Ppt on obesity management systems

Pediatric Obesity Kerry K. Sease, MD, MPH Medical Director, New Impact

23% 48% 33% 36% 35% 9% 0.5% Provider Perceived Barriers to Effective Treatment (Health Care Systems Work Group of the South Carolina Coalition for Obesity Prevention Efforts (SCCOPE), 2007) Weight Management Counseling Sensitive with nonjudgmental tone toward both the child and the parents family-based management strategy cannot be over-emphasized assess the familys therapeutic readiness Assess parental perceptions about their childs weight/


© Solving the Overweight/Obesity Management Puzzle 10/22/04 Rosemary Burke, RN, MS Robin F. Foust, BS, PAHM.

© Solving the Overweight/Obesity Management Puzzle 10/22/04 Rosemary Burke, RN, MS Robin F. Foust, BS, PAHM © BACKGROUND MediCorp Health System –28 facility healthcare system headquartered in Virginia Mary / group support ongoing & in addition to AW counselor meetings –Counselors apply behavioral change communication techniques to support lasting change Obesity Management – Gastric Bypass Surgery –Compliance with Policy –Monitoring and Support through Associate Wellness (AW) –Weight Watchers for group /


Commercial weight management solutions – what can you advise your patients? Robert Hobson Public Health Nutritionist.

and information Member forums Interactive activity demonstrations Magazine 1000’s of own brand food products – points system Slimming World Founded in UK, 1969 7500 weekly meetings Program combines healthy diet and physical activity/ lives: a cross government strategy for England. London. Department of Health. 3. NICE (2006) Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. London: NICE 4. Kate Jolly, Amanda Lewis, Jane Beach, John Denley/


Presented by: Carolyn Brown, M.Ed, RN, ARM, FCCWS National Director of Clinical Services C-3 Management of the Obese Population A Person Centered Care.

ignored assessment –Most common diagnosis = deferred –Embarrassing –Limited hygiene Increased endometrial cancer in obese women Gynecological Management Tips Gather appropriate supplies and adequate help –Longer speculum –Sit on metal bedpan Recommend pelvic floor/box type resident compartment – 1000 # capacity – Gurney with hydraulic lift – Aluminum rear loading ramps – Winch system Contacts: American Medical Response www.amr-inc.com “Build Your Own Bariatric Unit” www.swambulance.com Transport and /


MORBIDLY OBESE PARTURIENT

in left lateral position or semi upright position The Bullard Laryngoscope for Emergency Airway Management in a Morbidly Obese Parturient Aaron I. Cohn, MD et al Morbidly obese, 240 kg, 160 cm, 31-yr-old female presented for cesarean section due/ in Obstetrics- David Hill et al Department of Anaesthesia, Ulster Hospital, Belfast UK Remifentanil is most suitable for systemic opioid for use in obstetrics onset and offset are rapid analgesia is consistently high Maternal oxygen desaturation limits the dose/


1998 Clinical Practice Guidelines for the Management of Diabetes in Canada January 1999 CANADIAN DIABETES ASSOCIATION ASSOCIATION CANADIENNE DU DIABÈTE.

DIABETES ASSOCIATION ASSOCIATION CANADIENNE DU DIABÈTE Initial and follow-up physical examination Management General Height, weight, waist circumference (central obesity), BMI*, blood pressure (lying and standing), pulse Head and neck Eyes (pupillary reactions, extraocular movements, lens opacities and fundi), oral cavity (hygiene and caries), thyroid assessment Chest Routine Cardiovascular system Signs of congestive heart failure, pulses, bruits General Height, weight, waist circumference/


Lesson 4 : Nutrition Disorders Obesity and health consequences.

etc. � More job tasks automated � New technologies Alan Greenspan - Chairman, Board of Governors of the Federal Reserve System The major cause for the continued increase in the US economy without an increase in inflation throughout the 1990s was an /help people maintain health in an environment conducive to people weighing more? THE NEED FOR REALISTIC GOALS IN OBESITY MANAGEMENT Shift focus from changing appearance to improving health Consider healthier weight over time - not ideal weight Sustained moderate/


