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ON OBESITY: Obesity is a complex issue - Odessa American: People

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ON OBESITY: Obesity is a complex issue

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Posted: Sunday, March 1, 2015 4:15 am

If you ask most women and even men what is at the top of his or her wish list, weight loss and “being skinny” would top the majority. Sure, a few corvettes or million dollars might be sprinkled among the mix, but the desire to lose weight would certainly be a recurrent player. We see the trend on New Year’s resolutions and with the many “get skinny quick” commercials on television. In our nation, more than two-thirds of adults are either trying to lose weight or maintain their weight, but what is the benefit and how does one achieve this?

Obesity is a complex disease, which is increasing in almost all age groups in the United States. Other than being a cosmetic concern, it also increases the likelihood of high blood pressure, high cholesterol, type II diabetes, sleep apnea and various cancers. The abnormally high cholesterol accumulation in different bodily organs also leads to an increased risk of having a heart attack or stroke. It is crucial to help the overweight and obese patients find appropriate interventions, and clinicians can play a vital role in education and strategies for losing weight.

The goal of obesity management is to prevent, reverse, or improve the complications of obesity. Thus, the selection of patients for treatment is based upon initial risk assessment. This includes determining the degree of overweight with body mass index, measuring waist circumference, and assessing cardiovascular risk factors (high blood pressure, diabetes, high cholesterol, etc) and comorbidities (sleep apnea, nonalcoholic fatty liver, etc). Certain markers point towards the severity of risk associated with obesity, like elevated fasting lipid levels, a decreased high density lipoprotein (HDL), raised liver enzymes, and fasting blood sugar. An additional history about dietary habits, amount of physical activity, onset of obesity, recent change in occupation, current and past medications, psychiatric issues, and history of smoking cessation should be addressed.

Once risk stratification is complete and secondary causes of obesity like hypothyroidism, Cushing’s, and PCOS (to name a few) have been ruled out, it is important to set realistic and achievable weight loss goals. A patient should start by setting a goal of losing 5-7 percent of his or her body weight in the first six months. The initial management to achieve this feat is lifestyle intervention and includes creating a caloric deficit through calorie restriction and exercise. Lifestyle intervention is a combination of behavioral modification, diet, and exercise.

 The behavioral component enables devotion to diet and exercise plans and entails habitual self-monitoring of food intake with a food diary, physical activity, and body weight. Behavioral modification also helps in controlling cues and stimuli in the environment that trigger over eating. Eliciting the help of psychologists or weight loss groups are often helpful. The next component of lifestyle intervention is the diet.

 Options include balanced low-calorie diets, low-fat/ low-calorie diets, and low-carbohydrate diets. Any diet plan selected should be tailored to reduce caloric intake below caloric expenditure and take into account preferences in food types. No adult who has been studied in a metabolic chamber has needed less than 1000 kcal/day for weight maintenance. So, even subjects who profess that they “just cannot lose weight” should shed pounds if they abide by diet where they consume between 800 to 1200 kcal/day. The last component in lifestyle intervention is exercise. Diet may initially be more effective in losing weight, but increasing energy expenditure through regular physical activity has particular helpfulness in efforts at long-term maintenance of a lower body weight. The current recommendation for physical activity is spending 30-60 minutes exercising per day most days of the week.

Some patients may not achieve their weight loss goals with lifestyle intervention alone and adjunctive therapies may be utilized. These tools are available to individuals with a BMI ≥30 kg/m2 or who have a BMI of 27 to 29.9 kg/m2 with comorbidities. This includes pharmacologic therapy and bariatric procedures. Drug therapy works by reducing the appetite and altering the way we absorb our food. Commonly used medications include Qsymia, Phentermine, and Belviq. The pharmacologic options will be discussed more in depth in the article to follow. Bariatric surgery is another alternative that works well for the motivated patients having a body mass index of 40 or greater, as well as for those with BMI between 35-40 with co-morbid conditions. Lastly, liposuction, the removal of fat tissue by aspiration, can reduce the amount of fat, improving insulin resistance.

After reading this article, hopefully you inspired to begin your weight loss journey and can soon cross losing weight off your New Year’s resolutions. Shedding the extra weight will not only improve your overall health but also boost your self confidence. Now that you have begun scratching this off your list, ask your health care provider to discuss the specific weight loss options for you.

Next month, we will talk about options of management of Obesity

Dr. Suresh Prasad practices in Odessa. Britney Cornett, PA-C, Archana Chaurasia, MBBS, work with Prasad at Permian Internal Medicine.  This column is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only for general public. You assume full responsibility for how you choose to use this information.

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