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Weight
Management Home Obesity
1200
Calorie
Diet
1500
Calorie
Diet
What
is a
Food Portion?
Burn
Barometer
Body
Mass Index (BMI)/Protein
Tool
Trigger
Foods
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 Diagnosis
and Vertically Integrated Management of Obesity
Obesity, an excess
body fat accumulation, ultimately results from an increase in energy intake
over expenditure. However, there are individual variations in energy efficiency
based in part on body composition. Body weight for height or body mass
index ( BMI = weight divided by height squared) is used to diagnose obesity
even though these measurements are only indirect measures of body fat.
Body fat can be estimated using bioelectrical impedance analysis with
the advantage that lean overweight individuals such as athletes can be
differentiated from overfat overweight individuals. In addition, normal
weight individuals with reduced muscle mass due to inadequate protein
intake, reduced physical activity, or the effects of drugs that reduce
muscle mass, can be identified as having excess body fat.
The therapeutic impact
of this differentiation is significant. Individuals who have increased
lean mass will have a higher than average target weight, and need to be
encouraged to maintain their lean body mass through exercise and adequate
protein intake. They must also be encouraged to accept their target weight
which may be higher than what they imagined. Each pound of lean body mass
burns about 14 Calories per day. Individuals with reduced lean body mass
can be encouraged to increase lean body mass through heavy resistance
exercise in order to increase basal metabolic rate.
Vertically integrated
management of obesity is a system in which the modality used correlates
with the severity of obesity as measured by body mass index. In overweight
and mildly obese individuals, diet, exercise and lifestyle modalities
are used. The behavioral tools available include confirming readiness
to change, using stimulus control to minimize the intake of trigger foods,
use of meal replacements and portion-controlled meals to reduce caloric
intake, aerobic and heavy resistance exercise, relapse prevention, social
support, and stress reduction. For individuals with BMI > 27 with co-morbid
conditions or BMI >30, pharmacotheapy is added. Appetite suppressants,
satiety agents, and lipase inhibitors are available while other approaches
are still undergoing research. For individuals with BMI of 35 to 40 with
sleep apnea or other significant morbidity, or with a BMI > 40, gastric
surgery for obesity can be utilized. The patients using drugs or undergoing
surgery utilize the same principles of diet, exercise and lifestyle utilized
for milder forms of obesity. Drugs and surgery are adjuncts to diet and
lifestyle change for the treatment of obesity.
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