Obesity: Clinical Features and Treatment

In this article we will discuss about the Clinical Features and Treatment for Obesity.

Clinical Features of Obesity:

1. Some of the patients appear to be in good health and leading normal lives, they are likely to have a reduced exercise toler­ance with shortness of breath on exertion and to be unduly fatigued by continuing physical activity.

This is due to the bur­den of the increased weight that they carry always and to reduced capacity of the cir­culatory and respiratory systems that work under handicaps imposed by masses of internal fat and fatty infiltration of mus­cle.

2. They are also at increased risk when un­der anesthesia; surgical operations are more difficult and post-operative compli­cations are more likely.

3. In obesity grade III, the everyday activi­ties of the patients are seriously restricted by their enormous mass and they are likely to be suffering from diabetes, hyperten­sion, gall bladder diseases, fatty liver, gout, osteoarthritis, hernias, etc. Life expecta­tion is low. They have serious psychologi­cal disturbances.

Treatment for Obesity:

1. If a patient eats a diet providing 500-1,000 kcal less than which is needed for the ac­tivities of daily life, then and only then the excess reserves of energy in adipose tissue be drawn upon and there will be loss of weight at the rate of 0.5-1 kg each week.

2. Any curtailment of food intake is liable to reduce intake of essential nutrients. All reducing regimes should include ample fruits and vegetables and preferably whole meal bread. These should supply ample vitamins and minerals.

They also supply dietary fibre and this may help to make the inevitably small meals more satisfy­ing. It also prevents constipation and there is no need to take supplements of miner­als and vitamins. To prevent depletion a protein supplement should be given.

3. Patients should appreciate that there are no slimming foods although advised in magazines and daily newspapers and by radio and television. All foods are fattening if taken in excess. Foods legiti­mately advertised as aiding in a slimming diet are modified forms of conventional foods and beverages usually with a lower energy density.

4. Even if the exercise contributes only a lit­tle to a negative energy balance, it bene­fits by promoting physical fitness. Exer­cise prevents atrophy of muscle. Insuffi­cient use of the muscle of the trunk and limbs of the respiratory system and the myocardium increases the risk of patients to orthopaedic, respiratory and circulatory disorders.

5. Obese patients may be advised to walk, to climb stairs, to swim and to gardening’s. They are positive and enjoyable.

6. Amphetamine and its derivatives have been much used as “slimming agents’. They are psychomotor stimulants and also have an anorectic action. They may also cause insomnia, irritability, increases heart rate, raised blood pressure and severe psy­chotic reaction. Serious withdrawal symp­toms may occur on discontinuing the drug. So amphetamine should not be prescribed.

Diethylpropion, phenmetrazine and fenfluramine are the drugs which have some chemical resemblance to ampheta­mine. They are also psychomotor drugs and they may be prescribed for cases re­fractory obesity for periods of up to six weeks.

After this period their appetite-suppressing effect usually wears off. Patients with a history of depression or other psy­chological disturbance should not be treated by these drugs. Thyroxine stimulates metabolism and for this reason it has had an extensive trial in the treatment of obesity.

In euthyroid peo­ple thyroxine produces no increase in me­tabolism unless given in doses which cause tremor, diarrhoea, palpitation and tachycardia. Hence, the administration of thyroxine to obese euthyroid patients is not only useless but potentially danger­ous.

Methyl cellulose is indigestible and adds bulk to the diet. It has little effect in pro­moting weight loss. However, it is quite harmless.

Sedatives and tranquilizers can play no part in the treatment of obesity but they may be useful for some obese patients who suffer from an anxiety state.

Diuretics are potentially dangerous and are of no value in promoting weight loss unless the patient has oedema.

7. Diets providing only 500 kcal daily or a period of total starvation are justifiable in some patients who are not responding well to loss of vigorous restrictions. In selected patients with no orthopaedic or cardiovas­cular complication, it is possible to in­crease physical activities. Patients have been kept for up to six weeks on diets pro­viding only 400 kcal, whilst they walk 10 miles daily.

Negative energy balances of up to 3000 kcal/day, and weight losses of up to 3kg a week followed. If dietary in­take is below 1,000 kcal per day, multivi­tamin and mineral supplements may be necessary. Excessive losses of potassium and nitrogen may occur and urinary output of these should be checked regularly.

8. Surgical treatment to reduce food intake may be considered in patients in whom medical treatment has failed and whose life has been made miserable by severe obesity. Various forms of jejunoileostomy, which, by creating a bypass of the small intestine, lead to malabsorption—have been carried out.

The operation is un-physiological. Complications with features of the malabsorption syndrome and the blind loop syndrome frequently arise.

Gastroplasty is an operation in which the stomach is reduced to a small reservoir, about 60 ml. in capacity, in the fundus which drains through a narrow channel, about 12 mm in diameter, along the greater curvature and into the duodenum.

This is much more safe. Surgical removal of large masses of fat from the abdomen, thighs or arms is contraindicated. There may be appearance of irregular ugly lumps of fat at the opera­tion sites.