Obesity

Clinic A/P, adults

-BMI reviewed.
-Comprehensive high-intensity (12 to 26 sessions/year) lifestyle interventions, including a combination of diet (food choices & reduced caloric intake), exercise, and behavioral modification discussed with the patient.
-Nutritionist/dietician referral for help with food choice, meal planning, etc.
–Behavioral counseling/motivational interviewing.
-SMART weight loss goal: 1lb per week.
-Exercise Counseling.
-Indications for pharmacologic therapy & bariatric surgery reviewed.
-High-intensity behavioral intervention with 12 to 26 sessions per year is recommended, per USPSTF evidence.
-F/u in 2-4 weeks.

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** SBP decreases 0.5 to 2 mm Hg / Kg of weight loss.

High-intensity behavioral intervention
“The USPSTF found that the most effective interventions were comprehensive and were of high intensity (12 to 26 sessions in a year). Most of the higher-intensity behavioral interventions included multiple behavioral management activities, such as group sessions, individual sessions, setting weight-loss goals, improving diet or nutrition, physical activity sessions, addressing barriers to change, active use of self-monitoring, and strategizing how to maintain lifestyle changes. Weight-loss outcomes improved when interventions involved more sessions (12 to 26 sessions in the first year). Behavioral intervention participants lost an average of 6% of their baseline weight (4 to 7 kg [8.8 to 15.4 lb]) in the first year with 12 to 26 treatment sessions compared with little or no weight loss in the control group participants. A weight loss of 5% is considered clinically important by the U.S. Food and Drug Administration (FDA). For obese patients with elevated plasma glucose levels, behavioral interventions decreased the incidence of diabetes diagnosis by about 50% over 2 to 3 years (number needed to treat, 7). Behavioral interventions also demonstrated some improvement in intermediate health outcomes, such as blood pressure, waist circumference, and glucose tolerance”

Definition: Obesity is a chronic disease. It is multifactorial and impacted by social, spiritual (beliefs & values), cultural, behavioral, metabolic, and genetic factors. BMI ≥ 30.

“The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions” Grade B, USPSTF

AAFP Articles: http://www.aafp.org/afp/2010/0615/p1449.html; http://www.aafp.org/afp/2012/1115/od3.html

Pharmacologic therapy: “For individuals with a BMI >30 kg/m2 or a BMI of 27 to 29.9 kg/m2 with comorbidities, who have failed to achieve weight loss goals through diet and exercise alone, pharmacologic therapy should be added to diet and exercise.”

Bariatric Surgery: “For patients with a BMI ≥40 kg/m2 who have failed to lose weight with diet, exercise, and drug therapy, we suggest bariatric surgery. Individuals with a BMI >35 kg/m2 with obesity-related comorbidities (hypertension, impaired glucose tolerance, diabetes mellitus, dyslipidemia, sleep apnea) who have not met weight loss goals with diet, exercise, and drug therapy are also potential surgical candidates, assuming that the anticipated benefits outweigh the costs, risks, and side effects of the procedure.” UTD

“Obesity is a common condition that is associated with numerous medical problems such as cardiovascular disease, pulmonary disease, and diabetes mellitus. Primary care physicians have an important role in helping patients develop a successful weight loss plan to improve their overall health. Dietary strategies emphasizing reduced caloric intake, regardless of the nutrient composition, are important for weight loss. Behavioral interventions such as motivational interviewing and encouraging physical activity lead to additional weight loss when combined with dietary changes. Medication regimens for concomitant medical problems should take into account the effect of specific agents on the patient’s weight. Persons with a body mass index of 30 kg per m2 or greater or 27 kg per m2 or greater with comorbidities who do not succeed in losing weight with diet and activity modifications may consider medication to assist with weight loss. Medications approved for long-term treatment of obesity include orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion. Physicians should consider referring patients for bariatric surgery if they have a body mass index of 40 kg per m2 or greater. For those with obesity-related comorbid conditions, patients should be considered for adjustable gastric banding or other bariatric surgical approaches if they have a body mass index of 30 to 39.9 kg per m2. The most commonly performed procedures for weight loss are Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Bariatric surgery is the most effective intervention for weight loss in obese patients, and it leads to improvement in multiple obesity-related conditions, including remission of diabetes. ” AAFP 2016 article, Update on Office-Based Strategies for the Management of Obesity.

 

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