Obesity

Obesity, also called corpulence or fatness, is an excessive accumulation of body fat, usually caused by the consumption of more calories than the body can use. The excess calories are then stored as fat or adipose tissue. Being overweight, if moderate, is not necessarily obesity, particularly in muscular or large-boned individuals.

What is Obesity?

• Body mass index (BMI) is a calculation that takes a person’s weight and height into account to measure body size.
• Obesity is associated with a higher risk for serious diseases, such as type 2 diabetes, heart disease, and cancer.
• Factors such as age, sex, ethnicity, and muscle mass can influence the relationship between BMI and body fat. Also, BMI doesn’t distinguish between excess fat, muscle, or bone mass, nor does it provide any indication of the distribution of fat among individuals.
• Despite these limitations, BMI continues to be widely used as a way to measure body size.

Obesity is not just a cosmetic concern. It is a chronic medical disease that can lead to diabetes, high blood pressure, obesity-associated cardiovascular diseases such as heart disease, gallstones, and other chronic illnesses.

Causes

• Many factors influence body weight genes, though the effect is small, and heredity is not destiny; prenatal and early life influences; poor diets; too much television watching; too little physical activity and sleep; and our food and physical activity environment.

Screening Criteria

Suspected or known hyperlipidemia or dyslipidemia

Fasting Lipid Profile

• A fasting lipid profile is a primary test for diagnosing, making management decisions, and monitoring the treatment of dyslipidemia.

Suspected Diabetes Mellitus

• Plasma fasting glucose measurement: Fasting plasma glucose levels of 126 mg/dL (7 mmol/L) or greater are diagnostic of diabetes mellitus. In the absence of unequivocal hyperglycemia, results must be confirmed with repeat testing on another day.

Suspected Impaired Fasting Glucose (IFG) (prediabetes)

• Plasma fasting glucose measurement: Impaired fasting glucose is defined as a fasting plasma glucose level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) and indicates prediabetes.

Medical History

1. Gets no exercise
2. Alteration in nutrition: more than body requirements
3. Polycystic ovary syndrome [Polycystic ovary syndrome - Chronic]
4. Abnormal hormone production
5. Antipsychotic use
6. Family history of Obesity
7. Antidepressant use
8. Smoking

Findings

1. Weight increased
2. Obese abdomen
3. Increased blood pressure
4. Depression - Chronic
5. At risk for psychosocial dysfunction

Tests

Suspected or known hyperlipidemia or dyslipidemia

• Fasting lipid profile: A fasting lipid profile is a primary test for diagnosing, making management decisions, and monitoring the treatment of dyslipidemia.

Suspected diabetes mellitus

• Plasma fasting glucose measurement: Fasting plasma glucose levels of 126 mg/dL (7 mmol/L) or greater are diagnostic of diabetes mellitus. In the absence of unequivocal hyperglycemia, results must be confirmed with repeat testing on another day.

Suspected impaired fasting glucose (IFG) (prediabetes)

• Plasma fasting glucose measurement: Impaired fasting glucose is defined as a fasting plasma glucose level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) and indicates prediabetes.

Suspected or known hypothyroidism

• Thyroid-stimulating hormone measurement: Overt hypothyroidism is classified as a TSH above the upper limit of the reference range in the presence of a low serum free thyroxine (FT4). Subclinical hypothyroidism is a laboratory diagnosis defined as a TSH above the upper limit of the reference range in the presence of a normal FT4.

Treatment

Drug Therapy

• Patients with an initial body mass index (BMI) of 30 kg/m2 or greater or 27 kg/m2 or greater in the presence of other risk factors, such as hypertension, diabetes, dyslipidemia, coronary heart disease, or sleep apnea.

ORLISTAT

• Adults: 120 mg orally 3 times daily with meals

PHENTERMINE HYDROCHLORIDE

• Adults: Short-term (a few weeks) adjunct: 37.5 mg orally daily before breakfast or 1 to 2 hours after breakfast or divided into 2 doses; some patients may only require 18.75 mg daily

DIETHYLPROPION HYDROCHLORIDE

• Adults: Short term (a few weeks) adjuncts: controlled release, 75 mg orally daily, take midmorning or immediate release, 25 mg orally 3 times a day, 1 hr before meals; may take 1 dose mid-evening, if desired, to overcome night hunger

SIBUTRAMINE HYDROCHLORIDE

• Adults: Initial: 10 mg orally once daily; after 4 weeks may increase to a maximum dose of 15 mg orally once daily

Procedural Therapy

Adjunctive therapy of overweight and obese patients

• Behavioral therapy: Behavior therapy is important for the success of any weight loss program to facilitate changes in eating and activity behaviors.

Patients with a body mass index (BMI) of at least 40 kg/m2 or 35 kg/m2 with comorbid conditions and acceptable operative risks

• Gastric bypass surgery: Studies have shown that weight loss is greater with the gastric bypass procedure than with vertical-banded gastroplasty.