Obesity

Louis Carrillo

Family Medicine Rotation 3

Obesity Politics
The Council on Science and Public Health voted against
Cited BMI as a weak tool No specific symptoms More a risk factor Medicalizing makes you more reliant on drugs, surgery etc Overtreatment of otherwise healthy people College of Cardiologists and American Association of Endocrinologists supported

Now What?
Less stigma Better treatment options available today
Better reimbursements More insurance companies and possible Medicare will cover obesity pharmacotherapy, nutrition consults, diet and exercise planning

More physicians will actively try to treat obesity The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes

Screening
USPSTF has not differentiated between various obesity measurements No regular interval has been established Recording changes and remarking on improvement has been shown to improve course

The Grey Zone

Intensity tends to refer to frequency of sessions Atleast 12 sessions a year has been found to be helpful for the obese Best practices are still being established for the overweight

Obesity Paradox
A number of studies have shown better mortality outcomes in the overweight and mildly obese (stage 1) in heart failure patients Any ideas?
No wasting away, higher fat and energy reserves, more carefully watched, inability to differentiate muscle from fat using BMI

What Happened
In 1999 a percentile evaluation was a B recommendation Changed in 2005
No direct evidence screening and intervention improves age appropriate measures Percentile definitions had not changed but populations had Adult BMI more important determinant Primary care interventions have not conclusively shown to be effective in treating obesity or improving adult outcomes Some pharmacotherapy intervention had adverse effects

Family Doc tip

Cut 250 daily calories from your diet Burn 250 calories everyday 1750 calories lost each week from each strategy results in one pound lost

Slow and Steady

Mild goals that are reached through moderate change more long lasting and successful

Smoking
Major risk factor for CV disease and bladder cancer

Its not all on you or the patient

Variety of avenues are needed Research has shown more weight loss occurs with atleast 12 sessions (can be mixture or one single type)

Women are from Venus, Men are from

Abdominal obesity in women is considered at 35 inches compared to 40 for men

Reduce food intake by Intake is reduced, and choking off entrance. absorption changes as Adjustable balloon food bypasses stomach and duodenum

Usually first step in difficult cases. Reduced intake and absorption. Reduction of stomach reduces ghrelin reducing appetite

Second step. Reduce fat absorption further. Complications?

References
USPSTF
http://www.uspreventiveservicestaskforce.org/uspstf11/obes eadult/obesers.htm http://www.uspreventiveservicestaskforce.org/uspstf05/chov erwt/choversum.htm http://www.uspreventiveservicestaskforce.org/uspstf11/obes eadult/obesers.htm

Weight Control Network from the National Institute of Diabetes and Digestive Health and Kidney Diseases
http://win.niddk.nih.gov/publications/understanding.htm#f http://win.niddk.nih.gov/publications/gastric.htm

References
National Guideline Clearinghouse Management of Obesity
http://www.guideline.gov/content.aspx?id=15597&search=o besity#Section420

The American Academy of Family Physicians FamilyDoctor.org

http://familydoctor.org/familydoctor/en/diseasesconditions/obesity/treatment.html

NIH National Heart, Lung, and Blood Institute

http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_ wt/risk.htm http://www.nhlbi.nih.gov/health/health-topics/topics/obe/

References
Body mass index and mortality in heart failure: A metaanalysis American Heart Journal, Volume 156, Issue 1, Pages 13-22 Antigone Oreopoulos, Raj Padwal, Kamyar Kalantar-Zadeh, Gregg C. Fonarow, Colleen M. Norris, Finlay A. McAlister Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies The Lancet, Volume 368, Issue 9536, Pages 666-678 Abel Romero-Corral, Victor M Montori, Virend K Somers, Josef Korinek, Randal J Thomas, Thomas G Allison, Farouk Mookadam, Francisco Lopez-Jimenez

References
Andrew Pollack. New York Times June 18th, 2013. AMA recognizes Obesity as a Disease. http://www.nytimes.com/2013/06/19/business/ama -recognizes-obesity-as-a-disease.html?_r=1&