot;Patient education: Weight loss treatments (Beyond the Basics)&quot;.) ●Exercise improves blood sugar control in people with diabetes and can help prevent or delay the onset of type 2 diabetes. (See &quot;Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)&quot;.) ●Aerobic exercise helps decrease blood pressure; this effect may be even greater in people with high blood pressure. (See &quot;Patient education: High blood pressure treatment in adults (Beyond the Basics)&quot;.) ●Exercise often improves the blood fats (lipid profile) by decreasing triglyceride levels and raising high-density lipoprotein (good cholesterol) levels. (See &quot;Patient education: High cholesterol and lipids (hyperlipidemia) (Beyond the Basics)&quot;.) ●Most people report a reduction in stress after they exercise. Research has shown that exercise is associated with reduced tension, anxiety, and depression. ●Weightbearing exercise helps to prevent osteoporosis and reduces the incidence of fractures. (See &quot;Patient education: Osteoporosis prevention and treatment (Beyond the Basics)&quot;.) ●Exercise training can improve circulation and exercise tolerance for people who have angina (chest pain from a reduced blood supply to the heart). After exercise training, a person may be able to exercise longer or at a greater intensity. (See &quot;Patient education: Angina treatment — medical versus interventional therapy (Beyond the Basics)&quot;.) ●Some evidence suggests that exercise can provide protection against breast and prostate cancer, delay or prevent dementia, and decrease the risk of gallstone disease. ●Exercise can help with quitting sm
- Moderate levels of physical activity appear to confer a significant health benefit, although greater amounts of activity afford greater protection from premature death (figure 3) [36]. Progressing from lower to higher levels of physical activity has been shown to reduce overall mortality [33,35,37,39]. Vigorous exercise (at least 20 minutes three times a week) combined with regular exercise (at least 30 minutes of moderate activity most days of the week) was associated with a 50 percent decreased mortality risk in an observational study involving over 250,000 men and women aged 50 to 71 years [35]. Data from the Framingham Heart Study show that moderate and high, compared with low, physical activity levels increase life expectancy for men at age 50 by 1.3 and 3.7 years, respectively; results were similar for women (1.5 and 3.5 years) The risk of dying is decreased in those who exercise regularly. As an example, one study found that men who engaged in moderately vigorous sports had a 23 percent lower risk of death than men who were less active [2]. Exercise also helps to lower the risk of death in men with coronary artery disease (figure 1) [3]. ●Exercise is an essential component of weight management programs. Exercise burns calories and may help to burn calories even while not exercising. Dieting can lead to loss of muscle, but exercise can help maintain muscle mass while dieting. (See &quot;Patient education: Weight loss treatments (Beyond the Basics)&quot;.) ●Exercise improves blood sugar control in people with diabetes and can help prevent or delay the onset of type 2 diabetes. (See &quot;Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)&quot;.) ●Aerobic exercise helps decrease blood pressure; this effect may be even greater in people with high blood pressure. (See &quot;Patient education: High blood pressure treatment in adults (Beyond the Basics)&quot;.) ●Exercise often improves the blood fats (lipid profile) by decreasing triglyceride levels and raising high-density lipoprotein (good cholesterol) levels. (See &quot;Patient education: High cholesterol and lipids (hyperlipidemia) (Beyond the Basics)&quot;.) ●Most people report a reduction in stress after they exercise. Research has shown that exercise is associated with reduced tension, anxiety, and depression. ●Weightbearing exercise helps to prevent osteoporosis and reduces the incidence of fractures. (See &quot;Patient education: Osteoporosis prevention and treatment (Beyond the Basics)&quot;.) ●Exercise training can improve circulation and exercise tolerance for people who have angina (chest pain from a reduced blood supply to the heart). After exercise training, a person may be able to exercise longer or at a greater intensity. (See &quot;Patient education: Angina treatment — medical versus interventional therapy (Beyond the Basics)&quot;.) ●Some evidence suggests that exercise can provide protection against breast and prostate cancer, delay or prevent dementia, and decrease the risk of gallstone disease. ●Exercise can help with quitting sm
