Obesidad Teoria UIS
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Transcript of Obesidad Teoria UIS
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OBESIDAD: ENFOQUE Y MANEJO
Dra . Lina P a tric ia P ra d illa S .Mé dic a Inte rn is ta E ndoc rinólog a
Doc e nte Cá te dra Unive rs ida d Indus tria l de S a nta nde r
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CHEESEBURGER
20 Years Ago Today
333 calories How many calories are in today’s chees eburger?
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Calorie Difference: 257 calories
590 calories
20 Years Ago Today
333 calories
CHEESEBURGER
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Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
How long will you h a ve to lift we ig h ts in orde r to b urn th e e xtra 257 c a lorie s ? *
*Bas ed on 130-pound pers on
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If you lift weights for 1 hour and 30 minutes ,you will burn a pproxima te ly 257 calories .*
*Bas ed on 130-pound pers on
Calories In = Calories Out
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Tendencias en obes idad* en adultos norteamericanos : BRFSS, 1988
Mokda d A.H., CDC
(*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)
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Tendencias en obes idad* en adultos norteamericanos : BRFSS, 1994
Mokda d A H, e t a l. J Am Me d As s oc 1999; 282:16
(*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)
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Tendencias en obes idad* en adultos norteamericanos : BRFSS, 2000
Mokda d A H, e t a l. J Am Me d As s oc 2001; 286:10
(*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)
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Prevalence Obesity Body Mass Index > 30Kg/m2
Total Urban Rural p
Total sample (%)
101 (16.37)
71 (70.29)
30 (29.71)
<0.0001
Men (%)
24 (11.27)
16 (66.67)
8 (33.33)
0.0063
Women (%)
77 (19.06)
55 (71.43)
22 (28.57)
0.0003
p value: Х2 test urban vs rural
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Prevalence Obesity Waist Circumference
Total Urban Rural p
Men* (%)
78 (36.79)
45 (57.69)
33 (42.31)
<0.0001
Women** (%)
192 (47.52)
103 (53.64)
89 (46.36)
0.724
* Men: Waist circumference ≥ 90 cm
**Women: Waist circumference ≥ 80 cm
p value: Х2 test urban vs rural
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IMC e n S ha nha iDis tribuc ión de F re c ue nc ia
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SPAGHETTI AND MEATBALLS
20 Years Ago Today
500 calories1 cup s paghetti with s auce and 3 s mall meatballs
How many calories do you think are in today's portion of s paghetti and meatballs ?
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Calorie Difference: 525 calories
1,025 calories 2 cups of pas ta with s auce and 3 large meatballs
20 Years Ago Today
500 calories1 cup s paghetti with s auce and 3 s mall meatballs
SPAGHETTI AND MEATBALLS
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How long will you h a ve to h ous e c le a n in orde r to b urn th e e xtra 525 c a lorie s ? *
*Bas ed on 130-pound pers on
Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
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*Bas ed on 130-pound pers on
If you hous ec lean for 2 hours and 35 minutes ,
you will burn a pproxim a te ly 525 calories .*
Calories In = Calories Out
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De fin ic ione s
Indice de masa corporal (IMC) describe la relaciónEntre peso y talla: peso (kg)/talla (m2)
• Sobrepeso = 25–29.9 IMC
• Obesidad = >30 IMC
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B e ne fic ios de la pé rd ida de pe s o
• Dis minuc ión de l rie s g o CV• Dis minuc ión de g luc e m ia e ins u line mia• Dis minuc ión de la P A• Dis minuc ión de LDL y TAG , a ume nto de
HDL• Dis minuc ión de s e ve rida d de la a pne a de l
s ue ño• Me jora s ín toma s de a rtropa tía s
de g e ne ra tiva s• Me jora c ondic ione s g ine c ológ ic a s
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Ate nc ión de pa c ie nte s c on s obre pe s o u obe s ida d
Re quie re dos pa s os :• E va lua c ión• Ma ne jo
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E va lua c ión de s obre pe s o/obe s ida d
• Ind ic e de ma s a c orpora l–P e s o(kg )/ta lla (m 2)–P e s o (lb )/ta lla (in 2) x 703
• Circ unfe re nc ia de c intura ***–Alto rie s g o• Hombre s >102 c m (40 in.)• Muje re s >88 c m (35 in .)
