Management of Obesity

Aniza B. Pala-Mohamad, MD
 What are obesity and overweight?

• Overweight and obesity are defined as abnormal or excessive

fat accumulation that may impair health

• Body mass index (BMI)

– a simple index of weight-for-height that is commonly used to classify
overweight and obesity in adults
– defined as a person's weight in kilograms divided by the square of
his height in meters (kg/m2)
– provides the most useful population-level measure of overweight
and obesity as it is the same for both sexes and for all ages of adults
– should be considered a rough guide because it may not correspond
to the same degree of fatness in different individuals
• Adults
– WHO defines overweight and obesity as follows:
Overweight
BMI greater than or equal to 25
Obesity
BMI greater than or equal to 30
• Children under 5 years of age
Overweight
weight-for-height greater than 2 standard deviations
above WHO Child Growth Standards median
Obesity
weight-for-height greater than 3 standard deviations
above the WHO Child Growth Standards median.
• Charts and tables: WHO child growth standards f
or children aged under 5 years
 Classification (WHO)
• Based on BMI
Grade 1 overweight (commonly and simply
called overweight) - BMI of 25-29.9 kg/m2
Grade 2 overweight (commonly called obesity)
- BMI of 30-39.9 kg/m2
Grade 3 overweight (commonly called severe
or morbid obesity) - BMI ≥40 kg/m2
• Some authorities advocate a definition of
obesity based on percentage of body fat, as
follows:
Men: Percentage of body fat greater than
25%, with 21-25% being borderline
Women: Percentage of body fat great than
33%, with 31-33% being borderline
 Obesity Comorbidities
• including the following :
Respiratory: Obstructive sleep apnea, greater
predisposition to respiratory infections,
increased incidence of bronchial asthma, and
Pickwickian syndrome (obesity
hypoventilation syndrome )

Wijga AH, et al. BMC Public Health. 2010 Apr 9. 10:184.

 Obesity Comorbidities
Malignant: Reported association with
endometrial (premenopausal), prostate, colon
(in men), rectal (in men), breast
(postmenopausal), gall bladder, gastric cardial,
biliary tract system, pancreatic, ovarian,
renal, and possibly lung cancer, as well as with
esophageal adenocarcinoma and multiple
myeloma

Wijga AH, et al. BMC Public Health. 2010 Apr 9. 10:184.

 Obesity Comorbidities
Psychological: Social stigmatization and depression
Cardiovascular: Coronary artery disease, [10] essential
hypertension, left ventricular hypertrophy, cor
pulmonale, obesity-associated cardiomyopathy,
accelerated atherosclerosis, and pulmonary
hypertension of obesity
Central nervous system (CNS): Stroke, idiopathic
intracranial hypertension, and meralgia paresthetica

Wijga AH, et al. BMC Public Health. 2010 Apr 9. 10:184.

 Obesity Comorbidities
Obstetric and perinatal: Pregnancy-related
hypertension, fetal macrosomia, and pelvic
dystocia [11] 
Surgical: Increased surgical risk and
postoperative complications, including wound
infection, postoperative pneumonia, deep
venous thrombosis, and pulmonary embolism
Pelvic: Stress incontinence
Wijga AH, et al. BMC Public Health. 2010 Apr 9. 10:184.
 Obesity Comorbidities
Gastrointestinal (GI): Gall bladder disease
(cholecystitis, cholelithiasis), nonalcoholic
steatohepatitis (NASH), fatty liver infiltration, and
reflux esophagitis
Orthopedic: Osteoarthritis, coxa vera, slipped
capital femoral epiphyses, Blount disease and
Legg-Calvé-Perthes disease, and chronic lumbago
Metabolic: Type 2 diabetes mellitus, prediabetes,
metabolic syndrome, and dyslipidemia
Wijga AH, et al. BMC Public Health. 2010 Apr 9. 10:184.
 Obesity Comorbidities
Reproductive (in women): Anovulation, early
puberty, infertility, hyperandrogenism, and
polycystic ovaries
Reproductive (in men): Hypogonadotropic
hypogonadism
Cutaneous: Intertrigo (bacterial and/or
fungal), acanthosis nigricans, hirsutism, and
increased risk for cellulitis and carbuncles
Wijga AH, et al. BMC Public Health. 2010 Apr 9. 10:184.
 Obesity Comorbidities
Extremity: Venous varicosities, lower
extremity venous and/or lymphatic edema
Miscellaneous: Reduced mobility and difficulty
maintaining personal hygiene

Wijga AH, et al. BMC Public Health. 2010 Apr 9. 10:184.

 Diagnosis

Laboratory studies
Fasting lipid panel
Liver function studies
Thyroid function tests
Fasting glucose and hemoglobin A1c (HbA1c)
Index of inflammation (Hs-CRP, ferritin)
Uric acid in blood, if gout
Cardiovascular assessment (ergometry, echocardiography), if
indicated
Sleep apnea investigation, if indicated
Endocrine investigations (Cushing, hypothalamic disease), if
clinically indicated
 Diagnosis
Evaluation of degree of body fat
BMI calculation, waist circumference, and waist/hip ratio are
the common measures of the degree of body fat used in
routine clinical practice. Other procedures that are used in
few clinical centers include the following:
Caliper-derived measurements of skin-fold thickness
Dual-energy radiographic absorptiometry (DEXA)
Bioelectrical impedance analysis
Ultrasonography to determine fat thickness
Underwater weighing
 Management

starts with comprehensive lifestyle

management (ie, diet, physical activity,
behavior modification)
Prevention and Management of Risk
Factors

WEIGH PHYSICAL
T
LOSS ACTIVITY

PROPER REGULAR
NUTRITIO MEDICAL
N VISITS
The rationale for the approaches used in obesity
management

Durrer Schutz et al.: Management of Obesity Obes Facts 2019;12:40–66

Target goals

Durrer Schutz et al.: Management of Obesity Obes Facts 2019;12:40–66

Overview of a comprehensive step-by-step management of
obesity

Durrer Schutz et al.: Management of Obesity Obes Facts 2019;12:40–66

A guide to deciding an initial level of intervention to discuss with the patient

Durrer Schutz et al.: Management of Obesity Obes Facts 2019;12:40–66

Scheme of communication

Durrer Schutz et al.: Management of Obesity Obes Facts 2019;12:40–66

General nutritional and behavioral advise

Durrer Schutz et al.: Management of Obesity Obes Facts 2019;12:40–66

to reduce body weight by 7% to
10% over a period of 6 to 12
Grundy et al, Diagnosis and Management of the Metabolic Syndrome, Circulation 2005
 7% to 10% Less 500 to
weight reduction 1000 calories
per day

Grundy et al, Diagnosis and Management of the Metabolic Syndrome, Circulation 2005