Slides for presentations November 2008

DHC team should be multi- and interdisciplinary, and should establish and sustain a communication network among the health and community systems needed in the long-term care of the person with diabetes. Diabetes care should be systematic and, when possible, /and feedback on physical activity, healthy eating habits and weight loss [Grade C, Level 3 (31-34)]. Management of Obesity in Diabetes In overweight or obese adults with type 2 diabetes, a pharmacologic agent such as orlistat [Grade A, Level 1A (26)] or/


Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Focus on Obesity (Relates to Chapter 41, “Nursing Management:

Drug Therapy (Cont’d) Appetite-suppressing drugs  Decrease food intake through nonadrenergic or serotonergic mechanisms in the central nervous system (CNS) Phentermine Diethylpropion Phendimetrazine  Recommended for short-term use Copyright © 2010, 2007, 2004, 2000, Mosby,/assist transfer of unconscious patient During transfer ensure that patient’s  Airway is stabilized  Pain is managed In severely obese patients it is essential to monitor for rapid oxygen desaturation Copyright © 2010, 2007, 2004, 2000,/


Obesity: Pathophysiology, Risk Assessment, and Prevalence

Cravings for sweet high-fat foods among obese and bulimic patients may involve the endorphin system Hormonal Regulation of Body Weight Norepinephrine and dopamine—released by sympathetic nervous system in response to dietary intake Fasting and semistarvation/ cysts; infertility, acne, hirsutism and alopecia Increased risk of heart disease, type 2 diabetes, reproductive cancers Management of PCOS Symptom oriented, as etiology is unclear Individualized diet and exercise plan to promote weight loss and /


Management of Obesity An over review

The Lancet August 1997 The Lancet August 1997 Clinical assessment & management Management of Obesity Clinical assessment & management Clinical assessment & management Obesity Program Team Approach Bariatric surgeon. Dietitian. Physical therapist. Psychiatrist. Psychologist/ Ephedrine & Caffeine. BioEnterics® Intragastric Balloon BIB ™ System B.I.B. Placement Clinical results Dr. Bolwerk Jaw Wiring Bray et al CE&M 1999 Obesity Surgery Classification Restrictive Malabsorptive Combined %EWL after LAGB VBG/


TM Pediatric Obesity in Primary Care Sandra G. Hassink, MD, FAAP Director, Nemours Obesity Initiative Alfred I. duPont Hospital for Children Wilmington,

/nutrition/activity/readiness to change  Evidence based/evidence informed/expert opinion on high risk behavior for obesity  Stepwise approach to prevention and treatment  Addressed obesity management in primary and tertiary care  Multidisciplinary approach  Family centered/parenting/motivational interviewing Assessment of Child and Adolescent Overweight and Obesity. Pediatrics. 2007;120(Supplement 4):163-288. TM Expert Committee Recommendations  Assessment  Prevention  Prevention Plus  Structured/


MANAGING TYPE II DIABETES EAST & WEST LORI KELSEY RN-BSN DOM.

& Chan, 2013) regulate BGL Rehmanniae Widely used to treat diseases relating to blood, immune, endocrine, nervous, and cardiovascular systems in combination with others herbs. Animal Studies:  Rehmannia + ginseng, scutellariae, astragali->stimulated insulin secretion, pancreatic cell proliferation, improved/Bo, A., Gomez-Martinez, S., Nova, E. Marcos, A. (2015). Role of probiotics in obesity management. Nutricion Hospitalaria 31 Suppl 1:108. doi:10.3305/nh.2015.31.sup1.8702. Retrieved from www.aulamedica/


Primary Care Counseling for Obesity, Nutrition, and Physical Activity 2013 Eileen L. Seeholzer, M.D., MS Associate Prof. - Case Western University School.

requires ongoing adjustments by the affected person and interactions with the health care system. © 2006-2011 Improving Chronic Illness Care Obesity is often not reversible: Adipose tissue hyperplasia  At normal BMI ranges / convenience, type  Resources – time, money, place  Finances  Ability Lifestyle management: Connect patients to local resources  Refer to programs – nutritionists, Weight management clinic, behaviorists, appropriate commercial diets, self-help groups, local recreation centers, local /


Obesity and the Skin A look at Bariatric associated skin disorders.

