Obesity Flashcards
General Health Trends
Physical activity is decreasing
Auto trips are increasing
Serving sizes have increased
Metabolic Syndrome
This is a cluster of conditions:
Abdominal obesity Hyperinsulinemia High fasting plasma glucose impaired glucose tolerance Hypertriglyceridemia Low HDL-cholesterol Hypertension
Waist/Hip Ratio
An index of Abdominal versus Peripheral Obesity
Metabolic Syndrome’s impact on mortality
Mortality with CVD, as well as all other diseases, is greatly increased in patients with Metabolic Syndrome.
Obese patients account for 10% of total patients, but what % of total US healthcare costs?
64%
About how much does obesity add to a patient’s medical bills over a 10-year period?
$28,000
Obesity Treatments
Lifestyle Modification
Pharmacotherapy
Surgery
Lifestyle Modification
Diet: consider meal replacement
Physical activity
Behavior modification
Pharmacotherapy
adjunctive
Surgery
MIBS for BMI > 40;
unresponsive to intensive medical management;
onset < 25 yrs old
Meal Replacement costs
reduces overall costs from baseline (study)
Improving Long-term success
greater initial wight loss increases total weight loss and improves long-term maintenance
Exercise Recommendations
Adults: 30 min/day; 150 min/week
1/2 if vigorous exercise (talk-test)
Children: 60 min/day
Behaviors linked to weight-loss
consistency accountability self-monitoring low-fat eating physical activity
Most important aspect in determining successful weight management
amount of treatment in terms of duration and quantity
Daily Record-keeping
a way to keep the patient responsible to him/her self through self-monitoring
Keeping off 30 lbs. or more for > 5 yrs averaged how many kcals per week of physical activity?
2621 kcals
Strongest evidence of long-term efficacy
portion-controlled servings, including meal replacements
5 A’s of Obesity Management
Assess Advise Agree Assist Arrange
Assess
Identify behavior risks in need of intervention
gather data needed to prioritize and individualize care
Advise
Clinician advice establishes behavioral issues as an important part of health care and enhances the patient’s motivation to change.
- ask about patient’s interests in weight loss
- use collected data to evaluate need for intervention
Agree
Patient and clinician need to come to common ground on areas where behavior change is needed
Assist
Primary care clinician offers additional treatment to address barriers to change, increase the patient’s motivation and self-help skills.
- increase total contact time
- utilize support staff
- be specific in recommendations
Arrange
frequent and consistent follow-up
evaluate YOUR ability to provide necessary level of intervention
refer to more intensive or specialized treatment as necessary
