OBESITY the EPIDEMIC | September 2022 | Clinical Corners

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September 15, 2022

OBESITY the EPIDEMIC

 

Obesity is epidemic in the United States today and a major cause of death, attributable to heart disease, cancer, and diabetes. As the most prevalent Chronic Disease in the United States, obesity costs this country about $150 billion a year, or almost 10 percent of the national medical budget. Approximately one in three adults and one in six children are obese.

 

DEFINITIONS4:

Adults:

  • Healthy weight is a BMI of 18.5 to 24.9
  • Overweight is a BMI of 25 to 29.9
  • Obesity is a BMI of 30 or above

Children:

  • Healthy weight is a BMI between the 5th and the 85th percentile.
  • Overweight is a BMI between the 85th percentile and the 95th percentile.
  • Obesity is a BMI in or above the 95th percentile.

You may have a normal BMI but if you have a large waist circumference, you may have more fat in your abdomen than elsewhere, which contributes to obesity-related complications, including heart disease and diabetes.

  • For men, an unhealthy waist circumference is greater than 40 inches.1
  •  For women, an unhealthy waist circumference is greater than 35 inches.1

 

 

TREATMENT OPTIONS:

1: Increased physical activity or exercise is an essential part of obesity treatment. People with obesity need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss.

 

2: A behavior modification program can help make lifestyle changes to lose weight and keep it off. This includes counseling with a mental health professional to help address emotional and behavioral issues related to eating.

 

3: Endoscopic:

  • Endoscopic sleeve gastroplasty. This procedure involves placing stitches in the stomach to reduce the amount of food and liquid the stomach can hold at one time.
  • Intragastric balloon for weight loss. In this procedure, the balloon is then filled with water to reduce the amount of space in the stomach, so you'll feel full eating less food.

 

4: Surgical

 

  • Adjustable gastric banding. In this procedure, a tight inflatable band separates the stomach into two pouches.
  • Gastric bypass surgery. Also known as the Roux-en-Y procedure.
  • Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food.

     

    5: Pharmaceutical:

  • The FDA has approved five medications - orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), and semaglutide (Wegovy) - for long-term use. A sixth approved drug, setmelanotide (IMCIVREE), is limited to people who have been diagnosed with one of three specific rare genetic disorders. Phentermine (Adipex) is approved for short-term use up to 12 weeks.2
  • A newer cellulose-based medication recently approved (Plenity) has been shown to have a modest, at best, weight loss portfolio of about 5%.

 

 

SUMMARY:

Obesity has a negative affect quality of life, life expectancy, employment discrimination, annual health care expenditures and obesity-related non-communicable diseases, including type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease. It is imperative to assess and address the barriers that obese patients face which can delay pursuing their healthcare needs.

 

A 5% to 10% weight loss can significantly improve the health and quality of life of many obese patients.  Many people take prescription, over the counter or alternative medicine supplements in an attempt to lose weight. But to keep the weight off for the long term, there needs to be a change in eating patterns and unhealthy habits. In as much, research has shown a relationship between lack of sleep and obesity that begins as early as infancy. Experts recommend 7 to 8 hours of sleep per night for adults. Medications, surgery and dietary modifications are useful, but behavior and lifestyle changes are paramount for sustained weight loss.

 

REFERENCES:

  1. https://www.mayoclinic.org/diseases-conditions/obesity/diagnosis-treatment/drc-20375749
  2. https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity#:~:text=The%20FDA%20has%20approved%20five,%E2%80%94for%20long%2Dterm%20use.
  3. https://healthlibrary.uwmedicine.org/conditions/orthopedics/newsrecent/85,P07858
  4.  Overweight and Obesity - Symptoms and Diagnosis | NHLBI, NIH