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Obe s ida d Abdom ina l
• Ame ric a nos :– Hombre s > 102 cm– Muje re s > 88 cm
• E urope os :– Hombre s > 94 cm– Muje re s > 80 cm
• S ura s iá tic os -Ch inos :– Hombre s > 90 cm– Muje re s > 80 cm
• La tinos =? ? ?
International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome 2005(on line)
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Grado de obesidad IMC kg/m2
Bajo peso <18.5
Normal 18.5–24.9
Sobrepeso 25–29.9
Obesidad I 30.0–34.9
II 35.0–39.9
Obesidad extrema III 40.0
Cla s ific a c ión de s obre pe s o y obe s ida d
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De te rmine e s ta do de rie s g o a b s o luto
E va lúe :• Condic iones patológicas (e .j., CHD, DM2,
a pne a de l s ue ño)(+ )= muy a lto rie s g o
• Otras enfermedades as oc iadas a obes idad (e .j., a norma lida de s g ine c ológ ic a s , os te oa rtros is )
• Factores de ries go cardiovas cular: ta ba quis m o, HTA, a lto LDL, ba jo HDL, IOG , h x flia r (>3 = a lto rie s g o)
• Otros factores de ries go:– S e de nta ris m o– Hipe rtrig lic e ride mia (>200 mg /dL)
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Alg oritmo de tra ta mie nto NIHPatient Encounter
Hx of 25 BMI?
• Measure weight, height, and waist circumference
• Calculate BMI
Examination
Brief reinforcement/ educate on weight management
Periodic weight check
Advise to maintain weight/address other risk factors
Clinician and patient devise goals and treatment strategyfor weight loss andrisk factor control
Assess reasons for failure to lose weight
Maintenance counseling: Dietary therapy Behavior therapy Physical activity:
Treatment
Assess risk factors
No
Yes
1
2
14
15 13
12
11 1016
3
4 6
5 7
8
9
Yes
No
Yes
No
Hx BMI 25?
No
Yes
Yes
No
Does patient want to lose weight?
Yes
No
Progress being made/goal
achieved?
BMI 25 OR waist circumference
> 88 cm (F) > 102 cm (M)
BMI 30 OR
{[BMI 25 to 29.9 OR waist circumference
>88 cm (F) >102 cm (M)] AND 2 risk
factors}
BMImeasured in past 2 years?
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No
BMI 30 OR
{[BMI 25 to 29.9 OR waist >88 cm (F)
>102 cm (M)] AND 2 risk
factors}
Treatment Algorithm (Part 1 of 3)
Patient Encounter
Hx of 25 BMI?
• Measure weight, height, and waist circumference
• Calculate BMI
Assess risk factors
NoYes
1
2
3
46
5
7
Yes
No
BMI measured in
past 2 years?
BMI 25 ORwaist >88 cm (F)
>102 cm (M)
Yes
ExaminationTreatment
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Devise goals andtreatment strategy forweight loss and riskfactor control
Assess reasons forfailure to lose weight
Maintenance counseling
12
11 10
8
9
No
Yes
Yes
No Desire tolose weight?
Yes
No
Progress made?
BMI 30 OR
{[BMI 25 to 29.9 OR waist >88 cm (F)
>102 cm (M)]AND 2 risk
factors}
Examination
Treatment
7
Periodic weightcheck
• Advise to maintain weight
• Address other risk factors
13
16
Treatment Algorithm (Part 2 of 3)
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• Brief reinforcement • Educate on weight
management
Periodic weight check
• Advise to maintain weight
• Address other risk factors
14
15 13
16
5Yes
No
Yes
No
Hx BMI 25?
