Weight Management for Obesity: Diagnosis, Differential Diagnosis, Treatment Plan, and Patient Education

This presentation discusses the diagnosis, differential diagnosis, treatment plan, and patient education for weight management in obesity. It covers risk factors, treatment options, and follow-up for obesity. The presentation includes a case study, objective data, physical assessment, and prescription for medication. It also includes research article information and patient education.

August 29, 2
024
1
Weight
Management
For Obesity

August 29, 20242
Objectives
 To properly understand the different
complications related to obesity by case
presentation
 To evaluate patient’s subjective and objective
data related to obesity
 To discuss about differential and eventual
diagnosis of the disease
 To outline details regarding strategies to treat
people with obesity related complications

August 29, 20243
What is obesity?
 Obesity is a condition when an
individual has a weight that is
considered to be higher than normal.
This can be screened using the Body
Mass Index and Hip to Waist ratio.
 For adults, a BMI above 30 and a hip to
waist ratio above 0.90 is considered
obese

August 29, 20244
Prevalence of Obesity
 Since 1975, the global prevalence of
obesity has tripled.
 As of 2016, more than 650 million adults
(worldwide) were found to be obese
(13% of adults).
(who.int, 2018)
 In the US, 39.8% of adults (93.3 million
people) were Obese (cdc.gov, 2018).

August 29, 20245
History of patient’s illness
 Patient is 56 year old who was admitted to
hospital after a diagnosis of Obstructive
Sleep Apnea, Extreme Hypertension,
Palpitation and complaints of chest pain.
 The patient also complained of excessive
fatigue, lack of sleep, irritability and
frequent headaches.
 The patient’s work is getting affected due
to these conditions.

August 29, 20246
Social History
 The patient is employed as a store accountant and
spends most of his time working in front of the
computer, and gets very little physical activity.
 The patient is married for 20 years, and has one
daughter who studies abroad
 The patient is a regular smoker (smokes 20
cigarettes a day) and drinks heavily (about 3.5
litres of whiskey every week).
 His diet is very irregular and he mostly orders a lot
of fast food every day.

August 29, 20247
Medical History
 Even though the patient complains of
chronic fatigue, restlessness, and chest
pain, there is no record of heath service
record for the last 6 months. The patient
said his problems became unmanageable
over the last couple of weeks, due to
which he was admitted to hospital.
 For obstructive Sleep apnea, he was
using a CPAP mask since last year.

August 29, 20248
Family History
 Mother: Hypertension (deceased age 60)
 Father: Dabetes Type 2 (deceased age 70)
 Paternal Grandmother: Cancer (deceased, age
50)
 Paternal Grandfather: Unknown
 Maternal Grandfather: Stroke (Deceased, 79)
 Maternal Grandmother: Alive and healthy

August 29, 20249
Review of Systems
 Visual: Normal vision. The patient does not have
any eye complications, and does not wear glasses
or contact lenses.
 Auditory: No auditory problems
 Oropharyngeal: No problem chewing or
swallowing food.
 Cardiac: Hypertension and mild chest pain
towards the left side of the chest.
 Respiratory: Patient does not have any cough or
asthma. The patient is suffering from Obstructive
Sleep Apnea

August 29, 202410
 Gastrointestinal: Patient denied constipation, nausea,
vomiting or any other gastrointestinal problems.
 Genitourinary: No genitourinary complication
 Musculoskeletal: Patient denies of any
musculoskeletal problems or any problems with
mobility or range of movement.
 Neurological: Patient denied any neurological
condition
 Psychiatric: Patient complained of constant fatigue
due to inadequate sleep.
 Integumentary: No problems with skin.

August 29, 202411
Objective Data
 Vital Signs:
 Blood Pressure: 180/120
 Pulse Rate: 110
 Body Mass Index: 35
 Hip to waist ratio: 0.95
 Blood Sugar:
 Normal Blood Sugar: 98 mg/dl
 Postprandial blood sugar: 135 mg/dl
 Fasting blood sugar: 90mg/dl
 Triglyceride level: 160mg/dl

August 29, 202412
Physical Assessment
 Head: Atraumatic, normocephalic.
 Ears: No exudates or drainage from the ear canal. Tympanic
membrane is intact. No bulging or erythema to indicate infection.
Hearing is intact.
 Eyes: Normal vision, and no vision problems. No discharge.
 Nose: No discharge, deformity of bleeding from nose
 Oral Cavity: Lip and teeth normal, Oral mucosa is moist and pink,
Uvula is elongated, airways slightly obstructed, normal voice, no
stridor.
 Neck: Neck is supple, signs of jujular vein distention on both sides
of neck, signs of neck bruits. Trachea is midline
 Chest: Slight chest pain towards left side, symmetrical and equal
breath sounds
 Lungs: CTA bilateral, no wheezing sounds or rales or ronchi.

