DiagnosisIf your BMI is in the obese range, your health care provider will typically review your health history in detail, perform a physical exam and recommend some tests.These exams and tests generally include:. Taking your health history. Your doctor may review your weight history, weight-loss efforts, exercise habits, eating patterns, what other conditions you've had, medications, stress levels and other issues about your health.
Your doctor may also review your family's health history to see if you may be predisposed to certain conditions. A general physical exam. This includes also measuring your height; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen. Calculating your BMI.
Your doctor will check your body mass index (BMI) to determine your level of obesity. This should be done at least once a year. Your BMI also helps determine your overall health risk and what treatment may be appropriate. Measuring your waist circumference. Fat stored around your waist, sometimes called visceral fat or abdominal fat, may further increase your risk of diseases, such as diabetes and heart disease.
Women with a waist measurement (circumference) of more than 35 inches (80 centimeters, or cm) and men with a waist measurement of more than 40 inches (102 cm) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, your waist circumference should be checked at least once a year. Checking for other health problems. If you have known health problems, your doctor will evaluate them.
Your doctor will also check for other possible health problems, such as high blood pressure and diabetes. Blood tests.
What tests you have depend on your health, risk factors and any current symptoms you may be having. Tests may include a cholesterol test, liver function tests, a fasting glucose, a thyroid test and others. Your doctor may also recommend certain heart tests, such as an electrocardiogram. Gathering all this information helps you and your doctor determine how much weight you need to lose and what health conditions or risks you already have. And this will guide treatment decisions.
TreatmentThe goal of obesity treatment is to reach and stay at a healthy weight. You may need to work with a team of health professionals — including a dietitian, behavior counselor or an obesity specialist — to help you understand and make changes in your eating and activity habits.The initial treatment goal is usually a modest weight loss — 3 to 5 percent of your total weight. That means that if you weigh 200 pounds (91 kg) and are obese by BMI standards, you would need to lose only about 6 to 10 pounds (2.7 to 4.5 kg) for your health to begin to improve. However, the more weight you lose, the greater the benefits.All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan.Other treatment tools include:. Dietary changes. Exercise and activity.
Behavior change. Prescription weight-loss medications.
Weight-loss surgeryDietary changesReducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently.Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term.Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight-loss success.There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:. Cutting calories. The key to weight loss is reducing how many calories you take in. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back.
You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men. Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods — such as desserts, candies, fats and processed foods — are high in energy density.
This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have lower energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein — such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products.
Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils. Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended, and limiting these drinks or eliminating them altogether is a good place to start cutting calories. Meal replacements.
These plans suggest that you replace one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off.Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss.
The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets.Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight — and keep it off — you have to adopt healthy-eating habits that you can maintain over time. Exercise and activityIncreased physical activity or exercise is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking.To boost your activity level:. Exercise. People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight.
To achieve more-significant weight loss, you may need to exercise 300 minutes or more a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories.
Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day.Behavior changesA behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity.Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating.
Tailor your behavior changes to address your individual concerns.Behavior modification, sometimes called behavior therapy, can include:. Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety.
You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Therapy can take place on both an individual and group basis. More-intensive programs — those that include 12 to 26 sessions a year — may be more helpful in achieving your weight-loss goals. Support groups.
You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers.Prescription weight-loss medicationLosing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help.Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them.
If you don't make these other changes in your life, medication is unlikely to work.Your doctor may recommend weight-loss medication if other methods of weight loss haven't worked for you and you meet one of the following criteria:. Your body mass index (BMI) is 30 or greater. Your BMI is greater than 27, and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apneaBefore selecting a medication for you, your doctor will consider your health history, as well as possible side effects. Some weight-loss medications can't be used by women who are pregnant, or people who take certain medications or have chronic health conditions.Commonly prescribed weight-loss medications include orlistat (Xenical), lorcaserin (Belviq), phentermine and topiramate (Qsymia), buproprion and naltrexone (Contrave), and liraglutide (Saxenda).You will need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost.
Weight-loss surgeryIn some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can pose serious risks.Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven't worked and:. You have extreme obesity (BMI of 40 or higher). Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure. You're committed to making the lifestyle changes that are necessary for surgery to workIt doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term.
Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.Common weight-loss surgeries include:. Gastric bypass surgery. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch.
Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach. Laparoscopic adjustable gastric banding (LAGB). In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently.
