Obesity

Obesity

OVERVIEW:

Obesity is a condition of increased body weight (consisting of both lean and fat tissue) that leads to increased illness and death. Obesity is also defined as weight 20% greater than an individual's desirable weight.

SIGNS AND SYMPTOMS:

Increased body weight and adipose tissue

CAUSES:

• Multiple factors
• May have genetic cause
• Imbalance between food intake and energy expenditure
• Medical conditions (pancreatic disease, thalamus disorder, Cushing's syndrome)
• Drug side effect

SCOPE:

20-30% of adult men and 30-40% of adult women in the United States are overweight.

MOST OFTEN AFFECTED:

Obesity affects all ages; females affected more frequently than males; 20-25% of weight tendency is inherited.

RISK FACTORS:

• Parental obesity
• Pregnancy
• Sedentary lifestyle
• High-fat diet
• Low socioeconomic status

DIAGNOSIS

PHYSICAL EXAMINATION:

N/A

TESTS AND PROCEDURES:

• Blood tests
• Body mass index (BMI) may be calculated.

TREATMENT

GENERAL MEASURES:

• Health care providers should assess the degree of health risk from obesity; help set goals for therapy; counsel or refer to a registered dietician or weight loss program for in-depth work on diet, exercise, and behavior modification.
• Behavior modification can improve dietary adherence and longterm results of weight loss and should be included in any weight-loss program.
• Many reputable commercial and community programs offer weight reduction treatment. Look for programs with diets that meet the Recommended Daily Allowance (RDA) for nutrients, include exercise counseling, behavior modification, and provisions for longterm maintenance.
• Occasionally, patients with severe obesity are treated with a gastric bypass or stapling procedure. This complex procedure should only be done in a center skilled in this treatment. Surgical treatment is the most effective longterm weight loss treatment available for morbid obesity.

ACTIVITY:

Exercise alone rarely causes significant weight loss. It may improve longterm results of weight loss treatment and should be an integral part of any weight loss program.

DIET:

• Diet restriction is the cornerstone of obesity management (low-fat, high-complex carbohydrate and high-fiber).
• A 500 kilocalorie (kcal) reduction in calorie intake per day will result in approximately 1 pound of weight loss per week.
• Very low-calorie diets (400-800 kcal per day) are usually based on liquid formulas and cause more rapid weight loss. However, they can cause serious medical complications, and medical supervision is important.
• Avoid fad diets and miracle cures.

MEDICATIONS

COMMONLY PRESCRIBED DRUGS:

• Drug treatment is not usually recommended.
• Appetite suppressants may be indicated for short-term use (few weeks) along with a weight-toss regimen:
• Diethylpropion
• Phentermine
• Fenfluramine
• Mazindol
• Dexfenfluramine (Redux)
• Phendimetrazine
• Benzphetamine

CONTRAINDICATIONS:

Advanced atherosclerosis, cardiovascular disease, hypertension, hyperthyroidism, glaucoma, history of drug abuse, agitated states, use of monoamine oxidase (MAO) inhibitors

PRECAUTIONS:

• Abuse potential
• Weight gain after discontinuation of drug

DRUG INTERACTIONS:

N/A

Other Drugs:

• Phenylpropanolamine (PPA) is used in over-the-counter weight-loss preparations.
• Orlistat (xenical)

FOLLOW UP

PATIENT MONITORING:

Longterm followup and management is crucial to prevent further weight gain or regain after weight loss.

PREVENTION/AVOIDANCE:

Regular exercise and prudent diet with regular followup, especially in children and young adults and individuals with a family history of obesity or diabetes mellitus

COMPLICATIONS:

WHAT TO EXPECT:

• Longterm maintenance of weight loss is extremely difficult.
• If person is not motivated, successful weight loss is unlikely.

MISCELLANEOUS

OTHER FACTORS:

N/A

PEDIATRIC:

Prevalence of obesity is increasing in children, due, in part, to decreased physical activity and
increased television viewing.

GERIATRIC:

Acceptable weight ranges increase with age.

OTHERS:

Prepuberty and young adulthood appear to be sensitive periods for development of obesity.

PREGNANCY:

Pregnancy is a common time for onset of or increase in obesity.

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Medical Diagnosis » O » Obesity