August 29, 202413
 Heart: Signs of cardiac arrthmia, no murmur, but an s3
heart sound.
 Abdomen: Soft, tender and distended, bowel sounds normal
 Rectal: Normal tone, no masses, daily bowl movement
 Genitourinary: Normal
 Extremities: Clubbed fingernails, pulses are strong in
femoral and dorsalis pedis arteries, but non equal, no signs
of trauma.
 Skin: Skin with no wound, discoloration or deformity.
 Neurologic: All the cranial nerves (2 to 12 are intact),
normal gait. Insomnia, constant fatigue
 Psychiatric: Irritable and restless

August 29, 202414
Differential Diagnosis
 Differential diagnosis involves assessing diseases having
similar symptoms and signs
 The aim of differential diagnosis is to understand the
specific disease or condition that is causing the suffering
for the patient
 This helps to identify specific diseases and outline clinical
strategies and treatment options to manage the disease
 The diagnostics that can be used for the patient includes:
 Measuring systolic and diastolic blood pressure
 Polysomnography
 Home Sleep Apnea Testing
 Cortisol Measurements

August 29, 202415
Differential Diagnosis 1:
Hypertension
 Hypertension is also called high blood pressure, is
generally asymptomatic, but can cause
physiological conditions such as jugular vein
distention, clubbed nails and neck bruits, and can
also lead to constant fatigue.
 Rationale: vein dystention, clubbed nails and neck
bruits can be caused due to elevated blood
pressures, and can be indicative of immenent
health conditions.
 Diagnosis: Hypertension can be diagnosed by
simple blood pressure checkup

August 29, 202416
Differential Diagnosis 2:
Metabolic Syndrome
 Metabolic syndromes can be linked to obesity
and hypertension.
 Rationale: The patient’s condition can be caused
due to metabolic syndrome.
 Metabolic syndrome can occur if thee of the
following conditions exist:
 Abdominal obesity
 High levels of tryglycerides
 Low levels of HDL in blood
 High Blood pressure
 Fasting Glucose of more than 100 mg/dl

August 29, 202417
Differential Diagnosis 3:
Cushing’s Syndrome
 This condition is caused due to excessive production of
Adrenocorticotropic hormone (ACTH) due to a pituitary
tumour, thereby causing an increase in cortisol in blood
which increases the blood pressure, as well as cause
chronic fatigue, sleep deprivation, headache, and
irritability.
 Rationale: The patient complained of chronic fatige,
sleep deprivation, headache and irritability, and the
blood pressure is very high.
 Diagnosis: Cortisol measurement:
 Late Night Salivary Cortisol
 Urine Free Cortisol
 Low Dose Dexamethasone Supression testing

August 29, 202418
Diagnosis for Obesity
 Obesity can be diagnosed based on two
measurements:
 A body mass index higher than 30
 A hip to waist ratio of 0.90 or higher

August 29, 202419
Diagnostic Workshop
 Blood pressure tests
 BMI and hip-wait ratio measurements
 Cortisol Measurements
 Blood Glucose Levels tests
 Blood Cholesterol tests
 ECG
 Serum Creatinine Analysis
 Blood Urea Analysis
 Liver Function Tests
 Polysomnography and Home sleep apnea testing

August 29, 202420
Risk Factors
Several risk factors can increase the chances of obesity
and its related co morbidities:
 Genetic Makeup
 Family lifestyle
 Inactivity
 Unhealthy Diet
 Medical problems
 Specific medications
 Social and economic factors
 Age
 Smoking
 Alcoholism
 Lack of Sleep

August 29, 202421
Treatment Plan
 The patient data shows that indication of hypertension and
COPD
 Considering the conditions, it is important that
pharmacological intervention be used.
 The patient also needs to be educated about the risks
factors related to patient’s lifestyle (diet, smoking and
alcoholism, lack of physical activity). This can increase
awareness of the patient on how his condition (as well as
his ability to work) is getting aggravated by his lifestyle,
and what he can do to improve his condition.
 Follow-up is also needed to understand the rate of recovery
as well as the effects of the intervention strategy and
adherence to medical and care plan for the patient.

