Obesity III Treatment of Obesity

Obesity III Treatment of Obesity

Obesity treatment or weight loss is important as weight loss reduces the complications of obesity. It decreases chances of heart disease, diabetes, high blood pressure, stroke or hyperlipidemias. After weight loss, the metabolism of the body slows down and fewer calories are consumed. Hence weight loss is never easy. Lost weight may be regained (Recidivism). A person has to watch his weight regularly, exercise regularly and continue diet precautions usually lifelong.

Some times losing weight rapidly by consuming a very low fat diet may result in iformation of gall bladder stones. In them increasing fat in diet may reduce the risk of gall stones.

How to reduce your weight?

There are only 2 options: either burn more calories or reduce their intake in food.

The first option is more troublesome as very little calories are consumed in daily activities. A person who is hardly doing any physical work consumes only 1200 to 1500 calories a day.

Each gram of fat provides 9 cal while proteins and carbohydrates provide about 4 cal each.

About 20 – 25 cal/kg body weight will maintain a constant body weight. In order to reduce the weight about 500 cal less than this would be sufficient.

The initial goal may be to reduce weight by 5 to 7 %. Most of the obese patients report less intake of food than they actually consume.

Fats should form only < 30 % of the calories and should preferably be polyunsaturated. Proteins can form upto 45% and remaining provided by carbohydrates. Very low calories, mediterranean and other various diets have been found to be less useful but are more fashionable in various countries.

Obesity II

Obesity II

Obesity is evaluated by screening for confirmation and assessment of risk factors. Once the BMI confirms obesity severity is divided into

Grade I BMI >30 but < 35 Grade II BMI >35 but < 40 Grade III BMI > 40 Waist circumference is measured at the highest level of the hip bone by a tape placing it horizontally.

In woman a waist circumference of > 88 cm or 35 inches and in Man >102 cm or 40 inches signifies central obesity.

Persons with central obesity are more at risk for heart disease, diabetes, Obstructive sleep apnoea and hyperlipidemia (excess lipids in blood). Coexistence of coronary artery disease, atherosclerosis elsewhere, Sleep apnoea, high BP, h/o premature heart attacks in other close relatives, smoking and lack of exercise : all these act togather to increase mortality.

Treatment of Hypertension

Treatment of Hypertension

Why should hypertension be treated ?

The following are the benefits of treating hypertension:-

  • 50 % reduction in risk of heart failure
  • 30-40% reduction of risk of strokes of brain
  • 20-30 % reduction in risk of heart attacks.

The benefit occurs in all age groups including elderly. If a cause has been found (as happens in very few cases) treatment of underlying cause is useful e.g. treating kidney disease, removing adrenal tumours, stopping steroids, analgesics, contraceptive pills, certain anti depressants etc.

In the majority of cases, no cause is found. In these, we suggest non-pharmacologic ways as well as medicines to lower blood pressure.

Non-pharmacological methods may reduce blood pressure by 5- 10 mm on their own. These include

Reduction of weight if overweight

Reduction of salt in diet (avoid pickles, salted foods, preserved foods). Do not take salt substitutes if there is associated kidney disease.

Dash diet ( dietary approaches to stop hypertension diet ). Increase vegetables, whole grain cereals, low fat, low sugar and sweets, more fruits, fish and chicken if you are a non vegetarian

Increase physical activity, both physical aerobic activity and relaxation exercises may help

Stop or cut down on alcohol and smoking

Learn about Hypertension.

Pharmacological methods may reduce blood pressure

2 or more drugs are required if BP is >20/10 above the normal range. More medicines and higher doses are needed if blood pressure is due to kidney disease. These drugs may cause side effects and hence prescriptions are tailor made to suit particular requirements of the patient.

The drugs include

Diuretics : – which increase salt and water excretion in the body. These work only if salt is cut down in the diet.

ACE- inhibitors and ARB’s : -These are a class of medicines which protects against ill effects of high BP on kidneys, heart and brain. However, treatment is complicated and always should be under the guidance of a competent physician. These drugs are known to cause fetal malformations. Inform your doctor if you are pregnant or are planning to have a child,

Calcium Channel Blockers :- Very useful and often used class of drugs. Some times these may cause feet to swell otherwise these are well tolerated.

Betablockers:- These reduce heart rate and blood pressure. This is useful in reducing stress on the heart. However, these may cause serious worsening in asthma and may aggravate prostate symptoms, and may cause impotence.

Centrally acting and alfa blockers:- These are also useful in controlling BP. Some of these may cause or worsen depression.