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Cardio History
 
 

The Obesity History

 
 
 
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Overview

  • Ask About

  • 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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