| ID | 164 |
|---|---|
| Name | OBESITY |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | |
| Introduction | Obesity is a complex disorder that may be defined as an increase in weight of over 10% above normal or BMI (body mass index) > 30, due to generalized deposition of fat in the body. |
| History | |
| Etiology | Etiology: 1. Age- obesity is most prevalent in middle-age, but can occur at any age. 2. Socio-economic factors- more common in affluent countries. 3. Heredity- a familial tendency exists in many cases. 4. Endocrine factors- an endocrine influence on body fat is seen in cushing’s syndrome, hypopituitarism, hypogonadism etc. 5. Energy intake- a very small excess of calories, if habitual, can lead to obesity. 6. Energy expenditure- physical inactivity has an important role in the development of obesity. 7. Drugs- the use of steroids, oral contraceptives, insulin, etc. is commonly followed by obesity. |
| Clinical Features | Clinical features: In most cases the diagnosis will be apparent from the patients appearance but the degree of obesity should be assessed, usually by measurement of hight and weight. In addition, the skinfold thickness over the triceps muscle can be measured, obesity is indicated by a reading above 20mm in a man and above 28 mm in a woman. Obesity must be distinguished from gain in weight due to fluid retention associated with cardiac, renal or liver diseases. |
| Preventions | |
| Treatment | Treatment: A multidisciplinary approach to weight loss, with hypocaloric diets, change in eating behavior, aerobic exercise and social support can be a successful program in achieving the targeted body weight. 1. Diet contrail: A balanced diet suitable for the expected weight of the patient should be given. Daily calorie intake should be between 800-1500 calories. Diet should contain adequate protein but fat and carbohydrate should be drastically curtailed. Minerals, vitamines, water and salt should not be restricted. Long-term changes in eating behavior are required to maintain weight loss. 2. Exercise: Physical exercise must be encouraged (exercise should be regular and to the limit of tolerance of the patient). 3. Drugs: Catecholaminergic drugs: Such as- phentermine, diethylpropion, mazindol are approved as appetite suppressants for short-time use only. Sibutramine 10mg daily for 6-12 months may result in average weight losses of about 3-5kg. But, along this medication a low-calory diet should be maintained. Orlistat, a pancreatic lipase inhibitor, reduces fat absorption from the gut. A dose of 120mg with each main meal; if a meal is missed or contains no fat, the dose of orlistat may be omitted for that meal. This drug can be used for a long-term management of obese and overweight patients. A 2 years follow-up resulted in an average weight loss 2-4 kg greater than that of placebo. 4. Starvation therapy may be helpful sometimes. 5. Bariatic surgery: For localised adiposity surgery may be helpful for cosmatic reasons or in severe obesity. Jejunoileal by pass surgery is also helpful in the management of generalised obesity. |
| Complications | Complications: 1. Psychological- obese patients are often psychologically disturbed, they are ashamed of their unattractive appearance and develop psychosocial and sexual problems. 2 Mechanical disabilities- flat feet and osteoarthrosis of the knee, hips and lumber spine are common. They are prone to develop abdominal and diaphragmatic hernias and varicose veins. There may be exertional dyspnoea and increased susceptibility of respiratory infection. 3. Metabolic disorders- hyperlipidemia, gall stones, hyperuricemia and gout & non-insulin dependent diabetes mellitus are more common among the obese. 4. Cardiovascular disorders- hypertension and ischemic heart disease are more common. 5. Life-expectancy- overweight is associated with an increased rate of mortality at all age groups. |
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