hemoglobin component of red blood cells to permanently discolor the tissue) 26 Venous Insufficiency  Years-decades of obesity can damage the venous system and circulatory changes occur.  Which can lead to a more serious venous ulceration  Occur commonly over /care for the bariatric patient. J Ostomy Wound Management. 2014; 60(1): 12-21. 2. Yosipovitch. Gil MD, Devore, A MD, and Dawn, A. MD. Obesity and the skin: Skin Physiology and Skin manifestations of obesity. J American Academy of Dermatology. 2007; /


Weight Management in Patients With Type 2 Diabetes JOAN TEMMERMAN, MD, MS, FAAFP, CNS American Association of Diabetic Educators Annual Meeting, Indianapolis,

Summary of IDF Position Statement for T2DM Obesity and diabetes epidemics are serious chronic diseases & major global public health issues Prejudices about severe obesity, which also exist within the health care system, should not be a barrier to /al; NEJM 2011;365; Oct 27, 2011 ADA position: weight management; J Am Diet Assoc. 2009 Summary Weight management is most important therapy for patients with T2DM obesity promotes diabetes; weight loss counteracts it Comprehensive lifestyle intervention can produce/


Body Composition and Weight Management. Unit 5: Body Composition and Weight Management OBJECTIVES FOR THIS UNIT: Students will: 1) Understand the various.

our body. This is normally about 15-25% of our weight. The Term: Obesity Obesity is the condition of being very over-fat or having a high percentage of body /for the general population. The BOD POD The BOD POD Body Composition Tracking System uses patented Air Displacement Plethysmography for determining percent fat and fat-free mass/and Exercise No matter what the reason, successful weight loss and healthy weight management depend on sensible goals and expectations. If you set realistic goals for yourself/


Approach to obese patients Presented by: Abdulaziz Mosleh Alonazy Abdullah Saleh Alkhuraiji Abdulaziz Bandar Alsuwailem.

loss 3- Antiepileptic drugs: The antiepileptic drugs valproate (valproic acid) and carbamazepine, which are commonly used in the management of bipolar disorder, are associated with weight gain. 4- Diabetes drugs: Insulin stimulates weight gain, possibly through hypoglycemia,/services 4- nutrition services 5- staff health promotion 6- health educations for family ALL TRUE ABOUT OBESITY EXCEPT: A.It affects all body systems. B.It’s the fifth leading cause of death worldwide. C.It’s prevalence is decreasing /


YOUNG WOMEN & THE REPRODUCTIVE CONSEQUENCES OF OBESITY Healthy Weight Matters.

status 56% of white women are overweight or obese 73% of African American women are overweight or obese 56% of other minorities are overweight or obese NC Behavioral Risk Factor Surveillance System, 2010 Obesity among North Carolina mothers Pieces of the puzzle http/ of provider’s weight status Bardia A, Holtan SG, Slezak JM, Thompson WG. Diagnosis of Obesity by Primary Care Physicians and Impact on Obesity Management. Mayo Clin Proc. 2007;82(8):927-932 Tips for talking with patients Don’t ignore weight/


Focus on Obesity (Relates to Chapter 41, “Nursing Management: Obesity,” in the textbook) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier.

Elsevier Inc. 58 Drug Therapy Appetite-suppressing drugs  Decrease food intake through nonadrenergic mechanisms in the central nervous system (CNS) Phentermine Diethylpropion Phendimetrazine  Not recommended because of the potential for abuse Copyright © 2011, 2007 by /assist transfer of unconscious patient. During transfer, ensure that patient’s  Airway is stabilized  Pain is managed In severely obese patients, it is essential to monitor for rapid oxygen desaturation. Copyright © 2011, 2007 by Mosby, /


WEIGHT GAIN /OBESITY By Dr. Cuong Ngo-Minh Back to Basics April 14th 2010.

r/o congestive heart failure), somnolence (r/o sleep apnea). Symptoms of breast-colon-prostate cancer Review of system for comorbid conditions. Intolerance to cold, fatigue (r/o hypothyroidism), polydipsia and polyuria (r/o diabetes), / to dietician Refer multidisciplinary team (re: Civic weight management clinic) Refer to specialists re:endocrinologist appropriately for investigations and treatment of suspected condition. Goal of care for obesity/weigth gain Reduce mortality: by ↓ cardiovascular risk./


