Obesity

Last updated 25.08.13

 

Index

 

Definition

-    Chronic, complex, relapsing condition defined by a BMI > 30m2

 

Features

-    Australia has one of highest prevelences in world

-     60% adults, 25% children

-     Estimated 80% will be overweight or obese by 2025

-    One of greatest contributing factors to burden of disease

-    Moderate weight loss 5-10% can result in significant benefits

 

Classification & Risk

-    BMI 18.5 – 24.9 = Normal weight

-    BMI 25 – 29.9 = Overweight

-     Increased risk of HTN, DM2, CVD

-     High risk if waist circumference men > 102cm, women >88cm

-    BMI 30 – 34.9 = Obese class I

-     High risk of HTN, DM2, CVD

-     Very high risk if waist circumference men > 102cm, women >88cm

-    BMI 35 – 39.9 = Obese class II

-     Very high risk of HTN, DM2, CVD

-     Very high risk if waist circumference men > 102cm, women >88cm

-    BMI >39.9 = Obese class III

-     Extremely high risk of HTN, DM2, CVD

-     Extremely high risk if waist circumference men > 102cm, women >88cm

 

Cause/Risk Factors

-    High energy diets

-    Reduced human movement (exercise)

-    Early infant feeding practices

-    Genes

 

Complications

-    Endocrine

-     DM2

-     PCOS

-    Pulmonary        

-     OSA

-     Asthma

-     Obesity hypoventilation syndrome

-    Cardiovascular

-     HTN

-     CCF

-     IHD

-     CVA

-    Mental Health

-     Depression

-     Binge eating

-    Gastrointestinal

-     NAFLD

-     Cholelithiasis

-     Pancreatitis

-     GORD

-     Ca of bowel, oesophagus, gall bladder & pancreas

-    Genitourinary

-     ESRD

-     Kidney Ca

-     Urolithiasis

-     Prostate Ca

-     Stress incontinence

-     Sexual dysfunction

-     Ca of breast, ovary, endometrium

-     Miscarriage

-     Menstrual disorders

-     Infertility

-    MSK

-     OA

-     Spinal disorders

-     LBP

-     Foot pain

-     Morbid disability

 

Ix

-    Height, weight: BMI

-    Waist circumference

-    Ask, Assess, Advise, Assist, Arrange

-    BMI >30

-     BP: HTN

-     Fasting lipids & glucose: CVD risk

-     LFTs: NAFLD

-     Screen for OSA, Depression

 

Mx

-    Prevention

-    Obesity in pregnancy

-    Contraception

-     Progesterone methods MEC 1

-     COC MEC 2 if BMI 30-34, MEC 3 if >35

-    Risk Factor Control

-     Smoking cessation

-    Weight Loss

-     Lifestyle Intervention

-    First line treatment

-    Diet

-   Healthy eating

-   Reduction of energy intake

-    Exercise

-   Increase physical activity

-   Reduce sedentary behaviour

-    Psychological support

-     Intensive Interventions

-    Diet

-   VLEDs

-      If BMI >30 or >27 with comorbidities

-    Medication

-   If BMI >30 or >27 with comorbidities

-   Phenteramine (Duromine)

-   Orlistat (Xenical): pancreatic & gastric lipase inhibitor

-    Surgery

-   If BMI >40 or >35 with comorbidities

-   Most effective treatment for obesity in terms of achieving & maintaining substantial long term weight loss

-   Need lifelong monitoring

-   Laparoscopic Adjustable Gastric Banding (LAGB)

-   Roux-en Y Gastric Bypass (RYGB)

-   Sleeve Gastrectomy (SG)

-    Multi-disciplanary Approach

-     Dietician

-     Psychologist

-     Exercise physiologist

-     Weight management programs

-    BMI >40 or >35 with comorbidities

-    Available through some major hospitals

-     Surgeon

 

 

 

References

 

Obesity: Recommendations for management in General Practice and Beyond; AFP, Vol 42 No 8 August 2013