Obesity in adults: screening, and evaluation DR. ANAHITA BABAK

Transcription

1 1 Obesity in adults: screening, and evaluation DR. ANAHITA BABAK

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3 تعیین محدوده وزن مطلوب بر اساس BMI باالی 40 چاقی شدید وزن طبیعی کم وزنی چاقی درجه 2 اضافه وزن چاقی درجه >18.5

4 Waist circumference 4 measuring in overweight and obese adults to assess abdominal obesity 40 in (102 cm) for men 35 in (88 cm) for women Waist circumference measurement is unnecessary in patients with BMI 35 kg/m 2 as almost all individuals with this BMI also have an abnormal waist circumference and are already at a high risk from their adiposity. In Asian females a waist circumference 31 in (80 cm) and in Asian males a value 35 in (90 cm) are considered abnormal.

5 EVALUATION OF THE OBESE PATIENT 5 Investigating the cause: behaviors such as a sedentary lifestyle and increased caloric intake secondary causes of obesity are uncommon, should be considered and ruled out

6 additional medical history include: 6 age at onset of weight gain events associated with weight gain previous weight loss attempts change in dietary patterns history of exercise current and past medications: insulin, sulfonylureas, thiazolidinediones, antipsychotics history of smoking cessation

7 physical examination 7 thyroid goiter (hypothyroidism) proximal muscle weakness, purple striae, osteoporosis (Cushing's syndrome) acne/hirsutism (polycystic ovary syndrome)

8 Assessing obesity-related health risk 8 the degree of overweight (BMI) the presence of abdominal obesity (waist circumference) cardiovascular risk factors sleep apnea nonalcoholic fatty liver disease symptomatic osteoarthritis other obesity-related comorbidities The coexistence of several diseases, including established coronary heart disease (CHD), other atherosclerotic disease, type 2 diabetes mellitus, and sleep apnea, places patients in a very high-risk category for subsequent mortality.

9 Cardiovascular risk factors 9 Hypertension dyslipidemia (reduced levels of HDL or elevated levels of LDL) elevated triglycerides impaired fasting glucose or diabetes obstructive sleep apnea cigarette smoking

10 Diet and Lifestyle Evaluation 10 a diet record from the patient that ranges from 1 to 7 days in length adequacy of protein; essential fats; and complex carbohydrates, including fiber imbalance of saturated or transaturated fats, simple carbohydrates, or incomplete protein adequate intake of water and a wide variety of colorful vegetables and fruits

11 11 note activity for each day of the week at least 3 days of food intake that includes two weekdays and one weekend or nonwork day An easy recommendation that you can make during many office visits is to have your patients stop drinking all sugar-sweetened beverages

12 Other comorbidities 12 symptomatic osteoarthritis Cholelithiasis nonalcoholic fatty liver disease PCOS Depression impaired quality of life

13 Behavior modification 13 The goal is to help patients make long-term changes in their eating behavior by: modifying and monitoring their food intake modifying their physical activity controlling cues and stimuli in the environment that trigger eating included in programs conducted by psychologists or other trained personnel as well as many self-help groups

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15 تغذيه سالم 1 -ترتيب: مصرف بيشتر مواد موجود در پايين هرم تغذيه 2 -تنوع: مصرف همه مواد موجود در هرم تغذيه 3 -تناسب: تناسب تغذيه با سن و شرايط جسمي و فعاليت بدني تعادل: 4- مصرف مقادير کافی از مواد غذايی برای حفظ سالمتی بدن

16 5 گروه اصلی غذایی نان و غالت سبزی ها ميوه ها شير ولبنيات گوشت حبوبات تخم مرغ مغزها و دانه ها

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26 اشتباهات رايج در الگوی غذا خوردن پرخوی : میون غ اوذ خوی ب شو ب ییو ر ا هیواا ا هوه )ح ی ه مین غ کم( اال کم ا کالر : حجم اذ خی شیرین( )مثل اوذ اا رورو. ینب خی : مرتب ین ع ب اا اذ مصرف کالر حذف ع ب اذ یی

27 Thanks for Attention