COVID-19 remains center stage, and efforts to contain it endanger our focus on other conditions, including obesity, which is known to lead to many serious, life-threatening co-morbidities.
Obesity is defined by a BMI of ≥30Kg/m2 and abdominal obesity is defined by a waist circumference of ≥40 in. for men and ≥35 in. for women. Both BMI and waist circumference may vary according to racial norms.
33% of adults and 17% of adolescents and children in the US are clinically obese.
Causative factors include genetic inheritance, culture and environment, socioeconomic status, some medications, and long illness or injury recuperations, among others.
Diet and exercise are essential components of treatment:
Caloric intake of 1000-1200 kcal/day for women and 1200-1500 kcal/day for men
Initially, a low carbohydrate diet, followed at about 6 months with a high protein/low carbohydrate diet
Activity: 30 minutes a day, 5 days a week. Moderate activity such as walking, bicycling on level ground, and swimming are recommended, with level of difficulty and duration increased as tolerated
Adjunct psychological therapies, either web-based or in-office consultations can be effective in treating causes and challenges of an obesity diagnosis
Medications that have been shown to be effective are:
Orlistat, 60 mg PO TID
Phentermine/topiramate combination, initial 14-day dose 3.75 mg (phentermine)/23 mg (topiramate)PO QD, then 7.5 mg/46 mg PO QD for 12 weeks. If weight loss is ≤3% of baseline, discontinue or escalate as follows:
11.25 mg/69 mg PO QD x14 days, then 15 mg/92 mg PO QD for 10 more weeks. If weight loss is ≤5% after 12 weeks, discontinue.
Maintenance dose is 7.5mg Phentermine/46 mg Topiramate or 15 mg/92 mg PO QD
Liraglutide: escalated doses initially 0.6 mg SQ QD; add 0.6 mg weekly until the maintenance dose of 3 mg SQ QD is reached
Naltrexone/bupropion HCl combination: 8 mg (naltrexone)/90 mg (bupropion) PO QD initially, increased to maintenance dose of 16MG/180 mg BID
Surgery or balloon insertion are appropriate for patients with BMI ≥ 40 and for those with BMI ≥ 35 with co-morbidities.
Obesity: Not Just Appearance
COVID-19 remains center stage, and efforts to contain it endanger our focus on other conditions, including obesity, which is known to lead to many serious, life-threatening co-morbidities.
For more information:
https://www.aace.com/files/obesity/final-appendix.pdf
https://www.rethinkobesity.com/pdfs/aace-guidelines-brochure.html
https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
https://www.nhlbi.nih.gov/health-pro/guidelines/current/obesity-guidelines/e_textbook/txgd/4142.htm
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