Obesity from Clinical Evaluation to Management Local Perspective

IF 0.2 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Tariq Ashraf, Rafat Sultana, Asif Nadeem, M. Lashari
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Between 1980 and 2015, the prevalence surged from 11.1% to 38.3% for males aged 25 to 29 in low to middle-income countries.3 Pakistan ranks tenth among 188 countries, with half of its population classified as overweight or obese. Alarming projections from the World Obese Federation estimate that 5.4 million Pakistani school-aged children will grapple with obesity by 2030, emphasizing the dual challenges of overnutrition and poor nutrition.4,5 World Health Organization data indicates that 58.1% of Pakistanis are overweight, with 43.9% classified as obese. Asian cutoffs, though not globally recognized, suggest that 72.3% of Pakistanis are overweight, with obesity affecting 58.1% of the population. Research by Danielle H. Bodicoat et al. suggests an obesity threshold of 25 kg/m2 for South Asian individuals, coupled with a very high Waist Circumference (WC).6 A WC ≥ 31 inches (80cm) in Asian females and ≥ 35 inches (90cm) in Asian males is considered abnormal. The primary rationale for managing obesity is to mitigate morbidity, including conditions like diabetes, hypertension, dyslipidemia, heart disease, stroke, sleep apnea, and cancer, ultimately reducing mortality. The initial step in managing obesity involves screening to determine the degree of overweight using BMI and waist circumference measurements. However, studies reveal that only 6% of individuals receive ongoing care for weight management, such as prescriptions for obesity medication or referrals to dieticians.7,8 BMI classifications, primarily based on cardiovascular disease (CVD) risk, may underestimate risks for conditions like diabetes in the Asian population. Beyond BMI, measuring waist circumference is essential for identifying adults at increased risk for morbidity and mortality, especially in the BMI range of 25 to 35 kg/m2.9 In addition to physical examinations, measurements of fasting glucose (or glycated hemoglobin [A1C]), thyroid-stimulating hormone (TSH), liver enzymes, and fasting lipids should be conducted.10 Investigating the causes of obesity involves ruling out a sedentary lifestyle, increased caloric intake, and secondary factors. Medical history should include inquiries about medications that cause weight gain and smoking cessation. Weight loss interventions are recommended for those with a BMI exceeding 25 kg/m2, aiming to prevent, treat, or reverse complications associated with obesity. In conclusion, managing obesity in the Pakistani population requires a comprehensive approach involving clinical and laboratory assessments by physicians. This includes evaluating height, weight, BMI, waist circumference, blood pressure, serum triglycerides, serum HDL, cholesterol, fasting blood sugar/HbA1C, history of sleep apnea, medication history, physical activity, and etiological factors. Moreover, physicians should possess knowledge of dietary goals and medications promoting weight loss and consider bariatric surgery if non-responsive to other interventions. References World Health Organization. Obesity. Accessed December 12, 2023. Available at: https://www.who.int/health-topics/obesity#tab=tab_1 Defining adult overweight & obesity. Centers for Disease Control and Prevention. Updated June 7, 2021. Accessed May 24, 2023. cdc.gov/obesity/adult/defining.html GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017 Jul 6;377(1):13-27. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(11):1163-71. The Global Atlas on childhood obesity. World Obesity Federation. Accessed December 12, 2023. Available at: https://www.worldobesity.org/membersarea/global-atlas-on-childhood-obesity Bodicoat DH, Gray LJ, Henson J, Webb D, Guru A, Misra A, et al. Body mass index and waist circumference cut-points in multi-ethnic populations from the UK and India: the ADDITION-Leicester, Jaipur heart watch and New Delhi cross-sectional studies. PloS One. 2014;9(3):e90813. Perreault L, Suresh K, Rodriguez C, Dickinson LM, Willems E, Smith PC, et al. Baseline characteristics of PATHWEIGH: a stepped-wedge cluster randomized study for weight management in primary care. Ann Fam Med. 2023;21(3):249-55. Kaplan LM, Golden A, Jinnett K, Kolotkin RL, Kyle TK, Look M, et al. Perceptions of barriers to effective obesity care: results from the national ACTION study. Obesity. 2018;26(1):61-9. Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-96. Tsai AG, Wadden TA. In the clinic: obesity. 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引用次数: 0

Abstract

