Obesity Management

Obesity Management
By
Dr/samar Hamdoun
Over view :
Obesity is a complex disease involving an

excessive amount of body fat. Obesity isn't
just a cosmetic concern. It is a medical
problem that increases your risk of other
diseases and health problems, such as heart
disease, diabetes, high blood pressure and
certain cancers.
Causes of Obesity
1)Genetic factor.
2) Environmental factor.
(Some Drugs B. Blockers
Depression, Steroids, anti
Antiepilrptic Drugs. Arthritis.
3)Personal factor.
(excess caloric intake, poor
Poor life Style. Lack of activity)
Social and economic issues
Social and economic factors are linked to
obesity. Avoiding obesity is difficult if you don’t
have safe areas to walk or exercise. Similarly,
you may not have been taught healthy ways
of cooking, or you may not have access to
healthier foods. In addition, the people you
spend time with may influence your weight —
you’re more likely to develop obesity if you
have friends or relatives with obesity.
Age
Obesity can occur at any age, even in young

children. But as you age, hormonal changes and a
less active lifestyle increase your risk of obesity. In
addition, the amount of muscle in your body tends to
decrease with age. Generally, lower muscle mass
leads to a decrease in metabolism. These changes
also reduce calorie needs, and can make it harder to
keep off excess weight. If you don't consciously
control what you eat and become more physically
active as you age, you'll likely gain weight.
Other factors
Lack of sleep. Not getting enough sleep or getting too much sleep can
cause changes in hormones that increase your appetite. You may also
crave foods high in calories and carbohydrates, which can contribute to
weight gain.
Stress. Many external factors that affect your mood and well-being may
contribute to obesity. People often seek more high-calorie food when
experiencing stressful situations.
Microbiome. Your gut bacteria are affected by what you eat and may
contribute to weight gain or difficulty losing weight.
Previous attempts to lose weight. Previous attempts of weight loss
followed by rapid weight regain may contribute to further weight gain.
This phenomenon, sometimes called yo-yo dieting, can slow your
metabolism.
Complications
Cardiovascular disease.
Type 2 DM.
Sleep apnea.
Cancers.
Infertility.
Digestive problems.
Quality of life
Depression
Disability
Sexual problems
Shame and guilt
Social isolation
Lower work achievement
Prevention
Exercise regularly. You need to get

150 to 300 minutes of moderate-
intensity activity a week to prevent
weight gain. Moderately intense
physical activities include fast
walking and swimming.
Follow a healthy-eating plan. Focus on low-calorie, nutrient-
dense foods, such as fruits, vegetables and whole grains.
Avoid saturated fat and limit sweets and alcohol. Eat three
regular meals a day with limited snacking. You can still enjoy
small amounts of high-fat, high-calorie foods as an infrequent
treat. Just be sure to choose foods that promote a healthy
weight and good health most of the timE.
Be consistent. Sticking to your healthy-weight plan during the
week, on the weekends, and amidst vacation and holidays as
much as possible increases your chances of long-term success
Know and avoid the food traps that cause you to eat. Identify
situations that trigger out-of-control eating. Try keeping a
journal and write down what you eat, how much you eat,
when you eat, how you’re feeling and how hungry you are.
After a while, you should see patterns emerge. You can plan
ahead and develop strategies for handling these types of
situations and stay in control of your eating behaviors.
Monitor your weight regularly. People who weigh themselves at
least once a week are more successful in keeping off excess
pounds. Monitoring your weight can tell you whether your
efforts are working and can help you detect small weight gains
before they become big problems
ASSESSMENT OF Obesity :
1)Body weight.
2) Anthropometric mmeasurements.
. Height
Height. Waist Circumference.
3) Muscle mass. (Free fat Mass)
Bioelectric impedence.
BMI
To determine your body mass index,

divide your weight in pounds by your
height in inches squared and multiply by
703. Or divide your weight in kilograms
by your height in meters squared.
BMI Weight status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30:34.9 obese grade1
35:39. obese grade2
>40 Morbid obese

