CORESET2 obesity related pathophysiology

obesity related

1. Definitions
Body Mass Index (BMI) describes relative
weight for height: weight (kg)/height (m
2
)
•Overweight = 25–29.9 BMI
•Obesity = >30 BMI

2. Age-Adjusted Prevalence of
Overweight BMI (25–29.9) and Obesity (BMI >30)37.8
23.6
10.4
15.1
41.1
23.6
11.8
16.1
39.1
24.3
12.2
16.3
24.9
39.4
24.7
19.9
0
10
20
30
40
50
Men Women Men Women
NHES INHANES I NHANES IINHANES III
BMI >30BMI 25–29.9
CDC/NCHS, United States, 1960-94, ages 20-74 years
Percent

3. 14.9 15.2
22.1
27.727
32.7
41.9
37.8
0
10
20
30
40
50
Men Women
BMI <25BMI 25-<27BMI 27-<30BMI >30 NHANES III Prevalence of Hypertension*
According to BMI
*Defined as mean systolic blood pressure 140 mm Hg, mean diastolic 90 mm Hg,
or currently taking antihypertensive medication.
Brown C et al. Body Mass Index and the Prevalence of Hypertension
and Dyslipidemia. Obes Res. 2000; 8:605-619.
Percent

4. NHANES III Prevalence of
High Blood Cholesterol* According to BMI13.413
30.5
19.1
29.6
21.6
27
22
0
10
20
30
40
50
Men Women
BMI <25BMI 25-<27BMI 27-<30BMI >30
*Defined as >240 mg/dL.
Brown C et al. Body Mass Index and the Prevalence of Hypertension
and Dyslipidemia. Obes Res. 2000; 8:605-619.
Percent

5. 16.6
9
27.1
18.2
28.5
23.7
40.6
31.1
0
10
20
30
40
50
60
Men Women
BMI <25BMI 25-<27BMI 27-<30BMI >30 NHANES III Prevalence of
Low HDL-Cholesterol* According to BMI
*Defined as <35 mg/dL in men and <45 mg/dL in women.
Brown C et al. Body Mass Index and the Prevalence of Hypertension
and Dyslipidemia. Obes Res. 2000;8:605-619.
Percent

6. Health Benefits of Weight Loss
•Decreased cardiovascular risk
•Decreased glucose and insulin levels
•Decreased blood pressure
•Decreased LDL and triglycerides, increased HDL
•Decreased severity of sleep apnea
•Reduced symptoms of degenerative joint disease
•Improved gynecological conditions

7. Care of Overweight/Obese Patients
Requires two steps:
•Assessment
•Management

8. Assessment of Overweight and Obesity
•Body Mass Index
–Weight (kg)/height (m
2
)
–Weight (lb)/height (in
2
) x 703
–Table
•Waist Circumference
–High risk:
•Men >102 cm (40 in.)
•Women >88 cm (35 in.)

9. Obesity ClassBMI kg/m
2
Underweight <18.5
Normal 18.5–24.9
Overweight 25–29.9
Obesity I 30.0–34.9
II 35.0–39.9
Extreme Obesity III 40.0 Classification of Overweight and Obesity by BMI

10. Determine Absolute Risk Status
Evaluate:
•Disease conditions (e.g., CHD, type 2 diabetes, sleep apnea)
(+ = very high risk)
•Other obesity-associated diseases (e.g., gynecological
abnormalities, osteoarthritis)
•Cardiovascular risk factors: smoking, hypertension,
high LDL, low HDL, IGT, family hx (>3 = high risk)
•Other risk factors:
–Physical inactivity
–High serum triglycerides (>200 mg/dL)

11. Treatment Algorithm
Patient Encounter
Hx of 25 BMI?
•Measure weight,
height, and waist
circumference
•Calculate BMI
Examination
Brief reinforcement/
educate on weight
management
Periodic weight
check
Advise to maintain
weight/address
other risk factors
Clinician and patient
devise goals and
treatment strategy
for weight loss and
risk factor control
Assess reasons for
failure to lose
weight
Maintenance counseling:
Dietary therapy
Behavior therapy
Physical activity
:
Treatment
Assess risk
factors
No
Yes
1
2
14
15 13
12
11 1016
3
4 6
5 7
8
9
Yes
No
Yes
No
Hx BMI 25?
No
Yes
Yes
No
Does
patient want to
lose weight?
Yes
No
Progress
being made/goal
achieved?
BMI 25 OR
waist circumference
> 88 cm (F)
> 102 cm (M)
BMI
30 OR
{[BMI 25 to 29.9
OR waist circumference
>88 cm (F) >102 cm (M)]
AND 2 risk
factors}
BMI
measured in past
2 years?

12. No
BMI
30 OR
{[BMI 25 to 29.9
OR waist >88 cm (F)
>102 cm (M)]
AND 2 risk
factors}
Treatment Algorithm
(Part 1 of 3)
Patient Encounter
Hx of 25
BMI?
•Measure weight,
height, and waist
circumference
•Calculate BMI
Assess risk
factors
No
Yes
1
2
3
4
6
5
7
Yes
No
BMI
measured in past
2 years?
BMI 25 OR
waist >88 cm (F)
>102 cm (M)
Yes
Examination
Treatment

13. Devise goals and
treatment strategy for
weight loss and risk
factor control
Assess reasons for
failure to lose weight
Maintenance
counseling
12
11 10
8
9
No
Yes
Yes
No Desire to
lose weight?
Yes
No
Progress
made?
BMI
30 OR
{[BMI 25 to 29.9
OR waist >88 cm (F)
>102 cm (M)]
AND 2 risk
factors}
Examination
Treatment
7
Periodic weight
check
• Advise to maintain weight
• Address other risk factors
13
16
Treatment Algorithm
(Part 2 of 3)

14. •Brief reinforcement
•Educate on weight
management
Periodic weight
check
•Advise to maintain weight
•Address other risk factors
14
15
13
16
5
Yes
No
Yes
No
Hx BMI 25?
BMI 25 OR
waist >88 cm (F)
>102 cm (M)
Examination
Treatment
Treatment Algorithm
(Part 3 of 3)
* This algorithm applies only to the
assessment for overweight and obesity
and subsequent decisions based on that
assessment. It does not include any
initial overall assessment for
cardiovascular risk factors or diseases
that are indicated.