- Warm up — Exercise sessions should begin with a 5- to 10-minute period of warm-up. Start with some low-level aerobic exercises (walking, stationary cycling, calisthenics) and then do stretches and flexibility movements. The warm-up period allows for a gradual increase in the heart rate and may reduce the risk of injuries. Workout — It is a good idea to mix up aerobic exercise, strength training, and stretching so as to keep the workout fun and interesting. Aerobic exercise — Walking is an excellent aerobic activity. Cycling, rowing, stair machine climbing, and other endurance-type activities are also great. Swimming and water aerobics are excellent for people with arthritis. Low-impact activities are recommended because they are less likely to result in physical injury. Running on a street is a higher-impact activity because of the stresses on the feet and legs as they strike the ground with each step. The exercises should be enjoyable and simple to carry out to encourage a long-term commitment. It may be best to vary the exercises you do each week (such as swim on three of the days and walk on three of the days) to decrease repetitive strain to your muscles and other tissues. There is no age specific heart rate recommendation; a specific heart rate is not necessary to achieve health benefits. If you are breathless, fatigued, and sweating, you have worked hard enough. During moderate-intensity exercise, you should be able to carry on a conversation. A minimum of 30 minutes of moderate-intensity aerobic exercise (eg, brisk walking) is recommended on five days each week. Alternately, you can perform 20 minutes of vigorous-intensity aerobic exercise (eg, jogging) on three days each week. This recommendation is in addition to routine, light-intensity activities of daily living (eg, cooking, casual walking, shopping, etc) [4]. Resistance training — Resistance training can be done with weights, machines, or exercise bands. It should be performed at least twice a week with at least 48 hours of rest between sessions. Resistance training is commonly described in terms of &quot;sets&quot; of &quot;repetitions.&quot; ●A repetition is a single completed back and forth motion of a resistance exercise, such as bending and extending the arm at the elbow while holding a weight in the hand. ●A set is a number of repetitions done without resting. Most experts recommend at least one set of exercises, including 8 to 12 repetitions, for each of the major muscle groups. Begin with minimal resistance (light weights, resistive bands, or even a can of food) to allow the muscles and other tissues to adapt. Examples of exercises for the upper body are shown in a figure (figure 3). It is important to use proper technique. If you belong to a health club or gym you might ask a trainer to observe technique. Be sure to breathe normally while lifting weights. Do not hold the breath; instead, exhale with exertion. Do not perform resistance training if you are in pain or have swelling anywhere. Stretching — Stretching and flexibility exercises should include every major joint (hip, back, shoulder, knee, upper trunk, neck). It is best not to stretch &quot;cold&quot; muscles, so engage in a few minutes of low-intensity aerobic exercise first. Movement into a stretch should be slow, and the stretch itself should be held for approximately 10 to 30 seconds. Do not bounce while beginning or performing a stretch. Stretching exercises are shown in a figure (figure 4). Each exercise should be performed several times. Stretch and yoga classes are also a good way to remain flexible. The stretch should not cause pain but only mild discomfort. Cool down — Cool-down exercises should be done for approximately five minutes at the end of an exercise session. Similar to the warm-up period, cool-down may include low-level aerobic exercise (such as slow walking), calisthenics, and stretching. This allows the body to clear acid that has built up in the muscles and allows more blood back into the circulation because less is sent to the muscles. This helps to prevent muscle cramps and sudden drops in blood pressure that can cause lightheadedness.
- WHEN TO SEEK HELP — In order to exercise safely, it&apos;s important to know the warning signs that could indicate a problem. If any of these problems occur, you should stop the exercise or activity and contact your health care provider immediately: ●Pain or pressure in the chest, arms, throat, jaw or back ●Nausea or vomiting during or after exercise ●Palpitations or heart flutters or a sudden burst of a very fast heart rate ●Inability to catch your breath ●Lightheadedness, dizziness or feeling faint during exercise (feeling lightheaded after exercise may mean that a longer cool-down period is needed) ●Feeling very weak or very tired ●Pains in joints, shins, heels or calf muscles (this is not an emergency but should be evaluated if it does not resolve) PRECAUTIONS ●Remember to drink fluids during and after exercise. Thirst is a good indicator that more fluids are needed. ●Do not exercise outdoors if the temperature is too hot or too cold. ●In cooler weather, it is better to wear layers of clothes while exercising outdoors. A layer of clothing can be removed if needed. ●Wear supportive, well-fitting running or walking shoes. Replace shoes when signs of deterioration develop (eg, cracking, separation of shoe from the sole, imprint of the foot in the insole). The amount of time exercise shoes will last depends upon a number of factors, including how often and where the shoes are worn.
- Diet and exercise should be continued with medical treatment or surgery.
- There are several FDA approved medications. Discuss with your doctor to see which medication is best option for you. Orlistat (Xenical® or alli®) is available over-the-counter
- There are several FDA approved medications. Discuss with your doctor to see which medication is best option for you. Orlistat (Xenical® or alli®) is available over-the-counter
- These are available procedures and devices.