Overweight/Obesity & Physical Inactivity Healthy Kansans 2010 Steering Committee Meeting April 22, 2005.

reported data for ease of comparison Lack of health & physical education policy in schools Lack of skills among primary care practitioners in preventing &/or managing obesity Environment Family School Worksite Community Chronic Care Model Medical System Information Systems Decision Support Delivery System Design Self Management Support Patient Self-Management What Are Barriers or Liabilities That Are Limiting Progress in Kansas? Lack of third party reimbursement for lifestyle/


Obesity Training Jacques Courseault, M.D. www.exercisemenu.com.

expenditures American Obesity Association Is Obesity Considered a Disease ? Disease - an interruption, cessation or disorder of a bodily function, organ or system. Disease - an interruption, cessation or disorder of a bodily function, organ or system. 3 Criteria/2 diabetes are reported to be overweight or obese. –Obesity has been found to be the largest environmental influence on the prevalence of diabetes in a population. –Obesity complicates the management of type 2 diabetes by increasing insulin /


Approaches to Obesity Prevention and Treatment at School-Based Health Centers Matt Haemer MD Assistant Professor in Pediatrics Section of Nutrition CU.

Primary Care for Obesity 1. Training in clinical obesity care (comorbidities) 2. Training in counseling – MI 3. Technology-support for screening, counseling, and community resource referral B.Community-Based Treatment 1. Multidisciplinary 2. Delivered by trained local staff 3. At a School or Recreation Center 39 Intervention Overview 1. Clinical information system  HeartSmart screening/counseling system 2. Decision support  Training: Comorbidity Management and Referral laboratory/


Obesity, diabetes and cardiovascular disease

Reduces gastrointestinal glucose absorption (probably by stimulating conversion to lactate) ●Lowers plasma [triglyceride] and [FFA] ●Useful for obese patients because, unlike sulfonylureas, doesn’t cause weight gain 144 Mechanism of TNF  and FFA effects – serine /peristalsis and metabolism in the target organs. Enteric neurones manage the detailed program. 154 enteric nervous system (1) 155 enteric nervous system (2) The enteric nervous system is a complex, multi-layered network, which covers the/


Setting Up Camp: How Do We Improve Nutrition, Increase Physical Activity and Prevent and Control Obesity? William H. Dietz, MD, PhD Division of Nutrition,

.org) NCQA – HEDIS measures AAP priority – Jeanne Lindros Environment Family School Worksite Community Chronic Care Model Medical System Information Systems Decision Support Delivery System Design Self Management Support Family/Patient Self-Management Dietz WH et al. Health Affairs 2007;26:430 Settings for the Prevention and Treatment of Obesity Medical Settings School Work Site Community Medical Settings School Work Site Community Priority Physical Activity and Nutrition/


Pediatric Obesity Elizabeth H. Kwon MD, MPH. OBESITY DEFINED According to the AMA’s Expert Committee on the Prevention, Assessment, and Treatment of.

obese children in one study OSA leads to decreases in learning, attention span and memory OSA leads to decreases in learning, attention span and memory (Rhodes, J Pediatrics 1995;127:741-744; Greengerg GD, Watson RK, Deptula D., Sleep 1987; 10(3):254-62.) And increases in pulmonary hypertension, systemic/Pediatrician) Treatment of Obesity “The new recommendations detail treatment strategies organized in a stepwise protocol format. By facilitating a more aggressive approach to weight management in the primary/


UNDERSTANDING AND MANAGING SWEETNESS CONFERENCE September 17, 2009, Taj Mahal Hotel, New Delhi, India All Calories Count — Why Manage Calorie Balance John.