Taking history from the patient:
. Occupation.
. 24h recall.
. Food allergy.
. Family history of Obesity.
. Medications.
.previous attempts of losing weight.
. Associated diseases.
. Physical activity.
. Eating pattern. .
. Gyncological history.
Lab investigations :
Fasting lipid panel
Liver function studies
Thyroid function tests
Fasting glucose and hemoglobin A1c (HbA1c)
cBc
Ca ionized.
Total calcium.
Physical Examination:
Hair. (thin. Not shiny) zinc defIciency
Lips. Pale(iron deficiency)
Angular somatitis. Fisured tongue (B complex
deficiency)
Nail: spooning (anaemia)
Brittle nails (zinc and iron deficiency
Neck:acanthosis negricans.
Management of Obesity :
The goal of obesity treatment is to reach
and stay at a healthy weight. This
improves your overall health and lowers
your risk of developing complications
related to obesity
The initial treatment goal is usually a modest
weight loss — 5% to 10% of your total weight
Dietary changes
Reducing calories and practicing healthier

eating habits are vital to overcoming
obesity.
Methods to cut calories :
. Harris bendect equation.
. Calculate 24 hrs calories and reduce
1000.
. For food exchange wecan use this
equation for weight maintainence:
‫الطاقه االساسيه‬+ ‫طاقة النشاط اليومي‬
‫*الوزن المثالي‬٢٢.٥+ ‫* الوزن المثالي‬١١ ‫للنشاط الخفيف او‬٧
‫ للنشاط الشاق‬٢٢ ‫للنشاط المتوسط او‬.
But to lose weight :
We have to subtract 500 calories from

Total caloric intake.
The easiest method
Body weight *20 ifBMI <40

Body wt*16 if BMI 40or more
Then subtract 500 calories.

Criteria of good diet
Safe.
. SufficienT:patient does not feel hungry
. TaiLored, individualized, flexibLe.
. No lack of energy. Meet nutrition

requirements.
. Achieve weight loss.
Guid lineS for Healthy diet:
. AccepTable macro nutrient distribution range
45:60%carbs of total cal. Intake
. Pt n:25
.fat :25:30%
Fibers 30 :35 g/day
Poly unsaturated fatty acids 10%
Mono unsaturated fatty acids 20%
Sodium less than 2400 mg.
Ca 1000 :1500mg
Fad Diets
Rapid weight loss.
Restricted calories.
Avoidance of certain types of foods
Or stick to a certain Type of food.
Examples :
Atkin high protein diet

Low carb Diets
Cappage soup
Ketogenic:high fat diet
Body watcher
paleo
Feeling full on less
Some foods — such as desserts, candies, fats
and processed foods — contain a large amount
of calories for a small portion. In contrast, fruits
and vegetables provide a larger portion size with
fewer calories. By eating larger portions of foods
that have fewer calories, you reduce hunger
pangs, take in fewer calories and feel better
about your meal, which contributes to how
satisfied you feel overall.
Exercise
People with obesity need to get at least 150
minutes a week of moderate-intensity
physical activity to prevent further weight
gain or to maintain the loss of a modest
amount of weight. To achieve more-
significant weight loss, you may need to
exercise 300 minutes or more a week. You
probably will need to gradually increase the
amount you exercise as your endurance
and fitness improve.
Treatment selection based on BMI
From 25to 29.9: Life style modificationsphysical
activity.
No Pharmacotherapy nor surgeries.
From 30 :34.9 :
Life style, physical activity, Pharmacotherapy, no
sSurgerie
From 35:40 if associated with co-morbidities
refere to surgeon.
Pharmacotherapy
Orlistat
Liraglutide
Metformin???
contrave
Thank you

Obesity Management

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Obesity Management

Obesity is a complex disease involving an

Obesity can occur at any age, even in young

Exercise regularly. You need to get

To determine your body mass index,

30:34.9 obese grade1

35:39. obese grade2

>40 Morbid obese

Reducing calories and practicing healthier

We have to subtract 500 calories from

Body weight *20 ifBMI <40

Then subtract 500 calories.

. No lack of energy. Meet nutrition

Atkin high protein diet

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