Obesity II PDF

Obesity II Pro. Samia A Ali Elmiladi Consultant physician, Diabetes & Endocrinology Hospital , Associated professor –Tripoli -Libya Content Definition Prevalence of Obesity Associated ,Co-morbidity condition The benefi...

Obesity II Pro. Samia A Ali Elmiladi Consultant physician, Diabetes & Endocrinology Hospital , Associated professor –Tripoli -Libya Content Definition Prevalence of Obesity Associated ,Co-morbidity condition The benefits & difficulties of weight loss Obesity 1 Reducing the barriers to/maintenance weight loss The multidisciplinary weight loss team Intensive behavioral therapy pharmacological agent approved Obesity2 surgical intervention conclusions Framework for obesity Management Physical activity Medical Nutrition Therapy 3 pillars of obesity management support nutrition & physical activity Psychological intervention Pharmacological therapy Bariatric surgery Wharton S,et al.CMAJ.2020 An evidence-based management algorithm for the management of diabesity ; World J Diabetes 2023  Complication centric model for the care of persons with overweight /obesity (Adiposity-based Chronic Disease ) Step1:Assess BMI BMI ≤ 25 >25-27 >27-35 >35 Step 2:Assess stage Stage 1 Stage 2 ≥ one (no ABCD complication mild/moderate Stage 3≥ one sever ABCD Step3:Implement plan ABCD complication complication Maintain or Intentional caloric deprivation to optimize Structured diet achieve optimal weight with meal Nutrition weight replacement Aerobic exercise Physical activity ≥150/min/wk. Resistance training Structured exercise program 2-3 sessions/wk Screen for sleep Refer for formal sleep study Sleep Good sleep hygiene disorder Limited alcohol intake Screen for mood Formal psychological evaluation and Counseling Smoke cessation disturbance treat Medications No Consider Add Screen &manage Screen high risk ABCD ABCD consider Refer Intervention , Bays HF,et al Obes Pillars.2024,AACE consensus statement  Intensive behavioral therapy Nutrition :, caloric Physical activity :A plan Counseling: Reduced sleep duration :In adults, 6 deprivation of 500 to 1000 for physical activity should Depression and diabetes to 8 hours of sleep /night is kcal daily energy deficit in distress are prevalent in take into account any persons with T2D and recommended. OSA is highly the context of a healthy diet physical limitations and can result in non- prevalent in persons with T2D should be initiated. The adherence to diet, disabilities. Ideally, the exercise, and and/or obesity. Routine screening for selection of a diet should be amount of physical activity medication regimens. sleep disorders either clinically, with personalized, but choices Potential formal should progress to include questions about symptoms of OSA include Mediterranean, screening tools include moderate, aerobic exercise the WHO Wellbeing (snoring, choking, daytime, low-fat, low-carbohydrate, Index, the Patient ≥150 min/wk divided into 3 sleepiness, fatigue, and vegetarian, and Dietary Health Questionaire- to 5 sessions, combined 9, or the Beck nonrestorative sleep), or using a Approaches to Stop with 2 to 3 sessions of Depression Inventory formal screening tool, as the STOP- Hypertension (DASH) III. resistance training/wk Bang questionnaire. diets.  Intensive behavioral therapy Nutrition Physical activity Psychological Counseling: sleep disorders  Nutrition Should carbohydrate-modified diets be the first option for weight loss in people with impaired glucose metabolism? A scoping review Katie M. Ellison, Holly R. Wyatt, James O. Hill, R. Drew Sayer(14 February 2024) Given that dietary CHO are the primary signal for insulin secretion and that insulin inhibits lipolysis and promotes fat deposition, it is reasonable to hypothesize that pretreatment glycemic and/or insulinemic status may moderate weight loss responses to CHO-modified diets. Meta-analytical evidence has consistently demonstrated that compared with low-fat diets, low-CHO diets produce marginally greater weight loss in the short- to intermediate-term (i.e., ≤ 6 months), but that these differences are not often maintained with longer duration follow- up, the weight loss benefit of low-CHO diets has been demonstrated in people with and without T2D The CHO-modified diets(CHO-restricted diets ) as : reduced-CHO (i.e., non-ketogenic) diets, ketogenic diets, low glycemic index/load diets, and high-fiber diets. Definition of The terminology and definitions used for CHO-restricted diets vary considerably and are often defined based on the proportion of Total Daily Energy (TDE) from CHO and/or absolute CHO intake. A CHO-restricted diet is defined as CHO intake below the lower boundary of the acceptable macronutrient distribution range for healthy adults (45–65% TDE). A moderate-CHO diet is defined as 26–44% TDE from CHO (130–225 grams CHO/d for a reference 2000 kcal diet). A low-CHO diet as 10–25% TDE from CHO (50–130 grams CHO/d). A very-low-CHO diet(Ketogenic) as 35 kg/m2 and ≥1 ABCD complications, including prediabetes, that can be remedied with weight loss.(AACE).  Consider metabolic surgery as a weight and glycemic management approach in people with diabetes with BMI ≥30.0 kg/m2 (or ≥27.5 kg/m2 in Asian American individuals) who are otherwise good surgical candidates. A(ADA2024) Studies have documented diabetes remission after 1–5 years in 30–63% of individuals with RYGB.(N Engl J Med 2017) The Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial : 29% of those treated with RYGB(Roux-en-Y Gastric Bypass) &23% treated with VSG(vertical sleeve gastrectomy) achieved A1C of 6.0% or lower after 5 years ; at least 35–50% of pts who initially achieve remission of diabetes eventually experience recurrence. the median disease-free period following RYGB is 8.3 years. the majority of pts maintain substantial improvement of glycemia from baseline for at least 5–15 years (as :younger age, shorter duration of diabetes (