BMI 25 OR waist >88 cm (F)
>102 cm (M)
Examination
Treatment
Treatment Algorithm (Part 3 of 3)
* This algorithm applies only to the assessment for overweight and obesity and subsequent decisions based on that assessment. It does not include any initial overall assessment for cardiovascular risk factors or diseases that are indicated.
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FRENCH FRIES
20 Years Ago Today
210 Calories2.4 ounces
How many calories are intoday’s portion of fries ?
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610 Calories6.9 ounces
Calorie Difference: 400 Calories
FRENCH FRIES
20 Years Ago Today
210 Calories2.4 ounces
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How long will you have to walk le is ure ly in order to burn thos e extra 400 calories ?*
*Bas ed on 160-pound pers on
Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
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*Bas ed on 160-pound pers on
If you walk le is ure ly for 1 hour and 10 minutes you will burn a pproxim a te ly 400 calories .*
Calories In = Calories Out
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Metas de l tratamiento
• P re ve nir g a na nc ia de pe s o (me ta mínima )
• Re duc ir e l pe s o corpora l• Ma nte ne r un pe s o corpora l
má s ba jo a lo la rg o de l tie mpo
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Peso meta = Objetivos reales• Sustituya el “peso mas sano” por el ideal o
de referencia.
• Acepte progresos lentos y en ascenso hacia la meta.
— Meta a corto plazo: 5 to 10% de pérdida, 1 a 2 lb por semana.
— Meta intermedia: Mantenimiento.
— Meta a largo plazo: Pérdida adicional de peso si se desea y el mantenimiento de lo alcanzado a largo plazo.
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Metas de pérdida de pes o
Me ta : R e duc ir e l 10% de l pe s o c orpora l in ic ia l.
• S i la m e ta e s a lc a nz a da , pé rd ida s a d ic iona le s pue de n in te nta rs e s i e s tá n ind ic a da s .
• Lím ite de tie mpo ra z ona b le : 6 me s e s de tra ta mie nto– Dé fic it c a lóric o m ode ra do– P e rde r 1 a 2 lb/s e ma na
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Metas de la pérdida de pes o (2)
• In ic ia r e s fue rz os pa ra ma nte nimie nto de l pe s o de s pué s de 6 me s e s .– P ue de ne ce s ita r continua rlos
inde finida me nte• S i e s inca pa z de pe rde r pe s o,
MANTE NGA.
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Siempre que sea posible, el tratamiento para pérdidda de peso debe emplear la combinación de:
• Dietas bajas en calorías/grasas
• Aumento de actividad física
• Modificación de comportamiento
Tratamiento de obes idad
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Es trateg ias para pérdida de pes o y s u mantenimiento
• Die ta• Activida d fís ic a• Tra ta mie nto comporta me nta l• Te ra pia “combina da ”• F a rma cote ra pia• Cirug ía de pé rdida de pe s o
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Dieta (1 de 5)
Dietas bajas en calorías (LCD) son recomendadas para pérdida de peso en sujetos obesos y con sobrepeso.Evidencia Categoria A.
Reducción de grasa como parte de una LCD es una forma práctica de reducir calorías. Evidencia Categoria A.
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Dieta (2 de 5)
Dietas bajas en calorías pueden reducir el peso corporal total en promedio de 8% y ayuda a reducir el contenido de grasa abdominal en 6 meses. Evidencia Categoría A.
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Dieta (3 de 5)
Aunque las dietas bajas en grasas que no tienen como objetivo la reducción calórica pueden ayudar a promover la pérdida de peso al reducir la ingesta calórica, pero las dietas bajas en grasas con restricción calórica simultánea producen mayor pérdida de peso. Evidencia Categoría A.
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Dieta (4 de 5)
Dietas muy bajas en calorías producen una mayor pérdida de peso inicial que las dietas bajas en calorías. Sin embargo, a largo plazo (>1 año) la pérdida de peso no fue diferente de una LCDEvidencia Categoría A.
