@ Management of obesity:
A- History taking:
*history of chronic diseases
*was the wt gain over a short or long period of time.
*when did person start to complain of obesity.
*the appetite. *smoking habit
*psychological & social stress. *alcohol intake
*current drug therapy that affect the wt.
*risk factors such as angina, MI, stroke
*family history of obesity, eating behavior *number of meals per day.
*type of snakes
*ask about symptoms of hypothyroidism e.g. lethargy, slow speech.
*the symptoms of any diseases suspected to cause of secondary obesity.
B- Examination:
*look for signs of disease causing secondary obesity, blood pressure…….
*waist/hip ratio, weight, height, skin fold thickness.
*mid-arm muscle circumference, head circumference.
*body mass index (BMI) = WT/ (HT) 2=Kg/m2
The degree of obesity is classified as follows:
@BMI of 18.5-24.9 ------ within the range.
@BMI of 25-29.9 ------ over wt, relative risk.
@BMI of 30-35 ------ grade I obesity.
@BMI of 35-40 ------ grade II obesity.
@BMI of > 40 ------ morbid obesity, high risk.
C- Investigations: depend on our suspicion (e.g. NIDDM, Cushing syndrome), lipid profile, TSH, blood glucose (random &fsting), urine analysis, gamaglutamite transferase for alcoholic liver disease.
D- Treatment:
1- If we identify a specific cause(s), we treat it accordingly.
2- life-style modification: life style approaches offer a combination of treatment strategies that focus on all aspects of wt loss (e.g. diet, physical activity). By it the individuals make gradual changes in diet & physical activity with the use of behavioral strategies.
The result is progressive reduction in wt over time. Usually, the goal of this approach is an initial wt loss of approximately 10% which is associated with a decrease in obesity-related health consequences.
A- Diet: is to follow a balanced mildly hypo caloric diet. An important consideration for any change in diet is that individuals make slow changes over the course of time.
B- Physical activity: more likely exercise decrease appetite than increasing it, increase resting metabolic rate, when exercise intake after meals the thermic effect of meal may be increase. (Loss 500 calories/day=lose one pound each week)
c- Behavior modification: are used to encourage positive change in diet & activity levels. The most commonly used behavioral strategies are:
Self-monitoring, goal setting, stimulus control, problem solving & cognitive restructuring.
3- Psychological support: the obese person should not be blamed for his obesity but should be supported & encouraged from his doctor, family & friends to continue exercise & modify his eating behavior.
4- appetite suppressant : the national institute for health & clinical excellence in UK recommended pharmacotherapy, in conjunction with lifestyle modification.
5- Surgery: (used in morbid obesity) surgical techniques involve either creating a small bowel to produce a malabsorption of ingested calories, or creating a smaller stomach.