1. Obesity M.A.Kubtan MD - FRCS M.A.Kubtan1

2.  Childhood Overweight and Obesity  Management in Adults  Setting Goals  Diet  Physical Activity and Exercise  Behavioral Approaches  Medications  Complementary and Alternative Medicine  Surgery M.A.Kubtan2

3.  An initial goal of a 5% to 10% reduction in weight is reasonable.  A process-oriented target (lifestyle) may be more beneficial for some than a target weight.  A weight reduction rate of 1/2 to 1 Kg weekly is achievable if intake is reduced by 500 to 1000 kcal daily.  Caloric restriction alone is not as effective as combining it with an exercise program.  A low-energy-dense diet composed of generous quantities of vegetables and fruits promotes health and facilitates weight management. M.A.Kubtan3

4.  Childhood obesity rarely is associated with a primary medical disorder.  When present in childhood obesity, underlying disorders are almost always associated with statuary growth reduction.  The risk of adult obesity increases with the age of the obese child.  Intervention can be more effective in children than in adults and should involve the entire family. M.A.Kubtan4

5.  Lifestyle.  Parental involvement is a key component in childhood weight management.  In addition, health care providers may overlook obesity.  Adiposity rebound occurs between ages 5 and 7 years.  Breastfeeding should be encouraged up to the age of 1 year.  Elimination of sweetened beverages.  All children older than 2 years should be receiving low-fat dairy products.  Vegetables and fruits. M.A.Kubtan5

6.  It is important to help patients become aware of the medical implications and to engage them in management.  Prevention of weight gain with lifestyle therapy is indicated in any patient with BMI ≥25. M.A.Kubtan6

7.  Readiness/motivation to undertake weight loss.  Reasons/expectations for weight loss.  Available support.  Previous methods of weight loss and results (including why results were not successful).  Potential barriers to weight loss and maintenance (time, finances, established habits).  Periods of increased weight gain. M.A.Kubtan7

8.  Triggers to eating  Current (and past) exercise/activity  Factors the patient believes are responsible for weight  Binge eating, purging, laxative or diuretic use  Family history of obesity  Medications M.A.Kubtan8

9.  Diet.  Physical activity.  Behavior therapy [†] [†]  Pharmacotherapy.  Surgery. M.A.Kubtan9

10.  Total calorie intake must be reduced below energy expenditure for weight loss to occur.  Low-carbohydrate diets.  Satiety from fat are other possible mechanisms. M.A.Kubtan10

11.  The choice of exercise depends on individual interests.  The goal should be 30 minutes. M.A.Kubtan11

12.  Self-monitoring.  Identifying and avoiding environmental or social triggers  Group support may be helpful. M.A.Kubtan12

13.  Appetite suppressants work through their effects on neurotransmitters.  Orlistat inhibits gastric and pancreatic lipase. M.A.Kubtan13

14.  Ephedrine, often in combination with caffeine . Side effects : sympathetic activity, tachyarrhythmias, headache, and elevated BP,  Caffeine can increase sympathetic nervous system activity.  Antioxidants have been thought to have sympathetic activity. M.A.Kubtan14

15. Malabsorptive : Jejunoileal bypass. Biliopancreatic diversion. Restrictive : Vertical-banded gastroplasty Gastric banding. Gastric sleeve. Gastric plication. Malabsorptive and Restrictive Roux-en-Y gastric bypass M.A.Kubtan15