El documento habla sobre la obesidad y su manejo. Brevemente resume: 1) La obesidad ha aumentado significativamente en los últimos 20 años en Estados Unidos. 2) El tratamiento de la obesidad requiere una evaluación completa y un enfoque que incluya dieta, actividad física y terapia de comportamiento. 3) La meta del tratamiento es prevenir la ganancia de peso y lograr una pérdida gradual de peso a largo plazo a través de un déficit calórico moderado y cambios en el estilo

1. OBESIDAD: ENFOQUE Y MANEJO Dra. Lina Patricia Pradilla S. Médica Internista Endocrinóloga Docente Cátedra Universidad Industrial de Santander

3. CHEESEBURGER 20 Years Ago Today 333 calories How many calories are in today’s cheeseburger?

4. Calorie Difference: 257 calories 590 calories 20 Years Ago Today 333 calories CHEESEBURGER

5. Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to lift weights in order to burn the extra 257 calories?* *Based on 130-pound person

6. If you lift weights for 1 hour and 30 minutes, you will burn approximately 257 calories.* *Based on 130-pound person Calories In = Calories Out

7. Tendencias en obesidad* en adultos norteamericanos: BRFSS, 1988 Mokdad A.H., CDC (*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)

8. Tendencias en obesidad* en adultos norteamericanos: BRFSS, 1994 Mokdad A H, et al. J Am Med Assoc 1999; 282:16 (*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)

9. Tendencias en obesidad* en adultos norteamericanos: BRFSS, 2000 Mokdad A H, et al. J Am Med Assoc 2001; 286:10 (*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)

10. Prevalence Obesity Body Mass Index > 30Kg/m 2 p value: Х 2 test urban vs rural Total Urban Rural p Total sample (%) 101 (16.37) 71 (70.29) 30 (29.71) <0.0001 Men (%) 24 (11.27) 16 (66.67) 8 (33.33) 0.0063 Women (%) 77 (19.06) 55 (71.43) 22 (28.57) 0.0003

11. Prevalence Obesity Waist Circumference * Men: Waist circumference ≥ 90 cm **Women: Waist circumference ≥ 80 cm p value: Х 2 test urban vs rural Total Urban Rural p Men* (%) 78 (36.79) 45 (57.69) 33 (42.31) <0.0001 Women** (%) 192 (47.52) 103 (53.64) 89 (46.36) 0.724

12. IMC en Shanhai Distribución de Frecuencia

14. SPAGHETTI AND MEATBALLS 20 Years Ago Today 500 calories 1 cup spaghetti with sauce and 3 small meatballs How many calories do you think are in today's portion of spaghetti and meatballs?

15. Calorie Difference: 525 calories 1,025 calories 2 cups of pasta with sauce and 3 large meatballs 20 Years Ago Today 500 calories 1 cup spaghetti with sauce and 3 small meatballs SPAGHETTI AND MEATBALLS

16. How long will you have to houseclean in order to burn the extra 525 calories?* *Based on 130-pound person Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

17. *Based on 130-pound person If you houseclean for 2 hours and 35 minutes , you will burn approximately 525 calories.* Calories In = Calories Out

23. Clasificación de sobrepeso y obesidad

25. Algoritmo de tratamiento NIH Patient Encounter Hx of 25 BMI?  • Measure weight, height, and waist circumference • Calculate BMI Examination Brief reinforcement/ educate on weight management Periodic weight check Advise to maintain weight/address other risk factors Clinician and patient devise goals and treatment strategy for weight loss and risk factor control Assess reasons for failure to lose weight Maintenance counseling: Dietary therapy Behavior therapy Physical activity : Treatment Assess risk factors No Yes 1 2 14 15 13 12 11 10 16 3 4 6 5 7 8 9 Yes No Yes No Hx BMI 25?  No Yes Yes No Does patient want to lose weight? Yes No Progress being made/goal achieved? BMI 25 OR   waist circumference > 88 cm (F) > 102 cm (M) BMI   30 OR {[BMI 25 to 29.9 OR waist circumference >88 cm (F) >102 cm (M)] AND 2 risk  factors} BMI measured in past 2 years?

26. No BMI  30 OR {[BMI 25 to 29.9 OR waist >88 cm (F) >102 cm (M)] AND  2 risk factors} Treatment Algorithm (Part 1 of 3) Patient Encounter Hx of  25 BMI? • Measure weight, height, and waist circumference • Calculate BMI Assess risk factors No Yes 1 2 3 4 6 5 7 Yes No BMI measured in past 2 years? BMI  25 OR waist >88 cm (F) >102 cm (M)  Yes  Examination Treatment

27. Devise goals and treatment strategy for weight loss and risk factor control Assess reasons for failure to lose weight Maintenance counseling 12 11 10 8 9 No Yes Yes No Desire to lose weight? Yes No Progress made? BMI  30 OR {[BMI 25 to 29.9 OR waist >88 cm (F) >102 cm (M)] AND  2 risk factors}   Examination Treatment 7 Periodic weight check • Advise to maintain weight • Address other risk factors 13 16 Treatment Algorithm (Part 2 of 3)

28. • Brief reinforcement • Educate on weight management Periodic weight check • Advise to maintain weight • Address other risk factors 14 15 13 16 5 Yes No Yes No Hx BMI  25?  BMI  25 OR waist >88 cm (F) >102 cm (M) Examination Treatment Treatment Algorithm (Part 3 of 3) * This algorithm applies only to the assessment for overweight and obesity and subsequent decisions based on that assessment. It does not include any initial overall assessment for cardiovascular risk factors or diseases that are indicated.

