Overview
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- BMI - height, weight
- Associated diseases - metabolic syndrome, IHD, stroke, OSA, GI, PCOS, OA, gout
- Management - attempts to lose weight, diet, level of exercise, pharmacologic or surgical approaches
Classification
Based on body mass index (BMI)
- Underweight - <18.5
- Normal - 18.5 - 24.9
- Overweight - 25 - 29.9
- Obese - 30 - 34.9
- Severely obese - 35 - 39.9
- Morbidly obese - 40+
Conditions Associated with Obesity
- Metabolic syndrome - type 2 diabetes mellitus, hypertension, hyperlipidaemia
- Ischaemic heart disease (IHD)
- Stroke
- Respiratory - obstructive sleep apnoea, asthma
- Gastrointestinal - reflux, cholelithiasis, non-alcoholic fatty liver disease (NAFLD)
- Polycystic ovarian syndrome (PCOS)
- Osteoarthritis
- Varicose veins
- Gout
Management of Obesity
Pearls
- Set realistic weight loss goals (e.g. 5-10%)
- Aim to improve comorbid conditions, such as diabetes
- Use non-pharmacologic and pharmacologic strategies
Management Options
Non-Pharmacologic
- Diet - very low calorie; in conjunction with a dietician
- Exercise - increase incidental exercise and reduce sedentary time; consider exercise classes involving a physiotherapist
Pharmacologic
- Orlistat - an intestinal lipase inhibitor (essentially cases steatorrhoea)
- Phentermine (Duramine) - an appetite suppressant
- Naltrexone + buproprion (Contrave)
Surgical
- Restrictive - gastric banding, sleeve gastrectomy
- Malabsorptive - Roux-en-Y gastric bypass
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