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A CASE FROM THE WEIGHT LOSS CLINIC

A CASE FROM THE WEIGHT LOSS CLINIC. Dr Peter Goulden MD, FRCP, PGCE Assistant Professor Division of Endocrinology & Metabolism UAMS College of Medicine & Staff Physician CAVHS. A Case from the Weight Loss Clinic. 45 year old male

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A CASE FROM THE WEIGHT LOSS CLINIC

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  1. A CASEFROM THE WEIGHT LOSS CLINIC Dr Peter Goulden MD, FRCP, PGCE Assistant Professor Division of Endocrinology & Metabolism UAMS College of Medicine & Staff Physician CAVHS

  2. A Case from the Weight Loss Clinic • 45 year old male • Referred himself to the weight loss clinic as had been told weight loss would help his longstanding back pain • No other significant Past Medical History • BMI 45.6 kg/m2 • BP 145/85 • Waist 42” • Had been on a weekend “food trip” ahead of entering the program

  3. The Metabolic Syndrome: NCEP/ATPIII/AHA Diagnostic Criteria Individuals must have 3 or more of the following: • Abdominal obesity • Waist circumference > 40” in men or > 35” in women • High triglycerides • ≥ 150 mg/dL • Low HDL cholesterol • < 40 mg/dL in men or • < 50 mg/dL in women • High blood pressure • ≥ 130/85 mmHg • High fasting glucose • ≥ 100 mg/dL

  4. ADA 2013 Recommendations for Metabolic Syndrome • Weight loss is recommended for all overweight/obese individuals who have or are at risk for diabetes. (A) • Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss. 150min / week (B) • Structured education • Moderate weight loss (7% body weight) • Regular physical activity (150 min/week), • Dietary strategies including reduced calories • Reduced intake of dietary fat, (A)

  5. A Case from the Weight Loss Clinic • Fasting lab glucose of 153 mg/dL • Fasting triglycerides = 181 mg/dL • Alanine Aminotransferase = 50 IU/L • Would prefer to avoid medication

  6. Options • Diet & Lifestyle advice (Weight loss & carbohydrate moderation) • Medication (Metformin if no CI) • Both

  7. What We Did • Enrolled to a 1200kcal diet • Achieved 26.9 pounds weight loss in 12 weeks with close medical supervision

  8. UAMS Weight Loss Program • 16 week program & bespoke diet – daily restriction from 400kcal+ • Endocrinologist led and obesity educator delivered • Caloric restriction tailored to individual • Carbohydrate moderation • Weekly review with nutritionist • 1-2 monthly review with MD depending on case

  9. Losing Weight & Diabetes 108-144mg/dL 145-180mg/dL 181-216mg/dL 217-252mg/dL >253mg/dL

  10. A Tidal Wave of Pre-Diabetes

  11. Rising Numbers 57% due to obesity trends 43% due to ageing population (PBS MODEL)

  12. Personal Experience from GBWest Kent - 2009 • The prevalence of diabetes in West Kent is increasing and this trend is set to continue primarily due to rising levels of obesity and an ageing population. • An effective preventative strategy that deals with the rising trend in obesity is crucial to the long-term management of diabetes in the West Kent population.

  13. 1994 2000 1994 2000 No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0% No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0% Age-adjusted Percentage of U.S. Adults with Obesity or Diagnosed Diabetes Obesity (BMI ≥30 kg/m2) 2009 OBESIT Y Diabetes DIABETES 2009 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

  14. THE SCOPE OF DIABETES County-level Estimates of Diagnosed Diabetes for Adults aged ≥ 20 years: United States 2009 From the Centers for Disease Control and Prevention: National Diabetes Surveillance System. AGE-ADJUSTED PERCENTAGE: *Map and Data provided by the Centers for Disease Control

  15. 1921 Elliot Joslin • “There are entirely too many diabetic patients in the country…Therefore, it is proper at the present time to devote attention not alone to treatment, but still more, as in the campaign against the typhoid fever, to prevention. The results may not be quite so striking or as immediate, but they are sure to come and to be important.”

  16. Diabetes Telemedicine Focused Pilot Project:2013 • 20 subjects in Helena, AR • 2 hours of group education • 6-8 patients per group • 2 CDEs • Provided with basic MNT • Followed & reinforced using Telemedicine

  17. Literacy & Diabetes Outcomes

  18. Individualize nutrition care to the patient (Patient Centered Care – cognitive function, health literacy) Use of group education when appropriate Weight management and ‘carbohydrate awareness’ Agree targets and realistic goal setting How can weight loss programs be best delivered to the population allowing for variance in health literacy and other factors SUMMARY - Question for Discussion Our food should be our medicine and our medicine should be our food • Hippocrates 400BC

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