Weight Management Overview

Weight Management

Obesity Statistics

• US obesity prevalence (2017–March 2020): 41.9%.
• Increase from 1999–2000 to 2017–March 2020: Obesity +30.5%, Severe obesity +4.7%.
• Regional prevalence:
  • Midwest: 35.8%
  • South: 35.6%
  • Northeast: 30.5%
  • West: 29.5%.
• Medical cost of obesity in the US (2019): 173 Billion$.
• Global weight loss market: 143 billion$annually, expected to grow by 9.4$[66.5 + (13.8 × AdjBW) + (5 × Ht) – (6.8 × Age)] × 1.5
• Females: [655 + (9.6 × AdjBW) + (1.8 × Ht) – 4.7 × Age)] × 1.5

Ideal Body Weight (IBW) and Adjusted Body Weight (ABW)

• Devine IBW:
  • Men: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
  • Women: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
• Hamwi IBW:
  • Men: Wt (lb) = 106 + 6 × (Ht − 60 in)
  • Women: Wt (lb) = 100 + 5 × (Ht − 60 in)
• Adjusted Body Weight:
  • ABW = IBW + 0.4 × (ABW - IBW)

Weight Influence on Calorie Needs

• Weight loss decreases BMR and energy needs.

Caloric Needs and Activity Level

• To promote weight loss:
  • 1# per week: 500 calories/day reduction
  • 2# per week: 1000 calories/day reduction

Food List

• Carbohydrates
  • Starches: 15g CHO, 3g PRO, 1g FAT, 80 Calories
  • Fruits: 15g CHO, 60 Calories
  • Milk: 12g CHO, 8g PRO, 0-8g FAT, 100-160 Calories
  • Non-starchy vegetables: 5g CHO, 2g PRO, 25 Calories
  • Sweets, desserts, other CHO: 15(+) CHO, varies PRO & FAT, varies Calories
• Proteins
  • Lean: 7g PRO, 2g FAT, 45 Calories
  • Medium Fat: 7g PRO, 5g FAT, 75 Calories
  • High-Fat: 7g PRO, 8g FAT, 100 Calories
• Fats: 5g FAT, 45 Calories

BMI Calculation

• BMI = (Weight in pounds × 703) / (Height in inches)^2$$

BMI Interpretation

• Adult BMI Classification:
  • < 18.5: Underweight
  • 18.5 – 24.9: Normal weight
  • 25 – 29.9: Overweight
  • 30 – 34.9: Class 1 Obesity
  • 35 – 39.9: Class 2 Obesity
  • > 40: Class 3 Obesity
• Children/Adolescents:
  • BMI ≥ 95th percentile: Obese
  • 85th to < 95th percentile: Overweight

Obesity Treatment

• Successful treatment requires lifelong changes in:
  • Physical Activity
  • Dietary Intake
  • Lifestyle behavior and attitudes
• Recommended physical activity: 150-300 min/week moderate, or 75-150 min/week vigorous intensity.

Factors Affecting Weight Management

• Health Conditions: Thyroid, Cushing Syndrome, Polycystic Ovary Syndrome.
• Medications: Antidepressants, birth control, corticosteroids.
• Environment, stress, poor sleep, poor food choices, genetics.
• Genetic changes in human populations occur too slowly to be responsible for the obesity epidemic.

Genetic Obesity

• Three therapeutic categories to treat genetic obesity:
  1. lifestyle modification,
  2. medical treatment
  3. bariatric surgery
• Food restriction is the effective management.
• Genetic influences can increase appetite and reduce metabolism

Biologic Short Term Control of Body Weight

• Amylin: Reduces meal size via brainstem mechanisms
• Cholecystokinin (CCK): Controls meals size by slowing gastric emptying
• Ghrelin: Potent appetite stimulation
• Glucagon-Like Peptide 1 (GLP-1): Stimulates insulin release; reduces appetite
• Oxyntomodulin: Reduces appetite
• Pancreatic Polypeptide: Reduces appetite
• Peptide YY (PYY3–36): Reduces appetite

Biologic Long Term Control of Body Weight

• Adiponectin: Enhances insulin sensitivity, decreases inflammation
• Agouti-Related Peptide: Increases appetite; decreases metabolism
• Cocaine-Amphetamine-Regulated Transcript Neurons: Reduces energy intake
• Insulin: Reduces energy intake
• Leptin: Reduces energy intake
• Neuropeptide Y: Increases appetite; decreases metabolism
• Orexin: Increases appetite
• Pro-opiomelanocortin: Releases α-MSH; reduces energy intake

Nurture factors

• Maternal Health
• Postnatal
• Family Changes
• Lifestyle and Environment

Meal Plans for Weight Loss

• Meet essential nutrient needs.
• Reduce intake.

Strategies for Weight Loss and Maintenance

1. Dietary intervention
2. Activity intervention
3. Behavior change or modification

Benefits and Risk of Weight Loss

• Benefits
  • Improved mobility
  • Reduction in blood pressure
  • Improvement in blood glucose levels or prevention of developing T2DM
• Risks
  • Bone loss
  • Metabolic rate change
  • Increased risk of gallstones and kidney stones
  • Electrolyte imbalance

Diet Intervention

• Provide all essential nutrients except calories
• Protein
• Essential Fatty acids
• Carbohydrates
• Vitamins and Minerals
• Water

Physical Activity

• ≥ 150 minutes (2.5 hours) to 300 minutes (5 hours)/week of moderate-intensity
• OR 75 minutes (1 hour and 15 minutes) to 150 minutes (2.5 hours)/week of vigorous-intensity aerobic PA

Behavior Modification

• Seek professional counseling if needed.

Prescription Medications

• Bupropion-naltrexone (Contrave)
• Liraglutide (Saxenda)
• Orlistat (Alli, Xenical)
• Phentermine (Adiphex)
• Phentermine-topiramate (Qsymia)
• Semaglutide (Ozempic, Rybelsus, Wegovy)
• Metformin

GLP-1 Agonists

• Stimulates secretion of insulin
• Suppressing a hormone called glucagon, which can reduce hunger
• Increasing feelings of fullness by delaying the emptying of the stomach

Surgical Procedures

• Laparoscopic Sleeve Gastrectomy
• Roux-en-Y Gastric Bypass
• Duodenal Switch