Medical management of obesity: What to expect – Jamaica Observer

EFFECTIVE management of obesity is based on a partnership between a highly motivated patient and a committed team of health-care professionals. This team includes the physician, psychologist or psychiatrist, physical and exercise therapist, dietitian, as well as surgeon where indicated.

Treatment of obesity starts with comprehensive lifestyle management, which includes diet, physical activity and behaviour modification. Specifically, this refers to:

1. Self-monitoring of caloric intake and physical activity;

2. Setting goals;

3. Stimulus control;

4. Non-food rewards;

5. Relapse prevention.

Before embarking on any medically supervised weight loss programme, it is important for the patient to realise that the physician must have a clear idea of his/her expectations.

The physician plays a very important role in helping the patient create goals that are specific, measurable, attainable, realistic, and timely. A clear assessment of the patient’s level of motivation regarding dietary changes, exercise and behaviour is required to maintain weight loss.

MEDICAL ASSESSMENT

A full history, including a dietary inventory and an analysis of the patient’s activity level, is important in the assessment of the patient seeking weight loss treatment.

Almost 30 per cent of patients who are obese have eating disorders and management of these habits is crucial to successful weight loss.

Other information your physician may enquire about include:

1. A family history of weight problems;

2. Medication usage, for example, oral contraceptive pills, antidepressants;

3. A history of smoking cessation;

4. Other medical conditions, for example diabetes, hypertension and high cholesterol.

In carrying out the clinical examination, the physician will pay particular attention to signs suggestive of complications of obesity and document certain measurements such as weight, height, body mass index, waist and hip circumference. These measures help to determine the level of obesity.

Basic blood investigations, including tests for diabetes and thyroid function, will also be recommended, though the latter is typically normal. Of note, hypothyroidism or underactive thyroid rarely causes more than mild obesity.

TREATMENT

In terms of treatment, your physician will emphasise the importance of proper diet, exercise and behaviour modification, as these form the foundation of obesity treatment.

Obesity medications may be considered in patients who have associated medical illnesses, in whom diet and exercise alone have failed to result in weight loss. In some people, weight loss becomes even more essential because of the coexistence of high-risk conditions such as sleep apnoea, heart disease or diabetes.

When medical management and lifestyle changes prove insufficient, surgery may be considered.

MAINTENANCE

Weight loss maintenance is important to successful weight management. Factors associated with successful weight maintenance include:

• Self-monitoring of weight;

• Consumption of a low-fat diet;

• Daily physical activity of approximately 60 minutes;

• Limitation of sedentary activities; and

• Consumption of most meals at home.

Your physician will guide and support you in this phase.

As it relates to diet, studies that have looked at various diets indicate that caloric restriction, in addition to compliance to lifestyle adjustments, is more important to successful weight loss than any specific diet.

MANAGEMENT OF CHILDHOOD OBESITY

In cases of childhood obesity, the basic principles of management also include:

1. Modification of diet;

2. Increasing appropriate physical activity and exercise;

3. Reducing sedentary activities, for example watching tv, playing video games, using social media; and

4. Modifying behaviour.

Obesity in children must be recognised as a complex disorder and management emphasises long-term diet and exercise, family support and avoidance of dramatic variations in weight. The physician plays a very important role in coordinating management.

FOLLOW-UP

Regular follow-up is indicated in obesity management to reinforce nutritional goals and exercise objectives, identify social and emotional barriers to therapy, establish family support and organise counselling, assess metabolic parameters such as glucose and lipids, as well as identify obesity-related acute and chronic complications.

Finally, obesity has become a worldwide epidemic. As such, a concerted approach involving public education is important to both adults and children as a means of changing their eating and behavioural habits in order to be successful at losing weight and living a healthful life.

 

from myhealtyze http://www.myhealtyze.tk/medical-management-of-obesity-what-to-expect-jamaica-observer/