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Dieta (5 de 5)
Dietas muy bajas en calorías (menos de 800 kcal/día):
• Rápida pérdida de peso • Déficits son muy grandes• Inadecuada nutricionalmente• Mayor reganancia de peso• No cambios en el comportamiento• Mayor riesgo de colelitiasis
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Dieta baja en calorías – Pas o 1Nutrie nte Ing e s ta re c om e nda da
Ca loría s R e duc c ión de 500 a 1 ,000 kc a l/d ía
G ra s a tota l 30% o m e nos de l c ons umo c a lóric o tota l
S F A 8 a 10% de c a loría s tota le s
MUF A Ha s ta 15% de c a loría s tota le s
P UF A Ha s ta 10% de c a loría s tota le s
Cole s te ro l <300 m g /día
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Dieta baja en calorías – Pas o 1 (continuación)
Nutrie nte Ing e s ta re c om e nda da
P rote ína s ~ 15% de c a loría s tota le s
Ca rboh idra tos 55% o m á s de c a loría s tota le s
Na Cl No ma s de ~ 2.4 g de s od io o ~ 6 g de Na Cl
Ca lc io 1,000 a 1,500 m g
F ibra 20 a 30 g
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85 Calories 6.5 ounces
How many calories are in today’s portion?
SODA20 Years Ago Today
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Calorie Difference: 165 Calories
250 Calories 20 ounces
85 Calories 6.5 ounces
20 Years Ago Today
SODA
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How long will you h a ve to work in th e g a rde n to b urn th os e e xtra c a lorie s ? *
*Bas ed on 160-pound pers on
Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
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If you work in the g a rde n for 35 minute s , you will burn a pproxima te ly 165 calories .*
*Bas ed on 160-pound pers on
Calories In = Calories Out
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Actividad física: Por qué incluirla?
• Aumenta el gasto energético
• Protege y favorece la masa magra
• Mejora factores sicológicos
• Reduce morbi-mortalidad
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Impacto de actividad física en comorbilidades
• Aumenta el desempeño
cardiorespiratorio
• Mejora perfil lipídico
• Reduce la PA
• Aumenta la sensibilidad a la
insulina
• Mejora el control glicémico
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Actividad fís ica
R e c om e nda do c om o pa rte de un prog ra ma inte g ra l pa ra pé rd ida de pe s o y m a nte nim ie nto de pe s o porque :
• Contrib uye m ode s ta m e nte a la pé rd ida de pe s oEvidencia Categoría A
• P ue de d is m inuir la g ra s a a bdom ina lEvidencia Categoría B
• Inc re m e nta e l de s e mpe ño c a rd iore s p ira torioEvidencia Categoría A.
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Aumento de actividad fís ica
• E s lo m á s im porta nte pa ra pre ve n ir la re g a na nc ia de pe s o
• B e ne fic ios de s a lud s on inde pe ndie nte s de la pé rd ida de pe s o
• In ic ie le nta m e nte e inc re m e nte g ra dua lme nte— P ue de s e r e n una s e s ión ún ic a o
in te rm ite nte— Inic ie c on c a m ina ta s por 30 m in 3
d ia s /s e m — Aum e nte a 45 m in 5 ó m a s d ia s por
s e m— E s timule a c tivida de s de e s tilo de vida
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COFFEE 20 Years Ago
Coffee(with whole milk and s ugar)
Today
Mocha Coffee(with s teamed whole milk and mocha s yrup)
45 calories 8 ounces
How many calories are in today's coffee?
