Please enable JavaScript.
Coggle requires JavaScript to display documents.
gihep 17: obesity + eating disorders (i) (obesity treatment (bariatric…
gihep 17: obesity + eating disorders (i)
measuring obesity
% body fat = best, but time consuming + expensive
25-31% (female), 18-24% (male)
BMI = kg/m^2
not accurate for high muscle mass individuals
not accurate for adolescents
use tri-ponderal mass index (kg/m^3)
overweight = 16 (girl), 16.8 (boy)
obese = 18.8 (girl), 19.7 (boy)
waist circumference (>102cm = obese) or waist-hip ratio
Metabolic syndrome
waist > 102cm, hypertension, hyperlipidemia, hyperglycaemia
associated with excessive fructose consumption
1 metabolic equivalent gain in fitness = 15% decrease in all cause mortality
not all fat is the same...
ab/central obesity reflects visceral obesity
visceral fat = hormonally active
releases adipokines (associated with diabetes)
increases mortality
hip adiposity does not increase mortality
obesity treatment
exercise + diet
adherence = most difficult part
all diets seem to work, but need to be customised + maintained
must consume > 800kcals/day
pharmacological therapy
orlistat
for BMI >30
1st choice
inhibits pancreas lipase, decreases fat digestion
average loss = 8.8kg
60% adherence
others: sympathomimetics, high dose antidepressants, antiepileptics (insufficient data), camabinoid-1 antagonists (withdrawn due to psychiatric SEs)
bariatric surgery
decreases consumption + absorption
when BMI >40
resolves compilations of obesity too (e.g. hypertension)
sleeve gastrectomy
adjustable band gastroplasty
roux-en-Y bypass
liposuction
decreases subcutaneous fat
no evidence of clinical benefit
guidelines
1) orlistat for 2-4 years
2) surgery
fasting
prolongs life (based on animal data)
alternative day fasting: day 1 eat 20% of kcals, day 2 eat whatever
5:2 diet: eat normal for 5 days, fast for 2