الجامعة السورية الخاصة كلية الطب البشري قسم طب المجتمع

1. الجامعة السورية الخاصةكلية الطب البشريقسم طب المجتمع Obesity M.A.Kubtan MD - FRCS M.A.Kubtan

2. Management and Interventions  • Childhood Overweight and Obesity • Management in Adults  • Setting Goals  • Diet  • Physical Activity and Exercise • Behavioral Approaches  • Medications  • Complementary and Alternative Medicine  • Surgery  M.A.Kubtan

3. Approach to combating Obesity • An initial goal of a 5% to 10% reduction in weight is reasonable. • A process-oriented target (lifestyle) may be more beneficial for some than a target weight. • A weight reduction rate of 1/2 to 1 Kg weekly is achievable if intake is reduced by 500 to 1000 kcal daily. • Caloric restriction alone is not as effective as combining it with an exercise program. • A low-energy-dense diet composed of generous quantities of vegetables and fruits promotes health and facilitates weight management. M.A.Kubtan

4. Facts about children obesity • Childhood obesity rarely is associated with a primary medical disorder. • When present in childhood obesity, underlying disorders are almost always associated with statuary growth reduction. • The risk of adult obesity increases with the age of the obese child. • Intervention can be more effective in children than in adults and should involve the entire family. M.A.Kubtan

5. The approach of treatment in childhood • Lifestyle . • Parental involvement is a key component in childhood weight management. • In addition, health care providers may overlook obesity . • Adiposity rebound occurs between ages 5 and 7 years. • Breastfeeding should be encouraged up to the age of 1 year. • Elimination of sweetened beverages . • All children older than 2 years should be receiving low-fat dairy products . • Vegetables and fruits . M.A.Kubtan

6. Management in Adults • It is important to help patients become aware of the medical implications and to engage them in management. • Prevention of weight gain with lifestyle therapy is indicated in any patient with BMI ≥25 . M.A.Kubtan

7. Assessment Areas of Medical History in Obese Patient Evaluation •   Readiness/motivation to undertake weight loss . • Reasons/expectations for weight loss . • Available support. • Previous methods of weight loss and results (including why results were not successful). • Potential barriers to weight loss and maintenance (time, finances, established habits) . • Periods of increased weight gain . M.A.Kubtan

8. Continue • Triggers to eating • Current (and past) exercise/activity • Factors the patient believes are responsible for weight • Binge eating, purging, laxative or diuretic use • Family history of obesity • Medications M.A.Kubtan

9. Guidelines for Treatment of Obesity • Diet . • Physical activity . • Behavior therapy[†] • Pharmacotherapy . • Surgery . M.A.Kubtan

10. Diet • Total calorie intake must be reduced below energy expenditure for weight loss to occur. • Low-carbohydrate diets . • Satiety from fat are other possible mechanisms. M.A.Kubtan

11. Physical Activity and Exercise • The choice of exercise depends on individual interests . • The goal should be 30 minutes . M.A.Kubtan

12. Behavioral Approaches • Self-monitoring . • Identifying and avoiding environmental or social triggers • Group support may be helpful . M.A.Kubtan

13. Medications • Appetite suppressants work through their effects on neurotransmitters. • Orlistat inhibits gastric and pancreatic lipase . M.A.Kubtan

14. Complementary and Alternative Medicine • Ephedrine, often in combination with caffeine • . Side effects : sympathetic activity , tachyarrhythmias, headache, and elevated BP, • Caffeine can increase sympathetic nervous system activity . • Antioxidants have been thought to have sympathetic activity . M.A.Kubtan

15. Surgery Malabsorptive : Jejunoileal bypass . Biliopancreatic diversion . Restrictive : Vertical-banded gastroplasty Gastric banding . Gastric sleeve . Gastric plication . Malabsorptive and Restrictive Roux-en-Y gastric bypass M.A.Kubtan