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20 Years Ago
Coffee(with whole milk and s ugar)
Today
Mocha Coffee(with s teamed whole milk and mocha s yrup)
45 calories 8 ounces
350 calories16 ounces
Calorie Difference: 305 calories
COFFEE
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How long will you h a ve to wa lk in orde r to b urn th os e e xtra 305 c a lorie s ? *
*Bas ed on 130-pound pers on
Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
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If you walk 1 hour and 20 minutes , you will burn approximate ly 305 calories .*
*Bas ed on 130-pound pers on
Calories In = Calories Out
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Terapia de comportamiento
El uso rutinario de estrategias de terapia comportamental para promover dieta y ejercicio es recomendado, dado que son útiles en alcanzar pérdida y mantenimiento de peso
Evidencia Categoría B.
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Terapia de comportamiento (contin..)
Im ple m e nta c ión de e s tra te g ia s , b a s a da s e n princ ip ios de a pre ndiz a je , que prove e h e rra mie nta s pa ra s obre lle va r la s b a rre ra s a la a dh e re nc ia a c a m b ios e n d ie ta y e je rc ic io:
• Automonitore o• Ma ne jo de l e s tré s• Contro l de e s tímulos• R e s o luc ión de prob le m a s• Ma ne jo de c onting e nc ia• R e e s truc tura c ión c og nitiva• S oporte s oc ia l
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Automonitoreo
Gua rde re g is tros de :
• Ca ntida d y tipos de a lime ntos cons umidos
• F re cue nc ia , inte ns ida d y tipo de a c tivida d fís ic a
• Hora , lug a r y s e ns a c ione s
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Manejo de l es trés
Ca lme s itua c ione s que c onduz c a n a s obre a lim e nta c ión:
• “Coping s tra te g ie s ”
• Me dita c ión
• Té c nic a s de re la ja c ión
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Res oluc ión de problemas
Autoc orre c ión de prob le m a s re la c iona dos c on la a lim e nta c ión y e je rc ic io:
• Ide ntific a r prob le m a s re la c iona dos c on e l pe s o
• Lluvia de ide a s pa ra s o luc iona rlos• P la ne e e im ple m e nte a lte rna tiva s m a s s a na s• E va lúe ob je tivos• E s tim ule re e va lua c ión de c ontra tie mpos .
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Control de es tímulos
Té cnica s e n ca mbio de comporta mie ntos :
• Ape nde r a compra r comida s a na
• Ma nte ne r a lime ntos ricos e n c a loría s fue ra de ca s a
• Limita r e l tie mpo y lug a re s de a lime nta c ión
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Manejo de contingenc ia
Us o de re c ompe ns a s pa ra a c c ione s e s pe c ífic a s
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Rees tructurac ión cognitiva
P e ns a mie ntos ra c iona le s d is e ña dos pa ra re e mpla z a r pe ns a m ie ntos ne g a tivos :
En vez de… “Rompí mi dieta por comer es ta mañana una
donut.”
Use. . . “Bueno, comí una donut, pero aún puedo comer
de una manera s aludable e l res to del día.”
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Soporte s oc ial
Ma nte ne r la m otiva c ión y e l re forz a m ie nto pos itivo:
• F a milia
• Amig os
• Cole g a s
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PEPPERONI PIZZA
20 Years Ago Today
500 caloriesHow many calories are in two large s lices o f today’s pizza?
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20 Years Ago Today
500 calories 850 calories
Calorie Difference: 350 calories
PEPPERONI PIZZA
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How long will you h a ve to p la y g o lf (wh ile wa lking a nd c a rrying your c lub s ) in orde r to burn th os e e xtra 350 c a lorie s ? *
*Bas ed on 160-pound pers on
Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
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If you play go lf (while walking and carrying your c lubs ) for 1 hour you will b urn a pproxim a te ly 350 calories .*
*Bas ed on 160-pound pers on
Calories In = Calories Out
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Terapia combinada
• In te rve nc ión c omb ina da de d ie ta b a ja e n c a loria s , a ume nto de e je rc ic io y te ra p ia c omporta m e nta l e s la m á s e xitos a pa ra la pé rd ida y ma nte n imie nto de pe s o.
