Obesity is a MAJOR problem in the UNITED STATES.. In the United States approximately 1/3rd of the people are Obese. Obesity can have effects on both the physical and mental health of the effected individual, and should be considered as a serious problem demanding treatment. Obesity has a range which is based on BMI. BMI stands for Basal Metabolic Index and is calculated of (Weight in KG/ (Hight in Meters)2
Overweight – 25.0-29.0
Mild Obesity—30.0 -35
Moderate -35.0 -40
Severe- 40+++ ( THIS IS AN INDICATION FOR BARIATRIC SURGERY)
Obesity in child and Adolescents is defined as weight and height values >95%tile ..
Treatment should target the 3 principal mechanisms leading to obesity
1) Dietary management should consist of a LOW CALORIE DIET
2) Physical Exercise should be increased or added
3) Behavioral modification should also be a part of management as well
Weight loss goals should be 10% decrease from initial body weight within 6 months. The rate of weight loss should be 1 lbs /week.
Medications are indicated for BMI >30 or BMI >27 + Obesity related Risk factors ( CAD, DM,HTN)
SURGERY IS INDICATED ONLY FOR SEVERE OBESITY BMI > 40
Hypertension is one of the most common problems treated by family physicians. It effects up to 20 % of the population. It serves as a significant risk factor for other common conditions, such as CAD, and Stroke. Hypertension can occur in all ages and has many causes to its eitiology. It is very important to employ clinical guidelines and treating patients in a systematic way. Hypertension can be further divided into PRIMARY or SECONDARY ( meaning due to another disease process). Treatment of Hypertension is MULTIMODAL, IT involves Lifestyle modifications, medical management, and in some cases surgery.
Blood Pressure is a measure of two important factors : Cardiac Output and Total Peripheral Resistance.
BP = CO X TPR
Normal BP is 110/70
High BP is 140/90 (American Standards)
WHO defines it as 160/90
The mail cause of Hypertension is still unknown, however tertiary effects include,
Reno-Vascular Hypertension, (1-2%)
Neurological effects include Drugs-Oral Contraceptives, cocaine, Pre-eclempsia
The degree of hypertension is gauged primarily by the diastolic levels. Which represents the denominated number (bottom number).
Diagnosis of Hypertension is made by measuring the Blood pressure, and requires 3 SEPARATE READINGS usually done within 8 weeks.
Hypertension Class and associated treatment recomamdations
Pre- HTN 130/80-139/89 usually treated with LIFE STYLE MODIFICATIONS SUCH AS WEIGHTLOSS DASH Diet ( Hypertension low sodium diet), INCREASE PHYSICAL ACTIVITY Limit ETOH, X 6 MONTHS ( Weight loss is most important
modifiable risk factor in reducing bp)
CLASS -1 140/90-160/100 Try Life Style Modifications x 6 months if no reduction..TREAT WITH SINGLE AGENT ANTIHYPERTENSIV(Thiazide diuretic first line for most…)
CLASS-II 160/100-180/110 Life STYLE MOD + 2 DRUG TREATMENT (Will depend on clinical setting)
CLASS- III >180/110 Seek Emergent Care.
Non Pharmacological Interventions for lowering BP
1) WEIGHT LOSS!! ( this is the most significant modifiable risk factor for reducing BP)
2) DASH DIET( This is not just a low sodium diet but a Dietary Approach to Stop HTN)
3) Physical Exercise
Esential Hypertension has varying pathophysiology, statistically African Americans living in America the rate of HTN is greater then caucaisians.. But AA world wide have the same rate of HTN as caucasians!