For over two millennia, physicians have been aware of the morbidity and mortality linked to overweight and obesity. Various definitions of obesity, as outlined by the World Health Organization (WHO) and the Centers for Disease Control & Prevention (CDC), utilize the Body Mass Index (BMI) to characterize these conditions. Screening for high-risk patients is crucial for guiding lifestyle changes, treatment decisions, and risk reduction strategies.1,2 The assessment involves clinical and laboratory studies to categorize the type and severity of obesity, forming the foundation for effective management. Globally, the prevalence of obesity in 2015 exhibited a rising trend in females compared to males. Between 1980 and 2015, the prevalence surged from 11.1% to 38.3% for males aged 25 to 29 in low to middle-income countries.3 Pakistan ranks tenth among 188 countries, with half of its population classified as overweight or obese. Alarming projections from the World Obese Federation estimate that 5.4 million Pakistani school-aged children will grapple with obesity by 2030, emphasizing the dual challenges of overnutrition and poor nutrition.4,5 World Health Organization data indicates that 58.1% of Pakistanis are overweight, with 43.9% classified as obese. Asian cutoffs, though not globally recognized, suggest that 72.3% of Pakistanis are overweight, with obesity affecting 58.1% of the population. Research by Danielle H. Bodicoat et al. suggests an obesity threshold of 25 kg/m2 for South Asian individuals, coupled with a very high Waist Circumference (WC).6 A WC ≥ 31 inches (80cm) in Asian females and ≥ 35 inches (90cm) in Asian males is considered abnormal. The primary rationale for managing obesity is to mitigate morbidity, including conditions like diabetes, hypertension, dyslipidemia, heart disease, stroke, sleep apnea, and cancer, ultimately reducing mortality. The initial step in managing obesity involves screening to determine the degree of overweight using BMI and waist circumference measurements. However, studies reveal that only 6% of individuals receive ongoing care for weight management, such as prescriptions for obesity medication or referrals to dieticians.7,8 BMI classifications, primarily based on cardiovascular disease (CVD) risk, may underestimate risks for conditions like diabetes in the Asian population. Beyond BMI, measuring waist circumference is essential for identifying adults at increased risk for morbidity and mortality, especially in the BMI range of 25 to 35 kg/m2.9 In addition to physical examinations, measurements of fasting glucose (or glycated hemoglobin [A1C]), thyroid-stimulating hormone (TSH), liver enzymes, and fasting lipids should be conducted.10 Investigating the causes of obesity involves ruling out a sedentary lifestyle, increased caloric intake, and secondary factors. Medical history should include inquiries about medications that cause weight gain and smoking cessation. Weight loss interventions are recommended for those with a BMI exceeding 25 kg/m2, aiming to prevent, treat, or reverse complications associated with obesity. In conclusion, managing obesity in the Pakistani population requires a comprehensive approach involving clinical and laboratory assessments by physicians. This includes evaluating height, weight, BMI, waist circumference, blood pressure, serum triglycerides, serum HDL, cholesterol, fasting blood sugar/HbA1C, history of sleep apnea, medication history, physical activity, and etiological factors. Moreover, physicians should possess knowledge of dietary goals and medications promoting weight loss and consider bariatric surgery if non-responsive to other interventions. References World Health Organization. Obesity. Accessed December 12, 2023. Available at: https://www.who.int/health-topics/obesity#tab=tab_1 Defining adult overweight & obesity. Centers for Disease Control and Prevention. Updated June 7, 2021. Accessed May 24, 2023. cdc.gov/obesity/adult/defining.html GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017 Jul 6;377(1):13-27. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(11):1163-71. The Global Atlas on childhood obesity. World Obesity Federation. Accessed December 12, 2023. Available at: https://www.worldobesity.org/membersarea/global-atlas-on-childhood-obesity Bodicoat DH, Gray LJ, Henson J, Webb D, Guru A, Misra A, et al. Body mass index and waist circumference cut-points in multi-ethnic populations from the UK and India: the ADDITION-Leicester, Jaipur heart watch and New Delhi cross-sectional studies. PloS One. 2014;9(3):e90813. Perreault L, Suresh K, Rodriguez C, Dickinson LM, Willems E, Smith PC, et al. Baseline characteristics of PATHWEIGH: a stepped-wedge cluster randomized study for weight management in primary care. Ann Fam Med. 2023;21(3):249-55. Kaplan LM, Golden A, Jinnett K, Kolotkin RL, Kyle TK, Look M, et al. Perceptions of barriers to effective obesity care: results from the national ACTION study. Obesity. 2018;26(1):61-9. Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-96. Tsai AG, Wadden TA. In the clinic: obesity. Ann Intern Med. 2013;159(5):ITC3-16.
