Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

1072 Obesity

tests

Basic Tests: Blood

■Glucose, fasting

■Cholesterol: HDL, LDL, total

■Uric acid

■T3, T4

Basic Tests: Other

■Weight

■Height

■Blood pressure

differential diagnosis

■Chronic liver disease

■Renal failure

■Chronic steroid use

■Thyroid dysfunction

■Pregnancy

management

What to Do First

■Create energy deficit

■Assess attitudes, motivation, present behaviors

General Measures

■1 lb. Body fat=3500 kilocalories

➣500 kcal energy change/day=1 lb weight change/week

■Physical activity, gradual increase to≥30 minutes daily

■Specific, realistic, individualized short and long-term goals

■If <1200 kcal for women/1500 kcal for men, multivitamins needed

specific therapy

Indications for Treatment

■BMI >30 (obese)

■BMI=25–29.9 (overweight) with≥2 comorbidities or increased

waist circumference

Treatment Options

■Revised dietary guidelines for Americans (USDA)

■Physical activity each day

■Decreased:

➣saturated fats, cholesterol, total fats

➣sugars