|
|
|
|
|
|||
|
|||
|
Vertically
|
Diagnosis
and Vertically Integrated Management of Obesity Slide 8-7. In the vertically integrated management of obesity, the body mass index is used as a guide to therapeutic options while with each form of therapy, diet, exercise and lifestyle changes continue to be employed. With co-morbidities above a body mass index of 27 or even without co-morbidities at a body mass index of 30, pharmacotherapy is an option for patients where diet, exercise and lifestyle change alone are not adequate. Similarly, above body mass index of 40, surgery is an option for patients who have failed pharmacotherapy, but diet, exercise and lifestyle change are used with the surgical intervention. Slide 8-8. Both lean body mass and fat mass are increased in obesity as shown in this comparison of the body composition of a 70 kg man and a 105 kg man. The increase in lean body mass seen in a large proportion of all obese patients can be masked by factors reducing lean mass such as previous bouts of crash dieting leading to reductions in lean mass or inadequate protein intake combined with extreme inactivity. Slide 8-9. Sarcopenic obesity occurs when there is a low BMI with increased percent body fat. The weight for height is normal or low but the person has reduced lean body mass and increased body fat despite looking thin. Bioelectrical impedance measurements made of young women at increased risk of breast cancer demonstrated sarcopenic obesity in 38 out of 40 women. As illustrated, although the Body Mass Index is normal, the percentage of body fat is increased. This is the operative definition of sarcopenic obesity. Body fat is best reduced in these women by encouraging heavy resistance exercise rather than simply calorie restriction. They characteristically have low metabolic rates secondary to their low lean body mass. Slide 8-10. Human body composition can be described at five levels ranging from elements to the whole body: I: atomic; II: molecular (chemical); III: cellular; IV: tissue-system (including adipose tissue and muscle tissue); and V: whole body. Adipose tissue is distributed as subcutaneous, visceral, interstitial, and yellow marrow. With obesity there are variations in adipose tissue distribution in these compartments with gender and age. Slide 8-11. The fat-free mass increases gradually with increased body weight, but excess fat mass accounts for approximately 75% of the weight increment as body weight increases. With gradual weight loss, fat and protein are lost in these same proportions (75% : 25%). However, with rapid weight loss due to starvation or semistarvation, there will be protein depletion with up to 50% of the weight lost coming from skeletal muscle and visceral protein. Slide 8-12. High fat diets both in men and women, when eaten ad libitum, are associated with weight gain. These observations led to the development of low-fat and so-called non-fat foods. Unfortunately, when the calories saved through fat reduction are replaced with sugar there is no net reduction in caloric intake or any lasting effect on obesity. In order to reduce caloric intake, the high fat foods must be eliminated together with meal replacement and portion-control strategies. There are over 1000 fat-free foods, and many of these replace the fat calories completely with carbohydrates including refined sugar to maintain taste. If these foods do not result in the intake of fewer calories they have no role in a weight reducing diet. |
|
||||
|
|
|
Nutrition
101 - Natural
Remedies - Weight
Management - Physician
Education |
||||