Evidencia Categoría A.• Ning una in te rve nc ión fa rma c ológ ic a
de be ría in te nta rs e a l m e nos 6 me s e s a nte s de te ra p ia c om bina da
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Medicaciones aprobadas por la FDA pueden ser usadas como parte de un programa integral de pérdida de peso, que incluyan dieta y ejercicio. Evidencia Categoría B.
• Para pacientes con IMC de 30 o mas sin FR o enfermedades concomitantes
• Para pacientes con IMC de 27 o mas con comorbilidades (HTA, dislipidemia, CHD, DM2, apnea del sueño)
Farmacoterapia
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Farmacoterapia (continuac ión)
• Me dica c ione s nunca de be n s e r utiliz a da s s ola s .
• S ie mpre de be n da rs e e n combina c ión con die ta , e je rc ic io y modific a c ión de comporta mie nto.
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Medicac iones para pérdida de pes o
Droga Dos is Acc ión Efectos Advers os
S ibutra mine 5, 10, 15 mg Nore pine ph rine , Inc re a s e in h e a rt
(R e duc til) 10 mg po qd dopa mine , a nd ra te a nd
s e rotonin re upta ke b lood
pre s s ure . to s ta rt, ma y be inh ib itor.
inc re a s e d to 15 mg or
de c re a s e d to 5 mg .
Orlis ta t 120 m g Inh ib its pa nc re a tic De c re a s e in a b s orption
(Xe nic a l) 120 m g po tid lipa s e , de c re a s e s o f fa t-s o lub le
be fore me a ls . fa t a b s orption. v ita mins ; s o ft s tools
a nd a na l le a ka g e .
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R IO Líp idos y R IO Dia be te s : pé rd ida de pe s o (kg ): c a s os ob s e rva dos y UOP [me dia (E E M)]
Diferencia entre grupos, media (EEM)
UOP 20mg vs Pbo -5,4 (0,4) (p<0,001)
-2,3kg
-8,6kg
Media basal (DE) 94,1 (14,8)
-10
-8
-6
-4
-2
0
0 4 8 12 16 20 24 28 32 36 40 44 48 52 UOP
Diferencia entre grupos, media (EEM)
UOP 20mg vs Pbo -3,9 (0,3) (p<0,001)
-1,9kg
-6,1kg
Media basal (DE) 96,3 (14,7)
-10
-8
-6
-4
-2
0
0 4 8 12 16 20 24 28 32 36 40 44 48 52 UOP
RIO Lípidos RIO Diabetes
Després JP et al, 2005; Scheen A et al, 2006población ITT
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20 Years Ago Today
270 calories 5 cups
POPCORN
How many calories are in today’s large popcorn?
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20 Years Ago Today
270 calories 5 cups
POPCORN
630 calories11 cups
Calorie Difference: 360 calories
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How long will you h a ve to do wa te r a e rob ic s in orde r to b urn th e e xtra 360 c a lorie s ? *
*Bas ed on 160-pound pers on
Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
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*Bas ed on 160-pound pers on
If you do water aerobics for 1 hour and 15 minutes you will b urn a pproxim a te ly 360 calories .*
Calories In = Calories Out
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Cirugía para reducc ión de pes o
Opc ión pa ra núme ro lim ita do de pa c ie nte s c on obe s ida d c lín ic a me nte s e ve ra . Evidencia Categoría B.
• IMC >40 o >35 c on c omorb ilida de s• R e s e rva da pa ra qu ie ne s h a fa lla do e l
tra ta m ie nto mé dic o. • R e duc c ión g á s tric a o by-pa s s
P rog ra m a in te g ra do de be te ne rs e pre y pos tqu irúrg ic o.
