|
|
|
Obesity is defined as body weight 20% or more above
desirable weight for a given height and body build. This has been associated with
increased risks to health, and patients may be advised to reduce weight for preventive
reasons.
Causes
A. Metabolically determined and hereditary obesity.
Heredity plays a major role in obesity. A strong family history of obesity warrants extra
vigor in intervention.
B. Environmentally induced obesity
1. Increased food intake.
2. Sedentary lifestyle. In addition to the effects of exercise on “burning”
calories, lack of exercise has been associated with impaired satiety. Numerous
environmental factors contribute to a sedentary lifestyle in our society.
C. Endocrine disturbances such as:
1. Thyroid disease, which is a seldom cause of obesity.
2. Hypercortisolism (increased cortisone production in the body), polycystic ovaries,
hyperinsulinism (increased insulin production), and growth hormone deficiency.
3. Rare congenital disorders.
D. Increase in the number of fat cells in various parts of the body. For example, there
may be a increase in the size of thighs of women as an adaptive form of caloric storage
for supporting lactation.
E. Compulsive eating disorders.
F. Pharmacologically induced obesity
1. Medications that can cause increased appetite and metabolic changes. Such medications
include antidepressants, phenothiazines, oral contraceptives, and glucocorticoids.
Habituation to beer or other alcoholic beverages or to caffeinated beverages may cause
weight gain.
2. Smoking cessation is associated with weight gain.
Diagnosis
Most types of obesity are ascertained by careful history. If eating occurs in the absence
of appetite, compulsive eating or recreational eating may be suspected. Body mass index is a
frequently used measure of obesity.
Treatment
A. Basic counseling consists of advice to eat regular, low-fat balanced meals. Fat content
of 25% of total calorie intake helps promote weight loss without the need to weigh food or
count calories. Regular exercise is strongly associated with successful long-term weight
control. Other dietary measures may also be employed. A dietitian may be helpful in
designing meals that achieve satiety with minimal caloric load. Unfortunately, most obese
patients already know about proper food selection and the need for exercise. Success in
losing weight may depend heavily on individually characterizing the causes of the obesity
and devising means of dealing with these.
B. Family support may be the most important factor associated with successful long-term
weight loss. In many instances, the unit of treatment is more appropriately the family
than the overweight individual. It is not sufficient, for example, for a spouse to agree
that weight loss is a good idea. Support may mean keeping fattening foods out of the
house, avoiding unscheduled eating by any family member, or accompanying the obese patient
during daily exercise.
C. Pharmacologic treatment should only be attempted in extreme cases and is not
recommended in general. Even though in the past and presently various drugs have been
suggested for this purpose, with the belief that they were not harmful , it has turned out
that these drugs have severe side effects. For example, the combination of fenfluramine
and phentermine has resulted in serious cardiac valvular abnormalities. This later led the
FDA to withdraw the aprroval of fenfluramine.
D. Gastric operations have been used for massive obesity with only moderate success. Most
cases of massive obesity have multiple causes and are very difficult to treat.
Gastroplasty may be considered in these instances as a treatment of last resort.
|