Obesity & Health Public health officials worldwide are frustrated that consumers do not follow dietary guidelines to promote good health Private health practitioners and providers have similar frustrations Governments predict steep increases in the rates of chronic diseases, putting serious strains on the world’s healthcare systems/ physical activity, and other healthy lifestyle choices Sweetness, Obesity & Health Conclusions Managing sweetness involves reconciling our innate taste preferences with the /


بسم الله الرحمن الرحيم. Obesity and Being Overweight By Amr Abdelmonem,MD. Assistant professor of anesthesia,surgical intensive care and clinical nutrition.

currently taking antihypertensives What is the etiology that connects obesity and hypertension? Hyperinsulinemia and insulin resistance Mechanism 1.Increased sodium retention 1.Increased sympathetic nervous system activity 1.Alteration in the mechanics of blood vessels /obese Walking slower for a set distance is an appropriate exercise recommendation for weight management prescription in obese adults Raymond,etal. Obes Res.2005;13:891 Spot reduction Mentioned to be condemned Why treat overweight and obesity/


The Bariatric Patient The World is Growing Dixie Lee Davenport, RN, CEN, CCT-RN, PHRN EMS Outreach Manager Riverside Methodist Hospital OhioHealth.

sweet, high-fat foods among obese and bulimic patients may involve the endorphin systemCravings for sweet, high-fat foods among obese and bulimic patients may involve the endorphin system Obesity: A Higher Risk Heart diseaseHeart disease/ impeding access for IV fluids, taking BP Mobilization of manpowerMobilization of manpower Managing airwaysManaging airways Pulse oximetryPulse oximetry Obesity Challenges Airway Difficulties with intubation and BVMDifficulties with intubation and BVM Preoxygenation is/


PEDIATRIC OBESITY: A HUGE PROBLEM IN THE USA William J. Cochran, MD Department of Pediatric GI & Nutrition Geisinger Clinic.

on pediatric bariatric surgery n May be appropriate in individual cases u Severe obesity, BMI > 40 u Significant co-morbidities u Unresponsive to more conventional weight loss program BARIATRIC SURGERY n Preoperative evaluation in a pediatric weight management program n Psych evaluation u Depression u Ability to cope u Support system u Willingness to comply BARIATRIC SURGERY n Pediatric cases should be done/


Obesity: A Metabolic Perspective. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

Diabetes Care 28:888-894, 2005 Treatment benefits? Diabetes Care 28:888-894, 2005 Obesity management strategies Diet Physical activity Pharmacotherapy Surgery Obesity management strategies Diet –Best achieved by a combination of hypocaloric/low fat diet –Aim to /systemic absorption and no accumulation Significant GI side effects Xenical (n=8) Sibutramine (n=8)  Kg -1kg-4kg  HbA1c -0.7%0% SCGH prescriptions for Xenical and Sibutramine 6 months therapy 10% lose >10 kg at 6-12 months Management of Obesity/


Screening and Management of Obesity Ray Plodkowski, MD Chief Endocrinology and Metabolism VA Sierra Nevada Health Care System, Reno and Medical Director:

Screening and Management of Obesity Ray Plodkowski, MD Chief Endocrinology and Metabolism VA Sierra Nevada Health Care System, Reno and Medical Director: University of Nevada School of Medicine Division of Endocrinology, / Social Histories Identify support networks and cultural factors –May influence the patient’s ability to participate in a weight management program Other household members with obesity –May impact the ability for the patient to modify his or her lifestyle and diet. Dietary changes –Easier/


Bariatric Patients Presence Regional EMS System September 2015.

is essential Bariatric transport unit Bariatric assets (cot, lifting/moving equipment) Adequate number of personnel Cots Ferno LBS System 1000 lb. capacity Stryker Bariatric Cot 1600 lb. capacity Review Answer the following questions as a group. If doing/be done to control obesity? 4. 5. What are two ways that obesity might effect a patient psychologically? 6. 7. List three medical conditions complicated by obesity. 8. 9. 10. List 2 professional ways to approach the management of an obese patient. 11. /


Putting Prevention into Practice Canadian Task Force on Preventive Health Care Groupe d’étude canadien sur les soins de santé préventifs Obesity in Adults.

of evidence Write report 13 Review Topics and Questions 14 3 REVIEW TOPICS Prevention of Overweight/Obesity Management of Overweight/Obesity Maintenance of Weight Loss Adults KEY QUESTIONS: What are the benefits and harms of behavioural and/management) Language: studies published in English and French (KQ 1. new review on prevention) and English-only (KQ 2. updated search of previous USPSTF review on treatment) Study type: Included randomized control trials (RCTs) 17 GRADE Methodology The “GRADE” System/


بسم الله الرحمن الرحيم. Stress Response And Severely Obese For OP _ CAB Amr Abdelmonem, M.D. By Amr Abdelmonem,MD. Assistant professor of anesthesia,surgical.

