“The most dangerous food in the world is the wedding cake”
Definition
A chronic condition is characterized y excess adipose tissue leading to body weight 20% over expected weight, arising as a consequence of positive caloric balance. Also defined as Body mass index (BMI) (weight in kilograms divided by height in meters squared) over 30 kgm/square meter values between 25-30 being categorized as overweight.
Prognosis
Long-term weight loss zis extremely difficult to achieve. A great deal would depend upon the patient’s motivation. In wome higher levels of adiposity as measured by the body mass index were associated with increased risk for fateal and nonfatal coronary artery disease. This applies even for modest weight grains after 18 years of age. Excess ortality is associated, with the occurrence of other risk factors like elevated blood pressure alongside. `
Treatment
If obesity appears hormonal or pathological refer the patient to an endocrinologist.
Treatment of Simple Obesity;
Low calorie Diet – 800 to 900 cal/ day.
Don’t eat cereals, potatoes, root vegetables, sugar, all sweets, chocolates, puddings, dried or tinned fruits, butter, ghee, oil and fried foods.
Eat small quantities – green vegetables, fruits, soup, khakra, lean meat, fish.
Water intake < 1.5 litre/ day. And minimum salt, Use sugar substitutes skimmed milk and low sodium salt.
Avoid total starvation.
Regular exercise – walking, aerobic excercises.
Tab. Flabolin 20mg. bd to 2 tds (Fenfluramine) (Induces aneorexia. To be continues as it is producing weight loss. Taper off gradually)
Dietmann x 1 sachet stirred in 200ml water for 10 minutes x take immediately as Gel is formed x just before meals x 3-4 weeks. (Bulkying agent)
Watch regularly (every 6 months) for B.P and diabetes.
Starvation produces dramatic weight reduction, but the weight springs back equally quickly whrn regular diet is resumed.
Mainstay of treatment is Diet and exercise. Drugs are recommended only for severe obesity, due to their side effects.
If the patient falls in high risk category. i.e with Diabetes, Hypertesion, Angina, familu H/o. infaret etc. Then it is Family doctor’s duty to stress the importance of weight reduction, explain the risks and be after the patient to reduce weight.
Refer the patient to endocrinologist if:
Extreme obesity. Obesity at very young age. Moon face, buffalo hump with this legs. If sexual organs are underdeveloped.
Tab. Flabolin Dietmann
General Measures
I Diet Modification and Calorie control 1) Conventional reducing diet : In the overweight or moderately obese patient a practical approach is to effect an energy deficiency of 500 Kcal. Day, leading in most patients to a weight loss of 0.5 kg a week. (800-1200 K cal/day) depending on activity, and the patient’s life style. Should contain less calories than the patient’s maintenance requirement, should contain all essential nutrients, and should contain high fibre to give stiation and should be acceptable to the patient. 2) Total starvation: Is too drastic, disturbs body comkposition, and may lead to sudden death. Not to be attempted by patient. 3) Very low calorie diet: Indicated in the morbidly obese patient with risk to life and under close medical supervision only. VLCD ‘Protein sparing modified fasts’ with 50-80 gms/day high protein diet to prevent negative Nitrogen balance, and 400 K cal/day. Could be tried for short periods of up to 6 weeks, under medical supervision. Combining VLCD with behavioural therapy appears quite effective. VLCD is contraindicated in gout, renal insufficiency, and cardiac arrhythmias. Deaths reported at times in patients on long term therapy. Once the patient reverts to earlier diet, weight gain occurs.
II Physical Exercise Calls for adequate motivation, and an exercise regimen suited to individual patient with respect to age, fitness, etc. Usually, effect on body weight is only marginal.
II Behaviour modification Of great importance in therapy and is based on study of the patietn’s attitude to food and eating, social factors that influence his eating, non-nutritive stimuli for eating etc. Advice given would include eating slowly, making eating a pure experience, eating on a small plate, eating 3 times a day at the same time and place, learning to cope with self-defeating thoughts about futility of dieting, learning about nutritional requirements and energy consumption, taking more exercise, and so on. IV Surgical management of Obesity Surgery is the last resort in refractory serious morbidity with life threatening complications and includes 1) Liposuction –Trivial amounts removed mostly for cosmetic benefits but with risks of surgery, pulmonary embolism, passage of free fat in the urine, 2) Jaw-writing and waist cord with milk diet (1800 ml giving 1200 calories), with iron and vitamin supplements. Works well with loss of 1 kg/wwek. 3) Gastroplasty by a double-line of staples producing a small gastric reservoir. Yields good results. 4) Insertion of a silicone bubble into the stomach to act as a bezoar.
Advice to Patient
Behaviour Modification’ (vide supra) Explain hazards of obesity. Education on human nutritional requirements and calorie consumption. Education on the futility of several ‘popular dietary fads’
Follow Up
Very important and the patient has to be seen at periodic intervals by physician, dietician, and behaviour therapist.
Inadequate Response
To be expected and would call for review of all aspects of therapy. Morbid obesity continues to be a therapeutic problem.
Prevention
By proper education on nutrition, importance of exercise etc., ideally at a younger age.
