Primary Care – Weight Gain, Obesity: By Maja Artandi M.D.
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Primary Care – Weight Gain, Obesity: By Maja Artandi M.D.

March 7, 2020

Obesity is a chronic disease that is increasing
in prevalence and that is a major cause of morbidity and mortality. Obesity is defined with the help of the body
mass index, or BMI calculated as Weight (kg)/Height (m²). Normal BMI is between 18.5 and 24.9
kg/m². Overweight is defined as a BMI between 25 kg/m² and 29.9 kg/m². A patient with
a BMI of 30 kg/m² and above is obese. Obesity significantly increases the risk for
many other diseases. The strongest correlation is seen between obesity and the development
of type 2 Diabetes Mellitus. However, a patient who is obese also has a higher likelihood
of developing cardiovascular disease, hypertension, osteoarthritis, infertility, liver problems
and even cancer. Even though, obesity is a prevalent problem,
we often don’t do a good job of counselling our patients on the importance of weight loss
or the prevention of weight gain. The first step in obesity treatment is to
identify the problem. It is important that a patient’s BMI is calculated at every visit. Another important way to risk stratify patients
is by measuring waist circumference. The adverse consequences of obesity are most closely correlated
with the accumulation of intra-abdominal fat, estimated by the waist circumference. A waist
circumference in women above 88cm (35 inches) and in men above 102 cm (40 inches) is considered
abnormal. Another important part in evaluating the patient
is the identification of existing co-morbidities such as heart disease, diabetes mellitus,
obstructive sleep apnea or severe osteoarthritis. Counselling on weight loss should always be
done on an individual basis. It is important to understand and address every patient’s
barriers to weight loss rather than just giving the advice to eat fewer calories. Pharmacologic interventions are indicated
in Patients with a BMI of>30 kg/m² or with a BMI of 27 kg/m² with existing comorbidities
who have unsuccessfully tried to lose weight with behavioural modifications. It is important to realize that these medications
don’t lead to drastic weight loss and only work in conjunction with dietary modifications
and exercise. It is also important to avoid medications
that are known to be associated with weight gain. Patients with a BMI above 40 kg/m² or a BMI
above 35 kg/m² with existing comorbidities qualify for bariatric surgery, which is effective
in moderate and severe obesity but can also have significant complications.

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