Obesity/Nutrition

Background

• BMI = Body Weight (kg) + Height (meters) squared
• Overweight = BMI 25.0-29.9
• Obesity:
  • Class I 30-34.9
  • Class II 35-39.9
  • Class IIIA 40-44.9
  • Class IIIB 45-49.9
  • Class IIIC 50+

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Management

• Goals: Target initial weight loss of 5-7% body weight, schedule frequent follow up to assess progress. Request pts send 48 hr food log. Encourage accountability “buddies.” Consider weight loss apps: My Fitness Pal, Lose it
• Diet:
  • Calorie restriction > macronutrient composition (e.g., low fat, low carb)
  • Mediterranean: high in unsaturated fats, fruit/veg, legumes, grains; moderate dairy & EtOH; less meat (decreased overall mortality and CV mortality; may decrease diabetes incidence independent of weight loss)
  • Dot phrases below for pictoral representation of cultural diets adapted to fit Mediterranean guidelines (Asian, African, Latin American)
• DASH: High in fruits/vegetables, moderate dairy, < 25% caloric intake from fat (decreases SBP/DBP)
• Exercise: >30 min, 5-7 days per week, ideally a combo of aerobic + resistance training.
  • ​​​​​​​Exercise alone is not sufficient for weight loss.
  • Medications: If BMI ≥30 or BMI ≥27 with ≥1 comorbidity. Significant short term weight loss (~ 5-15 lbs), but weight is typically gained back when stopped
• Referral to medical weight loss: If BMI ≥ 30 or BMI ≥27 with comorbid conditions (fatty liver disease, diabetes mellitus, HTN, OSA)
• Referral to surgical weight loss: If BMI ≥40 or BMI ≥35 with comorbid conditions

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