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  1. Assessment for obesity: Calculation and identification of Body Mass
    Index (BMI)
    • -Significantly correlated with total body fat
    • content
    • -Used to assess obesity and to monitor changes in body weight
    • -Equal to Weight (in lb) X 703 / height squared (in in.)
  2. Assessment for obesity: High-Risk Waist Circumference
    • -Measuring the presence of excess fat in the
    • abdomen out of proportion to total body fat
    • -Women >35 inches
    • -Men > 40 inches
    • -Measure around abdomen at level of iliac crest at end of a normal respiration
  3. BMI Underweight
    BMI <18.5
  4. BMI Normal
    BMI 18.5-24.9
  5. BMI Overweight
    BMI 25.0-29.9 (disease risk is increased with normal waist circumference and high with high-risk waist circumference)
  6. BMI obesity class 1
    BMI 30.0-34.9 (disease risk is high with normal waist circumference and very high with high-risk waist circumference)
  7. BMI Obesity class 11
    • BMI 35.0-39.9 (disease risk is very high with normal waist circumference and very high
    • with high-risk waist circumference)
  8. BMI obesity class 111
    • (disease risk is extremely high with normal
    • waist circumference and extremely
    • high with high-risk waist circumference)
  9. Can increased waist circumference also be a
    marker for increased risk even in persons of normal weight?
  10. Describe management of obesity
    • -Initial goal of weight loss therapy is to reduce body weight about 10%
    • -Further weight loss considered after initial 10% loss is maintained for 6 months
    • -It is better to maintain a moderate weight loss over a prolonged period than to regain weight from a marked weight loss.
  11. Discuss when various weight loss therapies are
    appropriate: Diet, physical activity, and behavior therapy
    Started at 25-26.9 BMI with comorbidities
  12. Discuss when various weight loss therapies are
    appropriate: Pharmacotherapy
    started at 27-29.9 BMI withcomorbidities
  13. Discuss when various weight loss therapies are appropriate: Surgery
    Started at 35.39.9 with comorbidities
  14. Weight loss is not necessarily recommended for
    those with a BMI of...
    • 25-29.9 or a high waist circumference, unless
    • they have two or more comorbidities
  15. Consider pharmacotherapy only if patient has not lost one pound per week after 6 months or combined lifestyle therapy.
  16. Dietary therapy
    • Decrease calories by 500/day to get weight loss of 1-2 lb/wk.
    • Women– 1000-1200 calories/day
    •  Men –1200-1600 calories/day
  17. Physical activity
    May need to have a stress test/be monitored before starting Goal – 30 minutes moderate intensity
  18. Behavioral therapy
    Usually used with diet/exercise Look at stress levels and coping methods Involves attitudes/beliefs
  19. Combination therapy
    A combined intervention of behavioral therapy, diet, and physical activity provides the most successful therapy for weight loss and maintenance.
  20. Pharmacotherapy
    • Appetite Suppressants
    • Fastin– 12 weeks adults              
    • SE– increased BP, pulse, sleeplessness, nervousness 
    • Tenuate– 12 weeks adults 
    • SE– Dizziness, h/a, sleeplessness, nervousness
    • Obezine– 12 weeks adults 
    • SE– Sleeplessness, nervousness
    • GI Lipase Inhibitors 
    • -Xenical 
    •  Inhibitsfat absorption from small intestine
    • SE– decreases absorption of fat soluble vitamins/minerals
  21. Describe Bariatric surgery
    • Restrictive
    •    Vertical banded gastroplasty – VGB
    • band a pouch of stomach off, making stomach smaller
    • Lap-Band Surgery
    • Band a pouch of the stomach off, can be tightened/loosened
    •  Gastric Bypass 
    •        Roux-en-y
    •   Pre-surgery
    • Screenings for qualifications, psychiatric evaluation, and dietitian consult
  22. Post-surgery
    Leakage, Pulmonary complication, Infection, Stoma stenosis, Ulcer, gallstones
  23. What are pediatric concerns with obesity?
    • Type 2 diabetes, Sleep Apnea, Hypertension
    • Causes – heredity, environmental
  24. What are pediatric concerns with obesity?
    • Limit TV and other screen time to <2 hours/day
    • Put an hour of physical activity into the child’s play
    • Keep TV’s out of children’s rooms
    • Choose more whole grain choices but breakfast is important
    • Eat together as a family away from the TV
    • Have healthy snack
    • foods available and limit portions            
    • Replace soft drinks with low fat/skim milk for children over 2 years old
  25. What are recommendation for prevention of
    obesity in teens?
    • Better health education in schools
    • More physical activity programs
    • Better nutrition services
  26. What are recommendations for obesity in older
    • Helping them to adopt changes for a healthier lifestyle which include dietary modifications and physical activity.
    • Changes can be difficult due to family patterns and chronic health conditions.
    • Nutritional and physical activity counseling may be necessary.
    • The obese elderly client is more at risk for disability and possible nursing home placement than an elderly client who is not overweight.
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