Obesity and Tx

Question 1

What BMI should you start tx?

Answer 1

27

Question 2

Available tx options from low to high effectiveness

Answer 2

Accept weight where it is
Diet/Exercise:  3-10% weight loss
Drugs: 5-10% weight loss
Medically Supervised/Combination
   of Diet + Drug: 10-15% weight loss
Surgery: 15-30% weight loss

Question 3

Energy expenditure: greater in lean or obeses?

Answer 3

obese

Question 4

Do people over or underestimate energy intake?

Answer 4

underestimate

Question 5

Resting energy expenditure and fat free mass

Answer 5

linear correlation

Question 6

Weight loss

Answer 6

Create a negative energy balance
Most practical way to achieve this is reducing food intake
Goal is a reduction of 1 to 2 pounds per week
500 to 1000 kcal/day caloric deficit

Question 7

Tools for decreasing caloric intake

Answer 7

Food Diaries and Record Keeping
Fat Gram Budget
Based on calories and percent fat
Meal Replacements
Portion and fat control
Convenient
Decrease portions by 25-33%
Reduce energy density
Diet Books/Commercial Programs

Question 8

Which patients are most successful

Answer 8

The patients that keep food records lose 2.5-3x more weight that pts that don’t record well.

Question 9

NIH Recommended macronutrient content

Answer 9

Carb

Question 10

Does macronutrient content of diet influence weight loss after 6 mo?

Answer 10

No. So no single “best” diet in terms of macronutrient content.

Question 11

Exercise

Answer 11

• doesn’t produce initial weight loss
• doesn’t significantly increase initial weight loss over what is obtained by calorie restriction alone
• But WILL increase resting energy expenditure (so long term helps with weight loss)
• essential for weight loss maintenance

Question 12

Kcal per day deficit for weight loss

Answer 12

500-1000
No diet is best
Use structured approach
Physical activity critical for weight loss maintenance
30-60 minutes per day including walking (10,000 steps/day)
National Weight Control Registry strategies: low-fat diet, breakfast, self-monitoring, large amounts of exercise, limit TV