August 29, 202422
Treatment Options
 Diet change:
 Reducing calorie intake
 Consuming with low energy density
 Healthy food choices
 Restricting certain types of food
 Meal Replacement
 Exercise and Activity
 Regular exercise
 Increasing physical activities
 Behavioural Change
 Counselling
 Support Groups
 Medications:
 Phentermine and Saxenda
 Weight Loss Surgery:
 Gastric Bypass Surgery
 Laparoscopic adjustable gastric banding
 Biliopancreatic diversion with duodenal switch.
 Gastric sleeve
 Vagal Nerve Blockage

August 29, 202423
Prescription
 Phentermine: This is a appetite
suppressant, which can reduce the
sense of hunger and reduce
overconsumption.
 Dose: 8mg, 3 times a day
 Saxenda: Helps to lose weight
 Dose: 3mg injections, once a day

August 29, 202424
Research Article Information
 Johns et al. (2014) studied the effecacies of
weight management programs comparing
two strategies: physical activity programs,
management and combined strategy
(physical activity programs with diet
management), and found that strategies that
involved both physical activities and diet
management to be more useful to maintain
weight, compared to strategies that focussed
only on physical activities or diet changes.

August 29, 202425
Patient Education
 Comprehensive education on Obesity and related co
morbidities
 Physical activity at least 150min/week of intense physical
activity, and can also involve regular activities such as:
 Walking
 Climbing stairs
 Cycling
 Jogging
 Reducing sedentary lifestyle and time spent in front of television
 Improving choice of diet: Reducing intake of fast food and
increasing the consumption of food low in sugar or
carbohydrates and high in fibre. Avoiding food with high calorie
density
 Avoiding smoking and drinking

August 29, 202426
Follow up
The factors that can be assessed during the follow
up includes:
 Improvement in the symptoms after pharmacotherapy
 Any side effects caused by the medications
 Effect of changing diet and increasing physical activity
 Ability of the patient to follow the lifestyle modification
reccomendations
 Improvement in the BMI, Hip-Waist Ratio
 Decrease in chronic fatigue
 Better sleep

August 29, 202427
Goals
 Reduce blood pressure to below 120/80
 Pulse rate below 100
 BMI: Below 30
 Hip Waist ratio: Below 0.9
 Increase physical activity
 Limit calorie intake (less than 2500
calories per day)

August 29, 202428
Referrals
 Diet experts for making diet charts and
healthy diet recommendations
 Lifestyle instructors for making healthy
lifestyle choices
 Gym instructors to provide information
on effective techniques for exercising
 Psychologists for behavioural therapies
 Self help groups

August 29, 202429
Conclusion
 Obesity is a significant disease that affects the
health and well being of people, and increases
the risks of several co morbidities
 Weight management is important for obesity, as
it helps to reduce the risks of the related diseases
 Chances of obesity are increased by several risk
factors suchbas lifestyle, diet, as well as biological
and social factors. Addressing these factors are
necessary to reduce the burden of this disease
and prevent the related conditions.

August 29, 202430
References
 cdc.gov. (2018). Adult Obesity Facts | Overweight & Obesity |
CDC. Retrieved from
https://www.cdc.gov/obesity/data/adult.html
 Johns, D. J., Hartmann-Boyce, J., Jebb, S. A., & Aveyard, P. (2014).
Diet or exercise interventions vs combined behavioral weight
management programs: a systematic review and meta-analysis
of direct comparisons. Journal of the Academy of Nutrition and
Dietetics, 114(10), 1557-1568
 who.int. (2018). Obesity and overweight. Retrieved from
http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-
overweight
 who.int. (2018). WHO | Waist circumference and waist–hip ratio.
Retrieved from
http://www.who.int/nutrition/publications/obesity/WHO_report_w
aistcircumference_and_waisthip_ratio/en/

August 29, 202431
Thank You