By Prof Dr WALEED IBRAHIM. Obesity has been defined as excess body fat relative to lean body mass. ...
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Transcript of By Prof Dr WALEED IBRAHIM. Obesity has been defined as excess body fat relative to lean body mass. ...
Obesity has been defined as excess body fat relative to lean body mass.
The most widely accepted measure of obesity is the body mass index (BMI).
BMI= Patient’s weight in kg / square of patient’s height in meters (kg/m²).
A normal BMI ranges from 18.5 to 24.9 kg/m²
Definition
BMI 25-29.9 = overweight. BMI ≥30 = obesity. BMI ≥35 = severe obesity. BMI ≥40 = morbid obesity. BMI ≥45 = super obese.
Classification
GENETIC ( rare )
A. SYNDROMES INDUCING OBESITY: Prader- Willi : Hypotonia, Hyperphagia, M R, Facial
features
Laurence- Moon : Ret. Pig, M R , Sp. Pplegia, Hypogonad
Bardet-Biedl : Polydactyly, Renal failure
B. CHROMOSOMAL DEFECTS:
AETIOLOGY OF OBESITY
NUTRITIONAL : Intra-uterine, Infancy, Dietary.
PHYSICAL INACTIVITY : TV., Internet, Lifestyle, Technology.
TRAUMA :NEUROLOGICAL : Post op., Head injuries.PSYCHOLOGICAL : Stresses, Abuse….
MEDICATIONS : Steroids, Psychotropic drugs.
SOCIAL : Economic, Ethnic.
ENVIRONMENTAL
HYPOTHALAMIC-PITUITARY GONADAL : Polycystic Ovary ADRENAL : Cushing THYROID PANCREATIC : Hyperinsulinaemia
NEURO-ENDOCRINE
The American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of:
Elevated waist circumference:Men —Equal to or greater than 40 inches (102 cm)Women — Equal to or greater than 35 inches (88 cm)
Elevated triglycerides:Equal to or greater than 150 mg/dL
AHA
Reduced HDL (“good”) cholesterol:Men — Less than 40 mg/dLWomen — Less than 50 mg/dL
Elevated blood pressure:Equal to or greater than 130/85 mm Hg
FBS equal or greater than 100mg/dL
Morbidly obese patients are classified according to area of main fat mass:
Peripheral (Gynecoid) obesity: associated with degenerative joint disease and venous stasis in the lower extremities.
Central (Android) obesity: associated with the highest risk of mortality related problems due to the “Metabolic Syndrome” as well as increased intra-abdominal pressure.
Complications of obesity
1. Dietary therapy2. Physical activity therapy3. Drug therapy4. Behavioural therapy
Non surgical treatment
Candidates for surgery1) BMI ≤ 40 Kg/m² or ≤ 35 Kg/m² with
significant cormobidities.2) Failure of non surgical weight loss
programs.3) Capability of tolerating surgery.4) Absence of endocrine disorders that can
cause massive obesity.5) Psychological stability with supportive
social environment.
Surgical management
6) Age less than 60 years7) Basic understanding of how obesity
surgery causes weight loss.8) Realization that surgery itself does not
guarantee weight loss9) Absence of active alcohol and drug abuse.10) Commitment to post-operative follow up.
The aim of bariatric surgery is to induce weight loss that is sufficient to reduce obesity-related morbidities to acceptable levels.
Loss of visceral fat is associated with improved insulin sensitivity and glucose metabolism , also reduces intra-abdominal pressure and this change may result in improvement in urinary incontinence, gastroesophageal reflux, systemic hypertension, venous stasis disease, and hypoventilation.
Outcome of Bariatric Surgery
70-80% IMROVEMENT OF CO-MORBIDITIES :
- TYPE 2 DM. - HYPERTESION.
- DYSLIPIDAEMIA.- HYPERURICAEMIA.- SLEEP APNOEA.- CARDIAC RISK.- CANCER RISK.- GERD.- PCOS.
QUALITY OF LIFE:- SOCIAL.- WORK.- SEXUAL.- PSYCHOLOGICAL
IT WAS FOUND THAT THESE POSITIVE CHANGES START (& PERSIST) AS EARLY AS WHEN 10% EWL OCCURS.
1 st, 3 rd,6 th, 12 th MONTH POSTOPERATIVELY, THEN ANNUALLY.
DO NOT FORGET:-ELECTROLYTES.-B. SUGAR.-RENAL FUNCTIONS.-LIVER FUNCTIONS.-TRANSFERRIN.- LIPID PROFILE.
FOLLOW UP