Obesity

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    Obesity

    • Class III Obesity BMI ≥ 40
    • Class II Obesity BMI 35.0-39.9
    • Class I Obesity BMI up to 35.0
    • Indications for Bariatric Surgery
      • Age 18-70yo  (recently extended to 70) 
      • BMI ≥ 40
      • BMI 35-40 + comorbidities (such as diabetes, hypertension, arthritis limiting daily function, and cardiopulmonary failure)
      • BMI 30-35 -> can be considered, but usually not. 
      • Must have tried to lose weight by other means 
      • Must be evaluated by medical, surgical, psychiatric, and nutritional teams. 
    • Most common procedure is gastric bypass, but banding becoming common.
    • Medications:
      • Orlistat
      • Phentermine - sympathomimetic drug FDA-approved for short-term use (<12 weeks) as adjunctive treatment of obesity.
        • Patients appear to re-gain weight after discontinuation.
    • Low calorie diet
      • Calculate kcal/d required to maintain weight, and subtract 500-1000kcal/day.
      • Very low calorie diet (< 800 kcal/day) is almost impossible to maintain in long term.
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