2 diabetes. Lancet 1998; 352: 837–53 Neurohormonal changes Autonomic nervous system Autonomic nervous system Sympathetic nervous system activation Sympathetic nervous system activation Excess release of catecholamines Adrenal medulla Adrenal medulla Excess release of /the neurobiological and pathophysiological natures of the of the severely obese patients will enable physicians and scientists to approach the proper management of their stress response especially for CAB surgeries Regional anesthesia/


Physical Activity and Weight Management Julie Hagel, Pharm.D. September 24, 2003.

system Marketing Three levels of management Level III Health-oriented weight loss and physical activity improvement as a focal point of pharmacy practice Pharmacist is facilitator, motivator, educator Dedicated assessment room and classroom Program fee: primarily private pay Small group or individual counseling Marketing of screenings and classes Useful Resources www.nhlbi.nih.gov/about/oei/ Obesity Education Initiative www.obesity.org American Obesity Association/


Effective Methods of Decreasing the Incidence of Childhood Obesity in the United States By Kenya Baines and Stephanie Costa.

& Level of Evidence ResultsImplications for practice Barlow, S., E., & Dietz, W., H. Management of child and adolescent obesity (2002) The primary aim of this study was to identify interventions used by pediatric health care providers/childhood obesity, and presented recommendations to health care providers. Not listedLiterature review, Level V Suggested approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-/


Tackling childhood obesity - a better start Eustace de Sousa National Lead Children Young People and Families A Better Start Learning and Development event,

range of measures which, if implemented in parallel are likely to be effective. 23Tackling childhood obesity 23 Tackling childhood obesity All O R Health programme All O R Health programme aims to support and shape “health/management services www.gov.uk/government/publications/best-practice-guidance-for-weight- management-services www.gov.uk/government/publications/best-practice-guidance-for-weight- management-services Guidance on healthier and more sustainable catering www.gov.uk/government/uploads/system/


A FLAVOUR OF WHAT’S TO COME…. DEVELOPMENT, PREVENTION & MANAGEMENT OF OVERWEIGHT/OBESITY ACROSS THE LIFESPAN Suna Kassier PhD, RD (SA) Dietetics and Human.

(2014); World Bank (2015); FAO (2010); Qi & Cho (2008) Causes of overweight/obesity in Lesotho: → ↓ progress in improving community infrastructure & sound public health systems → urbanization → adoption of diets ↑ in carbohydrates, saturated fats & sugars → more sedentary / weight by 6 months postpartum: - predictor of obesity in mid life Postpartum period critical for weight management: - assess readiness, intention of behavioural change and related barriers Obese women more likely to: - eat in response/


BODY COMPOSITION AND WEIGHT MANAGEMENT Fitness for Life.

some health hazards with being overweight and be introduced to eating disorders. Body Composition and Weight Management Obesity Trends Among U.S. Adults between 1985 and 2009 Obesity is having a very high amount of body fat in relation to lean body mass, or /and there is generally not easy access for the general population. The BOD POD The BOD POD Body Composition Tracking System uses patented Air Displacement Plethysmography for determining percent fat and fat-free mass in adults and children. The simple,/


MarketsandMarkets Presents Weight Loss and Obesity Management Market worth $361 Billion By 2017

, Nutrition & Psychological Consultancy, Treadmill, Elliptical, Strength Training, Gastric Bypass, Intragastric Balloon System, Stomaphyx] - Global Forecasts To 2017 http://www.marketsandmarkets.com/Market-Reports/weight-loss-obesity-management-market-1152.html http://www.marketsandmarkets.com/Market-Reports/weight-loss-obesity- management-market-1152.html http://www.marketsandmarkets.com/Market-Reports/weight-loss-obesity-management-market-1152.html  This report studies the global weight loss diets (food/