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Gas tric Bypas s Surgery Complications : 14-Year Followup
Surgical Complications Number of Patients % of Patients
Vita min B 12 de fic ie ncy 23939.9
R e a dmit for va rious re a s ons 22938.2
Inc is iona l he rnia 14323.9
De pre s s ion 14223.7
S ta ple line fa ilure 9015.0
Ga s tritis 7913.2
Chole cys titis 6811.4
Ana s tomotic proble ms 59 9.8
De hydra tion, ma lnutrition 35 5.8
Dila te d pouch 19 3.2Da ta de rive d from s ource (P orie s e t a l.) a nd modifie d ba s e d on pe rs ona l communica tion.S ource : P orie s WJ , S wa ns on MS , Ma cDona ld KG J r, e t a l. Who would ha ve thoug ht it? An ope ra tion prove s to be the mos t e ffe c tive the ra py for a dult-ons e t dia be te s me llitus . Ann Surg. 1995;222:339-350; dis cus s ion 350-352.
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CHEESECAKE
20 Years Ago Today
260 calories3 ounces
How many calories are intoday’s large portion of chees ecake?
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CHEESECAKE
20 Years Ago Today
260 calories3 ounces
640 calories7 ounces
Calorie Difference: 380 calories
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How long will you h a ve to p la y te nn is in orde r to b urn th os e e xtra 380 c a lorie s ? *
*Bas ed on 130-pound pers on
Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
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*Bas ed on 130-pound pers on
If you play tennis for 55 minutes you will burn a pproxima te ly 380 calories .*
Calories In = Calories Out
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Tratamiento de obes idad en poblaciones es peciales
• F um a dore s– Todos los fum a dore s , inde pe ndie nte de l
pe s o, de be n s us pe nde r e l c ig a rrillo– Imple m e nta r pre ve nc ión de g a na nc ia de
pe s o, c on tra ta m ie nto a ne c e s ida d.
• Anc ia nos– E va lúe rie s g o/be ne fic io .
• Dive rs ida d de la pob la c ión.– Tra ta mie nto a la m e dida de l pa c ie nte
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Obe s ida d y Apne a de l s ue ño
Corre la c ione s de a pne a de l s ue ño:› P re va le nc ia ma yor e n
hombre s que muje re s› Ma yor pre va le nc ia e n
hombre s y muje re s obe s os (a s )› P ue de s e r ma yor la
pre va le nc ia e n pobla c ione s e s pe c ia le s con ma yor pre va le nc ia de obe s ida d.
Poulain M et al. CMAJ 2006;174:1293
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Obe s ida d y Apne a de l s ue ño
• La s ma yore s c ons e c ue nc ia s de la a pne a de s ue ño no tra ta da :– Hipoxe m ia a rte ria l s e ve ra– Inc re m e nta e l rie s g o de a rritm ia c a rd ía c a– Inc re m e nta e l rie s g o de HTA– Aum e nta e l rie s g o de s troke
NIH Publication. Disponible online http://www.nhlbi.nih.gov/health/prof/sleep/slpaprsk.htm
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CHICKEN CAESAR SALAD
20 Years Ago Today
390 calories 1 ½ cups
How many calories are in today’s chicken Caes ar s alad?
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CHICKEN CAESAR SALAD
20 Years Ago Today
390 calories 1 ½ cups
790 calories3 ½ cups
Calorie Difference: 400 calories
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How long will you h a ve to wa lk th e dog in orde r to b urn th os e e xtra 400 c a lorie s ? *
*Bas ed on 160-pound pers on
Maintaining a Healthy Weight is a Balanc ing ActCalories In = Calories Out
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If you walk the dog for 1 hour and 20 minutes , you will b urn a pproxim a te ly 400 calories .*
*Bas ed on 160-pound pers on
Calories In = Calories Out
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Materials for Patients & the Public
• Clin ic a l G uide line s : Hig h lig h ts for P a tie nts
• IQ Quiz z e s on P h ys ic a l Ac tivity/We ig h t• Na tive Ame ric a ns /His pa n ic s /Afric a n
Ame ric a ns • Lowe r re a d ing le ve l ma te ria ls• Na tiona l Ch ole s te ro l E duc a tion
P rog ra m (NCE P )• Na tiona l Hig h B lood P re s s ure
E duc a tion P rog ra m (NHB P E P )
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Menu Planner
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