Obesity

Obesity Management

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Obesity Management, Weight Reduction, Obesity Monitoring

  • Management
  • Select appropriate target weight loss
  1. Body Mass Index (BMI) > 30: Current BMI - 2
  2. Body Mass Index (BMI) <= 30: Lose 10% of current weight
  • Management
  • Establish basic weight loss program
  1. Establish regular follow-up visits
    1. Schedule at least one session per month for 3 months (AAFP recommendations)
    2. Focus on intensive counseling and behavioral intervention
    3. Simple interventions are effective with better compliance
      1. Higher fiber and more vegetables
      2. Stand more each day
    4. Practice Motivational Interviewing
      1. See Health Risk Motivational Counseling (e.g. Five Rs Technique)
      2. Express empathy
      3. Assess for patient motivation and confidence to achieve weight loss
      4. Juxtapose the risks and benefits of change
      5. Reinforce a patient's ideas and solutions to achieve weight loss
  2. Healthy eating and reduced Caloric Intake
    1. See Food Pyramid
    2. Reduce Caloric Intake
      1. See Energy Deficit Calculation
      2. Typical deficit: 500 kcal/day
        1. Avoid very low calorie diets (>800 kcal/day) except under close observation
        2. Women: 1200-1500 kcal/day
        3. Men: 1500-1800 kcal/day
    3. Eat a minimum of 3 times daily (esp. eat breakfast daily)
      1. Stop Binge Eating at bedtime
    4. Drink non-sugar, non-Caffeine fluid >64 ounces/day
    5. Observe serving size and ingredients closely
      1. Super-sized meals dramatically increases calories
      2. One 8 ounce soda contains 15 teaspoons of sugar
    6. Write down everything you eat (one approach)
      1. Weight watchers
      2. Handheld log
        1. Balance Log
          1. http://www.healthetech.com
        2. Vivonic
          1. http://www.vivonic.com
        3. Calorie Chart
          1. http://www.caloriechart.org
        4. Lose It!
          1. http://www.apptism.com/apps/lose-it
    7. Use high bulk, low density foods
      1. Eat Foods with high water, fiber, and lean protein
      2. Fruit: 3/4 pound grapes = 1.5 ounces chocolate kcals
      3. Vegetables: 1 pound carrots = 1 ounce peanuts kcals
      4. Reference
        1. Thompson (2005) Mayo Reviews Lecture, Rochester
    8. Choose dietary management for the longterm
      1. Diets are equally effective in weight loss
      2. Dansinger (2005) JAMA 293:43-53 [PubMed]
  3. Increase Physical Activity
    1. See Exercise in Obesity
    2. Start with 10 minutes everyday and build
    3. Goals
      1. Overall activity (HHS) of 150-300 min/week moderate activity (or 75-150 min/week vigorous activity)
      2. Prevent Obesity (NIH) with 45-60 min/day moderate activity
      3. Prevent regaining weight (NIH) with 90 min/day moderate activity
    4. Stand more each day
    5. Exercise is key in a weight loss
      1. However Exercise without dietary change does not result in weight loss
      2. Wing (1999) Med Sci Sports Exerc 31:S547 [PubMed]
  4. Incorporate Lifestyle change strategies
  5. Consider changing from Medications Associated with Weight Gain
  6. Consider organized weight loss program
    1. Weight Watchers
      1. http://www.weightwatchers.com
    2. TOPS (Take Off Pounds Sensibly)
      1. http://www.tops.org
  • Management
  • Modify weight loss program based on Obesity Risk
  1. Moderate Risk
    1. Basic weight loss program
    2. Consider low calorie diet
  2. High and very high risk
    1. Basic weight loss program
    2. Consider very low calorie diet
    3. Consider Obesity Medication
  3. Extremely high risk
    1. Basic weight loss program
    2. Consider very low calorie diet
    3. Consider Obesity Medication
    4. Consider surgical intervention