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Obesity Counseling

Behavioral Medicine

obesity is a BMI of __ or greater 30
overweight is a BMI of __ 25-29.9
morbid obesity is a BMI of __ or higher or BMI of __ or higher with co-morbidities 40, 35
there are an estimated __ obese adults worldwide 320 million
there are an estimated __ overweight adults worldwide 1.1 billion
one of the national health objectives is to reduce the prevalence of obesity among adults to less than __% 15
for each 5kg/m higher BMI there is an associated __% higher mortality 30
at a BMI of 30-35 median survival is reduced by __ years 2-4
ata BMI of 40-45 median survival is reduced by __ years (comparable to the effects of smoking) 8-10
__ deaths annually are attributable to obesity and sedentary lifestyle 400,000
estimated __% of national healthcare expenditures is related to obesity and its negative outcomes 10
almost __ dollars is spent annually on obesity related health care 100 billion
BMI below __ is underweight 18.5
BMI of __ is considered healthy weight 18.5 - 24.9
BMI is a __ tool not a diagnostic tool screening
detrimental health outcomes increase with a waist measurement of over __ inches in men and over __ inches in women 40, 35
BMI is combined with what further assessments to arrive at a more accurate health risk waist circumference, evaluations of diet, physical activity, family history, BP, physical inactivity
components of metabolic syndrome abdominal obesity (40in men, 35in women), serum triglycerides (>150), HDL cholesterol (<40 men, <50 women), hypertension (>130/85), insulin resistance/fasting blood glucose (>100)
approximately __% of the population in industrialized countries have metabolic syndrome 20-30
obese applicants are viewed as having poor self discipline, low supervisory potential, poor hygiene, less ambition and productivity
surgery for weight loss is only indicated for those with a BMI of __ 40 or greater, or 35 with comorbidities
pharmacotherapy for weight loss is only indicated for those with a BMI of __ 30 or greater, or 27 with comorbidities
five steps to facilitate behavior change identify behavior change goal, review when/how behaviors will be performed, have patient keep record of behavrior change, review progress at next treatment visit, congratulate patient on successes
cardinal behaviors of successful long-term weight management self monitoring, low cal/low fat, eat breakfast daily, regular physical activity
points to assessing weight loss readiness motivation (patient seeks wt reduction), stress level (free of major life crises), psychiatric issues (free of severe depression/substance abuse/bulimia), time (patient can devote 15-30 min/d to wt control for the next 26 weeks)
what do you do if the overweight/obese patient is not ready to lose wt prevent wt gain and explore barriers to wt reduction
calories in a 12oz beer 160
calories in a 5oz glass of wine 100
calories in a 2oz shot of liquor 128
recommended nutrient content of a weight reducing diet 55% carbs, 15% protein, 30% fat (1-8% saturated, 15% monounsaturated, 10% polyunsaturated)
medications that can cause weight gain psychotropic meds, beta blockers, DM meds, HAART, tamoxifen, steroid hormones
drugs currently approved by the FDA for treatment of obesity orlistat, sibutramine, phentermine
the most successful treatment for weight loss and maintenance combined intervention of a calorie-deficit diet, increased physical activity, and behavioral treatment
__ helps preserve fat free mass during weight loss physical activity
considerable __ is necessary for weight loss maintenance physical activity
with wt loss surgery max of wt loss is in the first __ 18-24 months
max amount of wt loss with surgery 100-180 lbs
Obesity Defn high amt body fat in relation to lean body mass, or BMI ≥30
BMI defn measure of wt relative to height: wt in kg div by the square of pt’s ht in meters
Obesity trends in US epidemic: 60M (doubled since 1980)
Overweight: adult defn An adult who has a BMI between 25 and 29.9
Obese: adult defn An adult who has a BMI of 30 or higher
Morbidly Obese: adult defn Adult who has BMI of 40 or higher (w/o comorbids) or who has BMI of 35 or higher with co morbidities
BMI Below 18.5 = Underweight
BMI 18.5 to 24.9 = Healthy weight
BMI 25.0 to 29.9 = Overweight
BMI 30 or higher = Obese
Considered an alternative to direct measures of body fat = BMI
How is BMI used? Screening tool - not a diagnostic tool
Risk for developing heart dz, etc, increases with waist measurement of: > 40 inches (men) & > 35 inches (women)
BMI: kids/teens: age & sex-specific; calculated same as for adults
BMI percentile = Plotted on CDC BMI-for-age growth charts (for girls or boys) to obtain a percentile ranking
BMI percentile growth charts show: wt status categories used w/ kids & teens (underweight, healthy weight, at risk of overweight, and overweight)
Underweight: percentile: < 5th%
Healthy weight; percentile: 5th% to < 85th %
*At risk of overweight: percentile: 85th % to < 95th %
*Overweight: percentile: ≥ to 95th %
Reasons that age and sex are considered for children and teens Amt of body fat changes with age; amt of body fat differs between girls and boys
Health consequences of overweight & obesity for adults HTN; dyslipidemia; T2DM; Coronary heart dz; Thromboembolic events; Sleep apnea / resp problems; Gallbladder dz; Osteoarthritis
Metabolic syndrome defn Abd obesity (waist > 102 cm /40 in (M) & >88 cm / 35 inches (F); TG ≥ 150; HDL ≤ 40 (M) & ≤ 50 (F); BP ≥130/85; Fasting blood glucose ≥110
Psychosocial consequences of obesity Negative attitudes; Stereotypes (lead to Stigma, Rejection, Prejudice, Discrimination); Verbal, physical & relational forms; Subtle and overt expressions
Obesity & peer victimization Vulnerability to bias increases with body wt; among the heaviest youth, 60% report victimization
Personal consequences of obesity = Psychological-low self esteem/ depression; Social (rejection); Economic (poor job satisfaction / reward); Medical (multiple co morbid conditions)
Selection of obesity tx Diet, Exercise, Behavior Tx at any obesity category; pharm tx (≥30; ≥27 w/comorbids) (never tx w/drugs alone); surgery (≥ 40; ≥35 w/comorbids)
Should first try non-pharm interventions for obesity for how long? At least 6 months
Behavioral Treatment of Obesity (Outpatient) structured, goal-oriented: realistic, ST goals; frequent pt visits to enhance compliance; LT contact: maintain motivation; ID office staff (weigh-ins & review self-monitoring); written education materials
Responding to Nonadherence Don’t take behavior personally; assume problem = lack of planning; Do not criticize pt; ID obstacles & how to handle them; acknowledge difficulty of behavior change; encourage; new plan, shorten interval required for success
Effect of High-Protein, Low-Fat Diet on Body Wt: Lose more wt than high-carb diet
FDA approved drugs to tx obesity Orlistat; Sibutramine, Phentermine (ST)
Phentermine: AE Amphetamine like response (irritability / tremulousness / increased HR); high BP; caution in pt w/ HTN & underlying heart dz
Orlistat MOA prevents fat digestion and absorption by binding to GI Lipases
Guidelines for Increasing Physical Activity Assessment (med / psych readiness; current activities, barriers to activity); physical activity plan; start activity slowly &and gradually increase planned aerobic to 200 min/wk; enhance compliance
Weight loss surgery: when: BMI >40 or >35 with comorbids; if med tx has failed
Weight loss surgery: maximum wt loss: in first 18-24 months
Created by: Adam Barnard Adam Barnard