Treatments for Obesity
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Treatments for Obesity

November 9, 2019

– My name is Dr. Matthew Payne, I’m a Family Medicine Physician at East Falls Primary
Care and Specialty Clinic. One of the most common conditions that we see in our primary care office is that of being overweight or obese. And many patients seek out our advise and help with weight loss. So today I’d like to talk about obesity with it’s associated health hazards as well as an overview of
the management of obesity. (gentle guitar music) I’d like to begin by
briefly defining obesity. Body mass index is the easiest and most practical way to define obesity. The World Health Organization and National Institutes of Health recognize overweight as a body mass index greater then 25 equal to 29.9 and obesity as greater then 30. Also waist circumference
is an important measurement when defining obesity. It has been shown that central obesity, particularly increases risk
of cardiometabolic risk. So in men of waist
circumference greater than 40 and in women greater then 35 is an important measurement to know. Obesity is a chronic
disease which has increased in prevalence and has now
become a global epidemic. There are many factors
that contribute to obesity including genetic factors,
environmental factors, medications as well as
the increased availability of energy-dense foods. However most cases of
obesity are related to increased caloric intake as
well as sedentary lifestyle. We’ve known for a long time that there are several health hazards
associated with obesity. The most prevalent among
these is Type II diabetes with about 80% of Type II diabetes being directly associated with obesity. There are other health risks associated with obesity including: hypertension, elevated
cholesterol, sleep apnea, increased risk of cardiovascular
disease and stroke. More then 2/3 of adults
are currently trying to lose weight or maintain their weight. I’d like to discuss some
of the medical strategies that we use to help those
patients accomplish that goal. The initial treatment of obesity includes: diet modifications, behavioral
therapies, and exercise, and in certain circumstances drug intervention or surgery. The goal of behavioral
therapy is to produce long-term changes in eating behaviors and to modify diet and improve exercise. There are many ways that
we can accomplish this: self-reporting by using a food diary, joining support groups, as well as seeing a dietician or nutritional counselor can all help in this regard. Other behavior changes can include changing of eating habits including: chewing your meal slowly,
drinking sips of water between bites or during the meal, or even leaving the table during a meal. One of the challenges
to behavioral therapy is setting realistic expectations that can be met by the patient. Most often patients would like to have an approximate 30% weight loss
from their current weight. This is often times unrealistic. Most studies show that
about 5 to 7% weight loss is an appropriate amount. Dietary changes are
also another key element of weight loss. It’s important to realize that calories from any source in excess
can cause weight gain. A lot of foods available
in our stores today, if it comes in a box or a can, are high in calories but low in nutrition. Some helpful tips when
choosing a diet would include: not shopping on an empty stomach, and also sticking to
the outside of the store where you can find the most
fresh fruits and vegetables and lean cuts of meat. Also it’s important to realize there are many types of diets. None of them have been shown to be more effective then another. The most important factor is being able to adhere and maintain the diet. Most diets recommend low caloric intake of about 800 to 1,200 calories per day. Exercise is also very
important in treating obesity and has been shown to be more effective in preventing obesity. Exercise has very minimal impact on overall weight loss but has been shown to be excellent at maintaining weight loss once achieved. The current recommendation is to exercise 30 minutes per day at
least 5 to 7 days per week. An important fact to remember is that exercise can be additive, meaning if you exercise only 10 minutes three times a day it’s the same as doing it all at once. There are also many drug
therapies and herbal remedies that have been used to promote weight loss and often times patient’s ask about these medications when they
come to our office visit. It’s important to realize
that many of these medications have side effects that need to be tailored to the individual. There are certain indications to using these medications
including a body mass index greater then 30 despite
efforts in weight loss related to diet and exercise. A key concept to remember
is that drug therapy is not a cure for obesity and that most of these medications will have a therapeutic maximal
effect at which point weight loss no longer occurs. And also in most patients
once the medications are stopped weight increases. There are several
prescription-strength medications that can be used for weight loss and I would encourage you
to talk to your physician about each of those individually. Also there are many
over-the-counter herbal remedies that people use to promote weight loss. These can include: green tea, Hoodia, and Garcinia Camogia. And lastly there are those patients who despite drug therapy, exercise and behavior modifications
still have increased risk of comorbid conditions including: heart disease, diabetes, who may benefit from bariatric surgery. Lastly bariatric surgery has been used as an option in those patient’s who have not been able to maintain weight loss through diet, exercise
and drug intervention. Obesity is a common and
complex medical condition but there are definitely
ways to treat this. I would encourage you to seek advice from your medical provider or physicians or schedule an appointment
for more information.

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