Obesity

Slides

FCM Treatise

TOPIC CHAPTER

FOUNDATION OF TREATMENT - COMES BEFORE AND CONTINUES DURING MEDICATION

COMORBIDITIES THAT CHANGE THE CHOICE OF AGENT

TO AVOID OVERTREATMENT

Gusso 176 — main topics

WHEN TO REFER

• Suspected secondary obesity requiring specialized investigation
• Obesity or comorbidity that needs a resource unavailable in primary care
• Indication for bariatric surgery
• Eating disorder or severe psychological distress beyond the reach of the family physician

MOST FREQUENT MISTAKES - BY THOSE WHO PROVIDE CARE

• Not weighing someone with visible obesity, and not offering help to lose weight
• Releasing from clinical follow-up those on the bariatric surgery waiting list: the wait lasts years, and those who reach surgery having already lost weight have a better prognosis

MOST FREQUENT MISTAKES - BY THOSE IN TREATMENT

• Unrealistic expectation of losing a lot of weight in a short time
• Trying to lose weight without physical activity
• Dropping diet and exercise after the initial loss
• Giving up everything after a single slip

TIPS - DIETARY RE-EDUCATION

• Feasible goal: about 500 g per week
• Eat slowly, four to five meals a day, including breakfast
• Switch to a smaller plate and start the meal with salad
• Keep low-calorie food at home and an "escape" agreed on in advance
• Gradual and permanent change: a radical diet is not sustainable
• In the long run there is no difference between a hypocaloric diet and a very-low-calorie diet
• Food diary for one week, with time, quantity, and quality

TIPS - CHILDREN

• Exclusive breastfeeding until 6 months
• Avoid sugar and soft drinks at least in the first year
• Fruit, vegetables, and legumes from an early age: children copy adults' habits
• When only one child has obesity, the change is for the whole family, not a diet imposed on that child
• No total deprivation: the child is growing, cutting the excess is enough

TIPS - PHYSICAL EXERCISE

• There is no ideal exercise: the best is the one the person likes and can keep up
• Prefer low joint impact - walking, swimming, water aerobics, weight training, dance
• In grade III obesity, start with walks of less than 10 minutes and build up
• Excessive load leads to musculoskeletal injury and dropout
• Embarrassment about exercising in a public place is a real reason: start at home
• A pedometer produces modest loss, around 1.3 kg

PROGNOSIS AND WEIGHT REGAIN

• Part of the weight returns about 1 year after bariatric surgery, and a little over 10% maintain the reduction for more than 5 years
• Success is associated with the frequency of consultations and the time devoted to them
• Favor regain: more calories, high-calorie-density foods, splitting into more than five meals, caloric drinks, stopping physical activity, and stopping monitoring

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