Obesity Pre-Diabetes to Type 2 Diabetes Gül Bahtiyar, MD, MPH Woodhull Medical Center Clinical Associate Professor NYU School of Medicine.

during the day  Onsite wellness centers, exercise/walking trails  Stress management programs  Encourage walking/biking to/from work and during breaks  Memberships/–288. Selection Oral Hypoglycemic Therapy Consider Insulin Secretagogue (Sulfonylurea); Non-obesity or mild obese Repaglinide (Prandin) or Nateglinide (Starlix) are useful for post-prandial/, Comprehensive Support Systems Less Motivated, Nonadherent, Limited Insight, Poor Self-Care Capacities, Weak Support Systems Cardiovascular Ismail-Beigi/


Chapter 9 Energy Balance and Weight Management. A Closer Look at Obesity Bodies come in many shapes and sizes. Which are healthy? © 2007 Thomson - Wadsworth.

34% men 54% women  Mexican Americans 32% men 42% women http://www.cdc.gov/obesity/data/trends.html#Race Copyright 2010, John Wiley & Sons, Inc. Weight Management Terms Energy balance occurs when energy consumed equals energy expenditure. Energy is measured in kilocalories (kcal/ fat stores most people carry. This fuel is no use to the nervous system because while the muscles and other organs use fat as fuel, the nervous system only possess enzymes to convert protein to glucose.  As the fast continues,/


Chapter 9: Energy Balance, Weight Management, and Eating Disorders; Exercise.

Data 9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics 2010 23 states >25% obesity 18 states >30% obesity 2 states ≥35% obesity Mississippi & West Virginia South has the highest (30.2%) and /will satisfy Appetite The psychological desire to eat Want of a specific food Common to have appetite without hunger Weight Management Are you really still hungry, or are you actually full? It takes 20 minutes for the brain to receive/


America’s Agenda Report from a quantitative study of voter attitudes on health care delivery system reforms. 1726 M St., NW Suite 1100 Washington, DC 20036.

3 Key Findings Voters across the political spectrum support health care delivery system reforms that will improve quality of health care and lower costs. Democrats/ deductibles for recommended preventive services and emphasize disease prevention including reducing obesity and smoking; Ensure that doctors have accurate and updated information on/ coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases, like diabetes, heart disease, and cancer,/


Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)/Utilization Inpatient Initiatives: Hospitalists / SNF ED / Urgent Care Case Management “Transitional Care Coordination” Complex Chronic Disease Management “The Patient-Centered Specialty Practice" Chronic Disease Management Promotion of Health and Well-Being “The Patient-Centered Primary Care/


Nutrition and Obesity David Freestone, DO PGY 1 UNSOM Dept. of Pediatrics.

of all patients Provide anticipatory guidance on healthy behavior Check BMI at each well-child visit Dont treat obesity like AOM Use the chronic care model Chronic Care Model Family/Patient Self Management Environment Family School Worksite Community Medical System Information systems Decision support Delivery system design Self-management support Expert Committee Studies since recommendations show that there is mixed adherence Mainly surveys and no RCT/


community healthy food choices. These 2010 Dietary Guidelines include recommendations for health promotion and disease prevention, including obesity prevention and weight management (p. 13-19). How do we teach our students to choose their resources? WE NEED TO FOLLOW/www.rwjf.org/childhood obesity/ http://www.rwjf.org/healthpolicy/ Apps that you might find useful myfitnesspal Get Fit Map Apps that you might find useful Smash Your Food Internet Resources The Snackwise® Nutrition Rating System All you do is /


Should I refer my obese patient for bariatric surgery? Dr. Khalid Azzam Assistant Professor of Medicine HHS Bariatric Medical Clinic 4 th McMaster University.

factors influence obesity; – Lifestyle – Social – Psychological – Financial – Cultural an – Environmental Complications, comorbidities and barriers to obesity management Sharma AM. Obesity Reviews (2010) 11, 808–809 Obesity Management Clinically Significant Weight/Obese Subjects Study (LOSS) Rayan D, et. al, Arch Intern Med. 2010;170(2):146-154 Percentage of the participants in the LOSS who met weight loss or gain categories at year 2 Medications Orlistat Pancreatic lipase inhibitor Works non- systemically/


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