Approach to Obesity

Open questions:

1. Motivation: Can you tell me why do you want to lose weight? Has anythinghappened recently that made you want to lose weight now?
2. Thoughts about weight: What areyour thoughts about your weight? How confidentare you of losing weight?

History:

1. Diet: How many times do you eat a day? Do you eat fatty foods (pizza, burgers) orsugary foods (snacks, fizzy drinks)? Do you eat snacks (crisps, biscuits) just beforebedtime?
2. Exercise: How much exercise do you do in a week? Do you do any intense exercise(football, swimming, cycling, jogging)? How long do you spend doing this?
3. Previous attempts: Have you tried losing weight before? What happened? Have youtried any diet plans or weight loss Programmes?
4. Associated history: Do you have any breathing problem (asthma), joint pain (OA),difficulty in breathing at night (sleep Apnoea), DM, hypertension, dyslipidemia,IHD?
5. Exclude hypothyroidism as differential: Do you feel tired and cold all the time? Doyou have dry skin or hair loss?
6. Drug history: Are you taking any medication? e.g., Steroids, beta blockers, lithium,atypical antipsychotics, anticonvulsants (valproate, gabapentin), antidepressants(TCAs, mirtazapine), antidiabetics (Sulphonylureas, glitazones).
7. Occupational history: Are you working at this moment? Does it involve anyphysical work?
8. Personal history: Do you smoke and how many sticks per day? Do you drinkalcohol?
9. Family history: Are there any illness that run in your family? e.g.,obesity,IHD,DM

Examinations:

Vitals:

Height:

Weight:

BMI:

Waist circumference:

1. Common: Lifestyle (Food, drink consumption), physical inactivity,social/psychological factors,genetic.
2. Conditions: Genetic (e.g. Padar-Willi syndrome), hypothyroidism, PCOS, GHdefeciency,Cushing's syndrome
3. Medications: Steroids, beta blockers, lithium, atypical antipsychotics,anticonvulsants (valproate, gabapentin), antidepressants (TCAs, mirtazapine),antidiabetics (Sulphonylurea, glitazones).

A. Dietary advice:

1. Eat 5 potions of fruit and vegetables each day, in place of foods higher in fat andcalories
2. Base meals on starchy foods e.g., rice, potatoes, bread, pasta; choose whole grainif possible.
3. Eat fiber-rich foods e.g., oats, beans, peas, lentis, fruit, vegetables, brown bread,brown rice, pasta.
4. Eat low-fat diet, avoid fried foods.
5. Avoid drinks and snacks high in fat and sugar (take away and fast foods),consider water.
6. Eat breakfast, watch the portion size of meals and snacks, and how often you areeating.

B. Exercise in obesity:

1. Make enjoyable activities part of everyday life e.g., walking, cycling, swimming,gym, gardening etc.
2. Minimize sedentary activities e.g., watching television, computer, video gamesetc.
3. Build activity into the working day e.g., take the stairs instead of the lift, take awalk at lunchtime etc.

C. Pharmacotherapy:

Indications:

1. BMI>30 kg/㎡ or BMI>27 kg/㎡ with concomitant obesity-related risk factorsor disease.
2. Unable to achieve weight loss goal despite therapeutic lifestyle change
3. No contraindications to use

Cap.Orlistat 120mg

1+1+1-30 mins before to 1 hour after meal-Continue

[Target: 5% loss in 3 months

SE: Wind, diarrhoea, fecal urgency, fecal incontinence

Contraindications:Malabsorption,breast feeding,cholecystectomy]

Indication of surgery:

1. When BMI>40kg/m2 or BMI > 35 kg/m2 with life threadening condition CVS diseases, severe disesase
2. Failure to achieve weight loss with other treatment modalitis

“Young people have the right to the information and skills they need to protect their health"

Protocols