Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. In most cases this is a lifestyle related condition but, in some cases, it is influenced by underlying medical conditions, endocrine disturbances, metabolic disorders or genetic predisposition. Hence it is very important to identify pre-disposing factors and treat it before starting treatment for obesity.
Evaluation of obesity health risk:
- Low risk – BMI (Body Mass Index) < 27 kg/m2 without additional health risk factors
- Moderate risk – BMI > 27 kg/m2(or > 25 with additional health risk factors)
- High risk (class 1 obesity) – BMI > 30 kg/m2(or > 27 with additional health risk factors)
- Very high risk (class 2 obesity) – BMI > 35 kg/m2(or > 30 with additional health risk factors)
- Extremely high risk (class 3 obesity) – BMI > 40 kg/m2(or > 35 with additional health risk factors)
Treatment plan based on obesity health risk:
- Low risk – Weight loss programme
- Moderate risk – Weight loss programme along with low calorie diet
- Class 1 and 2 obesity – Weight loss programme, low calorie diet and supportive medications
- Class 3 obesity – Weight loss programme, low calorie diet, supportive medications and considerations for surgery
Aim for weight loss: Ideal weight loss should be gradual and shouldn’t exceed 2 Kg per month to ensure it is sustained over a long duration.
Supportive medications:
- Cap. O-stat 60 (Orlistat 60 mg) – one tablet thrice a day with meals. Gradually increase till maximum dose of 120 mg three times a day. Stop this if no adequate response within 3 months.
- Tab. Ursocad 300 (Ursodiol 300 mg) – one tablet twice a day (to avoid gall stone formations during weight loss period).
- Cap. Multivite Gold (Multivitamins and herbal) – one cap once a day to improve absorption of fat-soluble vitamins.
Dietary advice:
- All dietary changes are based on individual patient characteristics and should be advised on case to case basis.
- As a general rule – aim to reduce calorie intake by 500 calories over a few weeks.
- Aim to limit weight loss to 2 Kg/month
- Aim for normal protein intake
- Gradually reduce salt, fat and carbohydrate intake to ensure diet plan is adhered to.
- Reduce or avoid intake of alcohol or sugary drinks
- Increase amount of vegetables and fibrous diet
- Drink about 2 litres of water per day if not contraindicated
Exercises:
- Advice types of exercises which are gentle and sustainable over a long period of time.
- Aim for exercises to increase heart rate to target level. For e.g. walking for 45 minutes.
- Target level of heart rate during exercise should not be more than 50% of calculated maximum tolerable heart rate.
- Maximum tolerated heart rate is approximately calculated as 220 – patient age.
Investigations:
The aim of investigations is to identify underlying common medical conditions and to rule out contraindications for anti-obesity treatment:
- Lipid profile
- Complete blood count & Erythrocyte sedimentation rate (ESR)
- Urine routine, serum electrolytes & renal function test
- Liver function test
- Fasting blood glucose level
- Thyroid function test
- Ultrasound abdomen
- DEXA scan
Anti-obesity treatment is contraindicated in conditions such as: Pregnancy; unstable mental or medical illness; gall stones; osteoporosis; anorexia nervosa; terminal illnesses; malabsorption disorders; post organ transplant; renal disorders and stones; pancreatitis; hypothyroidism and liver disorders.