Biliopancreatic diversion with duodenal switch. This procedure begins with the surgeon removing a large part of the stomach. The surgeon leaves the valve that releases food to the small intestine and the first part of the small intestine (duodenum). Then the surgeon closes off the middle section of the intestine and attaches the last part directly to the duodenum. The separated section of the intestine is reattached to the end of the intestine to allow bile and digestive juices to flow into this part of the intestine. Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food.
It's a less complicated surgery than gastric bypass or biliopancreatic diversion with duodenal switch.Other treatmentsVagal nerve blockade is another treatment for obesity. It involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full. This new technology received FDA approval in 2014 for use by adults who have not been able to lose weight with a weight-loss program and who have a BMI of 35 to 45 with at least one obesity-related condition, such as type 2 diabetes. Preventing weight regain after obesity treatmentUnfortunately, it's common to regain weight no matter what obesity treatment methods you try.
If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or overindulge in high-calorie foods. But that doesn't mean your weight-loss efforts are futile.One of the best ways to prevent regaining the weight you've lost is to get regular physical activity. Aim for 60 minutes a day.Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost.You may always have to remain vigilant about your weight. Combining a healthier diet and more activity in a practical and sustainable manner are the best ways to keep the weight you lost off for the long term.Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term.
Clinical trialstesting new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.Lifestyle and home remediesYour effort to overcome obesity is more likely to be successful if you follow strategies at home in addition to your formal treatment plan. These can include:.
Learning about your condition. Education about obesity can help you learn more about why you became obese and what you can do about it.
Caring For Obese Elderly
You may feel more empowered to take control and stick to your treatment plan. Read reputable self-help books and consider talking about them with your doctor or therapist. Setting realistic goals. When you have to lose a significant amount of weight, you may set goals that are unrealistic, such as trying to lose too much too fast. Don't set yourself up for failure. Set daily or weekly goals for exercise and weight loss.
Make small changes in your diet instead of attempting drastic changes that you're not likely to stick with for the long haul. Sticking to your treatment plan. Changing a lifestyle you may have lived with for many years can be difficult. Be honest with your doctor, therapist or other health care providers if you find your activity or eating goals slipping. You can work together to come up with new ideas or new approaches. Enlisting support.
Get your family and friends on board with your weight-loss goals. Surround yourself with people who will support you and help you, not sabotage your efforts.
Make sure they understand how important weight loss is to your health. You might also want to join a weight-loss support group. Keeping a record.
Keep a food and activity log. This record can help you remain accountable for your eating and exercise habits.
You can discover behavior that may be holding you back and, conversely, what works well for you. You can also use your log to track other important health parameters such as blood pressure and cholesterol levels and overall fitness. Identifying and avoiding food triggers. Distract yourself from your desire to eat with something positive, such as calling a friend. Practice saying no to unhealthy foods and big portions. Eat when you're actually hungry — not simply when the clock says it's time to eat.
Taking your medications as directed. If you take weight-loss medications or medications to treat obesity-related conditions, such as high blood pressure or diabetes, take them exactly as prescribed. If you have a problem sticking with your medication regimen or have unpleasant side effects, talk to your doctor.Alternative medicineNumerous dietary supplements that promise to help you shed weight quickly are available. The effectiveness, particularly the long-term effectiveness, and safety of these products are often questionable.Herbal remedies, vitamins and minerals, all considered dietary supplements by the Food and Drug Administration, don't have the same rigorous testing and labeling process as over-the-counter and prescription medications do.Yet some of these substances, including products labeled as 'natural,' have drug-like effects that can be dangerous. Even some vitamins and minerals can cause problems when taken in excessive amounts.
Ingredients may not be standard, and they can cause unpredictable and harmful side effects. Dietary supplements also can cause dangerous interactions with prescription medications you take. Talk to your doctor before taking any dietary supplements.Mind-body therapies — such as acupuncture, mindfulness meditation and yoga — may complement other obesity treatments. However, these therapies generally haven't been well-studied in the treatment of weight loss.
Talk to your doctor if you're interested in adding a mind-body therapy to your treatment. Coping and supportTalk to your doctor or therapist about improving your coping skills and consider these tips to cope with obesity and your weight-loss efforts:.
Journal. Write in a journal to express pain, anger, fear or other emotions. Connect. Don't become isolated. Try to participate in regular activities and get together with family or friends periodically. Join. Join a support group so that you can connect with others facing similar challenges.
Focus. Stay focused on your goals. Overcoming obesity is an ongoing process. Stay motivated by keeping your goals in mind. Remind yourself that you're responsible for managing your condition and working toward your goals. Relax. Learn relaxation and stress management.
