Bariatric Times

Insights into Patient Pop with Obesity 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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C8 Bariatric Times • December 2016 • Supplement C inches, respectively), Caucasians or Europids (37 and 31 inches, for men and women respectively), and South Asians, Chinese, and Japanese (35 and 31 inches, respectively). No data are yet provided for South and Central Americans as a category or for Sub-Saharan Africans, Eastern Mediterranean peoples, or Middle Easterners. For the Native Americans, South Asian criteria are to be employed until better data are available; for the African and Mediterranean peoples, Europid data should be used until more specific data are available. The cutoff BMI values for overweight and obesity vary based on ethnicity. For example, a BMI for obesity in Korea is 25kg/m 2 rather than 30kg/m 2 as it is in the U.S. Comorbid conditions are known to occur at lower BMIs in certain ethnic groups. Obesity Medicine Association (OMA) Obesity Algorithm. These guidelines were developed from survey data obtained from the Obesity Medicine Association (OMA) members along with expert consensus of OMA leaders and the algorithm authors. 6 The OMA Algorithm is updated regularly and provides information on a broad range of relevant and timely topics. It should be taken as the least prescriptive of the guidelines, in that it reflects current practice by peers and provides the range of options available that clinicians should take into consideration. In contrast to the other above-described guidelines which homed in on a few key points and discussed them in great depth, the OMA algorithm offers insight into everything from obesity as a multifactorial disease, adiposopathy, behavior therapy and weight loss, concurrent medications, obesity classifications, obesity medicines, and so on. The OMA Algorithm presents the various measures that can be used for obesity. This goes beyond the BMI; one can also use the percent body fat (calculated by bio- impedance, near-infrared reactance, DEXA scan or other measures), waist circumference, or the Edmonton Obesity Staging System. 15 The Edmonton Obesity Staging System is as follows: • STAGE 0: No apparent risk factors, no physical symptoms, functional limitations, and/or impairment of well-being • STAGE 1: Presence of obesity-related subclinical risk factors, mild physical symptoms, mild psychopathology, mild functional limitations, and/or mild impairment of well-being • STAGE 2: Presence of established obesity-related chronic disease, moderate psychopathology, moderate functional limitations, and/or impairment of well-being • STAGE 3: Established end-organ damage, significant psychopathology, significant functional limitations, and/or impairment of well-being • STAGE 4: Severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations, and/or severe impairment of well-being These tools may be used individually or may be combined. In some cases, where one metric is perhaps not entirely clear-cut, multiple measuring systems can be used to get sufficient data to draw a conclusion. GuIDANCe FOr PCPS Many PCPs are unfamiliar with these guidelines. A good starting place is to select one of these four main guidelines and incorporate it into practice. Over time, the other guidelines can be added. Since the guidelines are consistent with each other, this will not create conflicts in treatments. Indeed, the guidelines tend to supplement each other quite well to offer a well- rounded approach to clinical treatment for obesity. Although guidance clearly describes a prominent role for pharmacotherapy in the treatment of obesity, many eligible patients do not receive drug therapy and those who do tend to have higher BMI scores. 16 PCPs should recognize that the range of eligible patients who may benefit from drug therapy is likely much broader than they suspect and includes people with relatively low BMI scores. Obesity treatment is multifaceted and involves lifestyle interventions, physical activity, behavioral therapy, and possibly drug regimens, devices, and bariatric surgery. Despite the many aspects of obesity treatment, it can be appropriately and effectively managed in the primary care or managed-care setting. 17 PCPs and other clinicians may confidently rely on the guidelines to help craft evidence-based treatment models for their practice. Insights into the Patient Population with Obesity: Assessment and Treatment u

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