Obesity

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.
• Source:
  • J Clin Endocrinol Metab. 2008 Nov; 93(11 Suppl 1): S89–S96.
  • Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729256/