Home Care For The Elderly
Learning to recognize stress and developing stress management and relaxation skills can help you gain control of unhealthy eating habits.Preparing for your appointmentTalking to your health care provider openly and honestly about your weight concerns is one of the best things you can do for your health. In some cases, you may be referred to an obesity specialist — if one is available in your area. You may also be referred to a behavioral counselor, dietitian or nutrition specialist. What you can doBeing an active participant in your care is important. One way to do this is by preparing for your appointment.
Think about your needs and goals for treatment. Also, write down a list of questions to ask.
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Chances are good that in your practice, you treat obese patients. Obesity continues to be a national crisis. Current research has found that are obese. The obesity crisis not only contributes to growing health costs but also.Patients who have experienced an adverse medical event leading to a medical malpractice claim are frequently noted to be obese (based on documented height and weight). A review of 7,065 claims from 2011 to 2013 by, the nation’s largest physician-owned medical malpractice insurer, revealed that 28% were identified as having one or more comorbidities, and obesity was the most common (8.3% of total claims and 19.2% of total claims with a comorbidity).
When closed claims were analyzed, 26% of claims that resulted in indemnity payments listed obesity as a comorbidity.Increased risks: Complications and access issuesObese patients commonly have a variety of comorbidities. Many are associated with a metabolic syndrome (i.e., hypertension, dyslipidemia, and hyperglycemia) which increases the risk of stroke, ischemic heart disease, and diabetes mellitus. These patients also have increased risk of obstructive sleep apnea (which often contributes to opioid-induced respiratory depression), susceptibility to nosocomial and postoperative infections, and weight-associated wear and tear on joints that can lead to osteoarthritis. Additionally, bariatric surgery can be associated with both surgical and metabolic complications.In addition to the risks of comorbidities,. An inability to fit a morbidly obese patient into a conventional MRI machine or CT scanner is a unique problem necessitating use of an open MRI or CT. Healthcare facilities that are unable to accommodate morbidly obese patients in their MRI machine or CT scanner, or if their MRI or CT isn’t available at night or on weekends, should have transfer agreements with open facilities in place so there are no delays in urgent MRIs or CT scans.
The failure to transfer an obese patient to a facility with an open MRI machine or CT scanner in a timely fashion may result in a delay of diagnosis and/or surgical treatment—and, ultimately, in a malpractice claim.Steps to accommodate patients of all sizesPractices should have appropriately sized furniture in the waiting areas and exam rooms to meet the needs of obese patients. They should also have equipment—such as blood pressure cuffs, needles, and wheelchairs—designed for obese patients.Weight assessment tools are handy, and practices may want to consider providing weight education to patients.
It is key to understanding the importance of talking about weight with patients—the conversation should take place early for better prevention and treatment. Many factors can arise that inhibit a practitioner from speaking frankly about weight with a patient. As obesity rates continue to increase, it is worthwhile for doctors and other healthcare professionals to as this case study illustrates:A 44-year-old morbidly obese woman (body mass index BMI 65.8) had a sleep apnea test that was monitored by a technician on a recording system.The technician observed that the patient had fallen out of the bed and was unable to get up.
Instead of responding, the technician assisted another patient. The patient struggled for almost 10 minutes before she was able to get up by herself.The patient went back to sleep but awoke later with a prolonged episode of coughing. Again, the technician failed to assist in a timely manner and did not help the patient remove the CPAP mask. When the patient coughed some phlegm onto the floor, the technician chastised her. The patient left after that incident, saying that the staff at the healthcare facility had not treated her with respect.These episodes were captured on DVD as part of the sleep apnea workup. The technician was fired for his inattention and his unacceptable response to the patient.Personal biasThis case illustrates an employee’s inappropriate behavior toward a patient and may also indicate a negative attitude toward obese patients. This necessitates a closer examination of attitudes.
The Obesity Society offers advice to doctors and other healthcare providers to help address this issue. The first step is to become aware of any personal bias against obese people by asking these questions:. Do I make assumptions based only on weight regarding a person’s character, intelligence, professional success, health status, or lifestyle behaviors?.
Am I comfortable working with people of all shapes and sizes?. Do I give appropriate feedback to encourage healthful behavior change?. Am I sensitive to the needs and concerns of obese individuals?. Do I treatAnswering these questions can assist doctors in developing empathy and meeting the needs of obese patients.
It can also help them create a positive health experience for obese patients.