Medical management of Obesity
Medical management of Obesity
When managing obesity, the primary aim is, naturally, weight-loss. It is important, however, not to focus on weight-loss alone; mental health support must complement weight-loss at every stage.
Weight loss should ideally occur at a rate of 0.9-1.5kg/week, but this figure should be individualised, and as such, should vary person to person. This initial weight-loss goal should be set with the patient’s norms in mind, taking into account natural variation in culture and family.
Studies have indicated that a 10% loss in weight for those >40 BMI is sufficient to reduce co-morbidities. Weight-loss beyond this point is considered beneficial, but not essential; as such, it is generally spurred by cosmetic needs.
In children, however, reduction beyond 10% of weight loss is recommended. Paediatric cases should aim to return to the normal curve for their age/height. This is achieved primarily through modified diet, increased exercise and decreased sedentary activity. Medication should not be considered in majority of paediatric cases.
Caloric intake remains an efficient and first-line treatment for weight-loss. Approximately 22kcal are required to maintain each kg of body weight. Caloric intake should be restricted as such. This should be adjusted by approximately 100kcal per decade above the age of 30.
Very low caloric diets (<800kcal/day) are useful in losing 1.5-2.5kg/week; they are, however, ineffective at long-term weight loss, and often lead to further complications. Electrolyte levels must be monitored strictly as it can easily lead to cardiac arrhythmia. Hair loss, hypothermia, skin thinning and cholelithiasis are all common side effects. The only indication for a VLCD is pre-operatively.
When choosing which diet to adhere to, or of what the diet should be composed, the National Weight Loss Institute (US) has shown compliance to a diet more important than any other aspect including exercise levels, and overall caloric reduction more important that reduction in any of the main energy groups (fats, proteins, carbohydrates). This said, a reduced fat diet has proved greater success than a reduced carbohydrate diet, owing probably to increased compliance. It is important that no matter what diet is chosen, micro- and macronutrients intake is continued.
As a minimum, sustained aerobic exercise of 30-60 mins, 5-7 times a week is recommended for weight loss. This is higher in children.
Many drugs have been trialled in weight-loss, and whilst majority of them have been quite successful, the side effects have nearly always outweighed the benefits. Addiction, cataracts, neuropathy, arrhythmias, electrolyte imbalance, pulmonary hypertension and sudden deaths have all been the result of drugs. Even those drugs approved for use today have unwanted side-effects.
Surgery is the only available modality that has been shown to reduce weight significantly and sustainable. A wide variety of surgeries are available, all involving a modification of stomach or bowel. Surgery is not, however, indicated in those <40 BMI.
To successfully implement this programme, a multi-disciplinary approach is essential. The physician, counsellor, dietician, physical/exercise therapists and other sub-specialties should be involved in the initial management team. Further specialists such as surgeons may be required later in the treatment plan.
Public health initiatives seem to hold the most hope for obesity, and the implication of advertising and infiltration of the market with high-energy, low-nutritional value foods must be taken seriously. A campaign similar to that undertaken with smoking has been put forth by many. Significant changes are yet to occur.
Thanks to the folk at eMedicine.
http://www.emedicine.com/med/topic1653.htm
When managing obesity, the primary aim is, naturally, weight-loss. It is important, however, not to focus on weight-loss alone; mental health support must complement weight-loss at every stage.
Weight loss should ideally occur at a rate of 0.9-1.5kg/week, but this figure should be individualised, and as such, should vary person to person. This initial weight-loss goal should be set with the patient’s norms in mind, taking into account natural variation in culture and family.
Studies have indicated that a 10% loss in weight for those >40 BMI is sufficient to reduce co-morbidities. Weight-loss beyond this point is considered beneficial, but not essential; as such, it is generally spurred by cosmetic needs.
In children, however, reduction beyond 10% of weight loss is recommended. Paediatric cases should aim to return to the normal curve for their age/height. This is achieved primarily through modified diet, increased exercise and decreased sedentary activity. Medication should not be considered in majority of paediatric cases.
Caloric intake remains an efficient and first-line treatment for weight-loss. Approximately 22kcal are required to maintain each kg of body weight. Caloric intake should be restricted as such. This should be adjusted by approximately 100kcal per decade above the age of 30.
Very low caloric diets (<800kcal/day) are useful in losing 1.5-2.5kg/week; they are, however, ineffective at long-term weight loss, and often lead to further complications. Electrolyte levels must be monitored strictly as it can easily lead to cardiac arrhythmia. Hair loss, hypothermia, skin thinning and cholelithiasis are all common side effects. The only indication for a VLCD is pre-operatively.
When choosing which diet to adhere to, or of what the diet should be composed, the National Weight Loss Institute (US) has shown compliance to a diet more important than any other aspect including exercise levels, and overall caloric reduction more important that reduction in any of the main energy groups (fats, proteins, carbohydrates). This said, a reduced fat diet has proved greater success than a reduced carbohydrate diet, owing probably to increased compliance. It is important that no matter what diet is chosen, micro- and macronutrients intake is continued.
As a minimum, sustained aerobic exercise of 30-60 mins, 5-7 times a week is recommended for weight loss. This is higher in children.
Many drugs have been trialled in weight-loss, and whilst majority of them have been quite successful, the side effects have nearly always outweighed the benefits. Addiction, cataracts, neuropathy, arrhythmias, electrolyte imbalance, pulmonary hypertension and sudden deaths have all been the result of drugs. Even those drugs approved for use today have unwanted side-effects.
Surgery is the only available modality that has been shown to reduce weight significantly and sustainable. A wide variety of surgeries are available, all involving a modification of stomach or bowel. Surgery is not, however, indicated in those <40 BMI.
To successfully implement this programme, a multi-disciplinary approach is essential. The physician, counsellor, dietician, physical/exercise therapists and other sub-specialties should be involved in the initial management team. Further specialists such as surgeons may be required later in the treatment plan.
Public health initiatives seem to hold the most hope for obesity, and the implication of advertising and infiltration of the market with high-energy, low-nutritional value foods must be taken seriously. A campaign similar to that undertaken with smoking has been put forth by many. Significant changes are yet to occur.
Thanks to the folk at eMedicine.
http://www.emedicine.com/med/topic1653.htm
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