肥胖症从临床评估到管理的地方视角
两千多年来,医生们一直意识到超重和肥胖与发病率和死亡率有关。世界卫生组织(WHO)和美国疾病控制与预防中心(CDC)对肥胖做出了各种定义,并利用体重指数(BMI)来描述这些症状。对高危患者进行筛查对于指导改变生活方式、治疗决策和降低风险策略至关重要。1,2 评估包括临床和实验室研究,以对肥胖的类型和严重程度进行分类,为有效管理奠定基础。在全球范围内,2015 年女性肥胖症患病率较男性呈上升趋势。在 1980 年至 2015 年期间,中低收入国家 25 至 29 岁男性的肥胖率从 11.1%飙升至 38.3%。3 巴基斯坦在 188 个国家中排名第十,其一半人口被归类为超重或肥胖。世界肥胖者联合会(World Obese Federation)的预测令人震惊,估计到 2030 年,540 万巴基斯坦学龄儿童将面临肥胖问题,强调了营养过剩和营养不良的双重挑战。亚洲的分界线(虽然不是全球公认的)表明,72.3% 的巴基斯坦人超重,58.1% 的人口肥胖。Danielle H. Bodicoat 等人的研究表明,南亚人的肥胖临界值为 25 kg/m2,同时腰围(WC)很高。6 亚洲女性腰围≥ 31 英寸(80 厘米)和亚洲男性腰围≥ 35 英寸(90 厘米)被认为是不正常的。控制肥胖的主要理由是降低发病率,包括糖尿病、高血压、血脂异常、心脏病、中风、睡眠呼吸暂停和癌症等疾病,最终降低死亡率。管理肥胖症的第一步是进行筛查,通过测量体重指数和腰围来确定超重程度。然而,研究显示,只有 6% 的人接受了持续的体重管理护理,如肥胖症药物处方或转介给营养师。7,8 主要基于心血管疾病(CVD)风险的体重指数分类可能低估了亚洲人患糖尿病等疾病的风险。除 BMI 外,测量腰围对于识别发病和死亡风险增加的成年人也很重要,尤其是 BMI 在 25 至 35 kg/m2 之间的人群。9 除体检外,还应测量空腹血糖(或糖化血红蛋白 [A1C])、促甲状腺激素 (TSH)、肝酶和空腹血脂。病史应包括询问导致体重增加的药物和戒烟情况。建议对体重指数(BMI)超过 25 kg/m2 的人群进行减肥干预,以预防、治疗或逆转与肥胖相关的并发症。总之,管理巴基斯坦人的肥胖症需要医生进行临床和实验室评估的综合方法。这包括评估身高、体重、体重指数、腰围、血压、血清甘油三酯、血清高密度脂蛋白、胆固醇、空腹血糖/HbA1C、睡眠呼吸暂停病史、用药史、体力活动和病因。此外,医生应了解饮食目标和促进减肥的药物,如果对其他干预措施无效,应考虑进行减肥手术。参考文献 世界卫生组织。肥胖症。访问日期:2023 年 12 月 12 日。网址: https://www.who.int/health-topics/obesity#tab=tab_1 成人超重和肥胖的定义。美国疾病控制和预防中心。2021 年 6 月 7 日更新。访问日期:2023 年 5 月 24 日。cdc.gov/obesity/adult/defining.html GBD 2015 肥胖合作者。195 个国家 25 年间超重和肥胖对健康的影响。N Engl J Med.2017 Jul 6;377(1):13-27.Curry SJ、Krist AH、Owens DK、Barry MJ、Caughey AB、Davidson KW 等:《预防成人肥胖相关发病率和死亡率的行为减肥干预》:美国预防服务工作组建议声明。JAMA.2018;320(11):1163-71.全球儿童肥胖地图集》。世界肥胖联合会。2023 年 12 月 12 日访问。Available at: https://www.worldobesity.org/membersarea/global-atlas-on-childhood-obesity Bodicoat DH, Gray LJ, Henson J, Webb D, Guru A, Misra A, et al. Body mass index and waist circumference cut-points in multi-ethnic populations from the UK and India: the ADDITION-Leicester, Jaipur heart watch and New Delhi crosssectional studies. PloS One.PloS One.2014;9(3):e90813.Perreault L, Suresh K, Rodriguez C, Dickinson LM, Willems E, Smith PC, et al.
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来源期刊
Pakistan Heart Journal
Pakistan Heart Journal CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
0.20
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64
审稿时长
6 weeks
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