29. FRENCH FRIES 20 Years Ago Today 210 Calories 2.4 ounces How many calories are in today’s portion of fries?

30. 610 Calories 6.9 ounces Calorie Difference: 400 Calories FRENCH FRIES 20 Years Ago Today 210 Calories 2.4 ounces

31. How long will you have to walk leisurely in order to burn those extra 400 calories?* *Based on 160-pound person Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

32. *Based on 160-pound person If you walk leisurely for 1 hour and 10 minutes you will burn approximately 400 calories.* Calories In = Calories Out

39. Dieta (1 de 5) Dietas bajas en calorías (LCD) son recomendadas para pérdida de peso en sujetos obesos y con sobrepeso. Evidencia Categoria A. Reducción de grasa como parte de una LCD es una forma práctica de reducir calorías. Evidencia Categoria A.

40. Dieta (2 de 5) Dietas bajas en calorías pueden reducir el peso corporal total en promedio de 8% y ayuda a reducir el contenido de grasa abdominal en 6 meses. Evidencia Categoría A.

41. Dieta (3 de 5) Aunque las dietas bajas en grasas que no tienen como objetivo la reducción calórica pueden ayudar a promover la pérdida de peso al reducir la ingesta calórica, pero las dietas bajas en grasas con restricción calórica simultánea producen mayor pérdida de peso. Evidencia Categoría A.

42. Dieta (4 de 5) Dietas muy bajas en calorías producen una mayor pérdida de peso inicial que las dietas bajas en calorías. Sin embargo, a largo plazo (>1 año) la pérdida de peso no fue diferente de una LCD Evidencia Categoría A.

46. 85 Calories 6.5 ounces How many calories are in today’s portion? SODA 20 Years Ago Today

47. Calorie Difference: 165 Calories 250 Calories 20 ounces 85 Calories 6.5 ounces 20 Years Ago Today SODA

48. How long will you have to work in the garden to burn those extra calories?* *Based on 160-pound person Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

49. If you work in the garden for 35 minutes, you will burn approximately 165 calories.* *Based on 160-pound person Calories In = Calories Out

54. COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces How many calories are in today's coffee?

55. COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces 350 calories 16 ounces Calorie Difference: 305 calories

56. How long will you have to walk in order to burn those extra 305 calories?* *Based on 130-pound person Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

57. If you walk 1 hour and 20 minutes, you will burn approximately 305 calories. * *Based on 130-pound person Calories In = Calories Out

58. Terapia de comportamiento El uso rutinario de estrategias de terapia comportamental para promover dieta y ejercicio es recomendado, dado que son útiles en alcanzar pérdida y mantenimiento de peso Evidencia Categoría B.

67. PEPPERONI PIZZA 20 Years Ago Today 500 calories How many calories are in two large slices of today ’ s pizza?

68. 20 Years Ago Today 500 calories 850 calories Calorie Difference: 350 calories PEPPERONI PIZZA

69. How long will you have to play golf (while walking and carrying your clubs) in order to burn those extra 350 calories?* *Based on 160-pound person Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

70. If you play golf (while walking and carrying your clubs) for 1 hour you will burn approximately 350 calories.* *Based on 160-pound person Calories In = Calories Out

76. RIO Lípidos y RIO Diabetes: pérdida de peso (kg): casos observados y UOP [media (EEM)] Diferencia entre grupos , media (EEM) UOP 20mg vs Pbo -5,4 (0,4) (p<0,001) -2,3kg -8,6kg Media basal (DE) 94,1 (14,8) -10 -8 -6 -4 -2 0 0 4 8 12 16 20 24 28 32 36 40 44 48 52 UOP Diferencia entre grupos , media (EEM) UOP 20mg vs Pbo -3,9 (0,3) (p<0,001) -1,9kg -6,1kg Media basal (DE) 96,3 (14,7) -10 -8 -6 -4 -2 0 0 4 8 12 16 20 24 28 32 36 40 44 48 52 UOP RIO Lípidos RIO Diabetes Despr é s JP et al, 2005; Scheen A et al, 2006 población ITT

77. POPCORN 20 Years Ago Today 270 calories 5 cups How many calories are in today’s large popcorn?

78. POPCORN 20 Years Ago Today 270 calories 5 cups 630 calories 11 cups Calorie Difference: 360 calories

79. How long will you have to do water aerobics in order to burn the extra 360 calories?* *Based on 160-pound person Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

80. *Based on 160-pound person If you do water aerobics for 1 hour and 15 minutes you will burn approximately 360 calories.* Calories In = Calories Out

83. CHEESECAKE 20 Years Ago Today 260 calories 3 ounces How many calories are in today’s large portion of cheesecake?

84. CHEESECAKE 20 Years Ago Today 260 calories 3 ounces 640 calories 7 ounces Calorie Difference: 380 calories

85. How long will you have to play tennis in order to burn those extra 380 calories?* *Based on 130-pound person Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

86. *Based on 130-pound person If you play tennis for 55 minutes you will burn approximately 380 calories.* Calories In = Calories Out

90. CHICKEN CAESAR SALAD 20 Years Ago Today 390 calories 1 ½ cups How many calories are in today’s chicken Caesar salad?

91. CHICKEN CAESAR SALAD 20 Years Ago Today 390 calories 1 ½ cups 790 calories 3 ½ cups Calorie Difference: 400 calories

92. How long will you have to walk the dog in order to burn those extra 400 calories?* *Based on 160-pound person Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

93. If you walk the dog for 1 hour and 20 minutes, you will burn approximately 400 calories. * *Based on 160-pound person Calories In = Calories Out

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