BACKGROUND
Obesity has become one of the most important and growing public health problems not only in resource-rich countries and transitional economies but countries like Pakistan too where resources are limited and economic instability prevails. As the prevalence of obesity increased, so did the prevalence of the comorbidities associated with obesity. For this reason, it is imperative that health care providers identify overweight and obese children so that counseling and treatment can be provided.
The term "obesity" refers to an excess of fat. However, the methods used to directly measure body fat are not available in daily practice. For this reason, obesity usually is assessed by the relationship between weight and height (i.e. anthropometrics), which provides an estimate of body fat that is sufficiently accurate.
DISEASE OCCURRENCE IN POPULATION:
According to World Health Organization (WHO) estimates, 26 % of women and 19% of men in Pakistan are obese (Body Mass index (BMI) > 25) but only 4% of women and 1 % of men are recognized as obese using the standard criteria (BMI > 30). The prevalence of obesity is even higher in urban areas (56% in men and 67% in women) when Asian specific definition for obesity is used.
RISK FACTORS:
Many factors contributes in the development of obesity
SIGN AND SYMPTOMS:
Although several classifications and definitions for degrees of obesity are accepted, the most widely accepted classifications are those from the World Health Organization (WHO), based on body mass index (BMI). The WHO designations are as follows:
Some authorities advocate a definition of obesity based on percentage of body fat, as follows:
DIAGNOSTIC TEST:
Standard laboratory studies in the evaluation of obesity should include the following:
TREATMENT OPTIONS:
Based on your measurements and your medical history, your doctor or nurse can determine what combination of weight loss treatments would work best for you. Treatments may include changes in lifestyle, exercise, dieting and, in some cases, weight loss medicines or weight loss surgery.
LIFESTYLE CHANGES:
Programs that help you to change your lifestyle are usually run by psychologists, nutritionists, or other professionals. The goals of lifestyle changes are to help you change your eating habits, become more active, and be more aware of how much you eat and exercise, helping you to make healthier choices.
This type of treatment can be broken down into three steps:
TRIGGERS TO EAT: Determining what triggers you to eat involves figuring out what foods you eat and where and when you eat them. To figure out what triggers you to eat, keep a record for a few days of everything you eat, the places where you eat, how often you eat, and the emotions you were feeling when you eat.
EATING: You can change your eating habits by breaking the chain of events between the trigger for eating and eating itself. There are many ways to do this. For instance, you can:
The types of foods we eat on a regular basis are related to whether we gain or lose weight over time. Whole grains, fruits, vegetables, nuts, and yogurt are associated with lower weight over four years, as contrasted with weight gain seen when eating french fried potatoes or chips, sugar-sweetened beverages, and red or processed meats.
WEIGHT LOSS MEDICINE:
Taking a weight loss medicine may be helpful when used in combination with diet, exercise, and lifestyle changes. Weight loss medicines work by reducing your appetite or by changing the way you digest food.
Weight loss medicines may be recommended for people who have not been able to lose weight with diet and exercise who have a:
Some of the weight loss medicines are described below
ORLISTAT: Orlistat is a medicine that reduces the amount of fat your body absorbs from the foods you eat. The recommended dose of the prescription version is 1 capsule three times per day, taken with a meal; you can skip a dose if you skip a meal or if the meal contains no fat.
Side effects occur in 10 to 15 percent of people and may include stomach cramps, gas, diarrhea, leakage of stool, or oily stools. These problems are more likely when you take orlistat with a high-fat meal
LORCASERIN: is a medicine that reduces appetite and thereby reduces body weight in men and women. Lorcaserin appears to have similar efficacy as orlistat. After one year, the mean weight loss is approximately 12.8 pounds compared with 6.4 pounds in the placebo group. Adverse effects of lorcaserin included headache, upper respiratory infections, nasopharyngitis, dizziness, and nausea, occurring in 18, 14.8, 13.4, 8, and 7.5 percent of patients, respectively.
LIRAGLUTIDE: Liraglutide at 3.0 mg/day is approved by the US Food and Drug Administration (FDA) for weight loss. It can be used at a lower dose to treat diabetes. Patients without diabetes taking the highest doses of liraglutide for approximately six months lost 7.4 percent of their initial body weight (16 pounds [7.2 kg]), compared with 4.3 percent (9 pounds [4.1 kg]) in patients taking orlistat. Adverse effects of liraglutide include nausea (37 to 47 percent), vomiting (12 to 14 percent), diarrhea, low blood sugar, and loss of appetite. Serious but less common side effects include pancreatitis, gallbladder disease, renal impairment, and suicidal thoughts.
SURGERY:
Bariatric surgery (from the Greek words "baros," meaning "weight," and "iatrikos," meaning "medicine") is the term for a surgery that is done to help you lose weight.
Weight loss surgery is recommended only for people with one of the following:
PRECAUTIONS:
BECOME MORE ACTIVE: Many types of physical activity can help, including walking. You can start with a few minutes a day and add more as you get stronger.
IMPROVE YOUR DIET: No single diet turns out to be better than any other. It is healthy to have regular meal times and smaller portions, and not to skip meals. Avoid sweets and processed snack foods, and instead eat more vegetables and fruits.
QUIT SMOKING: (if you smoke)
LIMIT ALCOHOL: Drink no more than 1 drink a day if you are woman, and no more than 2 drinks a day if you are a man.
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