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Weight loss

therapeutic weight loss,pathologic weight loss,bariatric surgery, weight loss

Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bones mineral deposits, muscle, tendon and other connective tissue.

Weight loss may be due to dieting, exercise, starvation or decreased nutritional intake which accompanies old age. Alternatively weight loss may signify disease; that greater than 10% loss of body weight over a period of three months.

Pathological weight loss:

The common cause of weight loss is due to some pathological process occurring in the human body. Major factors affecting are chronic diseases, malignancy, psychiatric diseases and specific diseases of any major organ systems.

Some important causes are listed below:

•Psychosocial- deprivation, starvation
-eating disorders
-depression, bipolar illness
-chronic pain/sleep deprivation

•respiratory – COPD
-pulmonary tuberculosis
-occult malignancy(esp. small cell carcinoma)

•gastrointestinal – poor dentition
-any cause of dysphasia
-malignancy at any site
-inflammatory diseases
-chronic infection

•neuro-degenerative – parkinsonism
-motor neuron disease

•endocrine – diabetes mellitus
-Addison’s disease
-diabetes insipidus

•cardiac – congestive cardiac failure
-infective endocarditis

•renal – occult malignancy
-chronic renal failure
-salt-losing nephropathy

•chronic infection – HIV/AIDS
-gut infections
-mixed connective tissue disorders

The first step in the management of these patients is to identify the cause of the weight loss with due importance to thorough history taking, physical examination and various investigations.

“Treat the cause” rule applies to effectively stop the disease process and to prevent further weight loss. This should be accompanied with proper nutritional support.

Physiologic weight loss:

It can also be termed as “intentional weight loss”. Weight loss may refer to the loss of total body mass in an effort to improve fitness, health, and/or appearance.

This has been a recent trend among the people with both fitness and glamour having a major influence. In some cases it is with the goal of improving athletic performance or to meet weight classifications in a sport. In other cases, the goal is to attain a more attractively shaped body.

Maintainence of ideal body weight has been proved to have major health benefits.

To name a few:
A 10kg loss in weight will lead to following health improvements

•>20%fall in total mortality
•<30%fall in diabetes related deaths
•>40%fall in obesity related cancer deaths

Blood pressure :
•Fall of 10 mmhg of systolic blood pressure
•Fall of 20 mmhg diastolic blood pressure

Diabetes mellitus:
•Fall of 50%in fasting glucose

Lipids :
•Fall of 10%in total cholesterol
•Fall of 15% in low-density lipoprotein cholesterol
•Fall in 30% in triglycerides
•Increase of 8% in high density lipoprotein cholesterol

There is no single strategy to achieve a desired weight loss. It is the proper guidelines and combined interventions which help in a successful weight loss program. Some of the components are:
1.Support from a trained health-care professional in a group setting since greater weight loss is achieved using groups than individual consultations.
2.A diet consisting of a moderate reduction in energy intake of about 600kcal less than expenditure assessed on weight, age and sex.
3.Behavioural modification therapy which is designed to process a change in individual’s attitude, perception and behaviour as regards food intake, lifestyle and physical activity.
4.Finally promotion of increased physical activity, which can be maintained on a long term.

Apart from these, for people who are overweight or obese, depending on their BMI (basal metabolic index) additional interventions are indicated.

These therapeutic weight loss techniques are enlisted below.

Medical management:

1.Drugs – appetite suppressants ->hypothalamic catecholaminergic pathway affecting .( e.g. amphetamine, diethyl propion and mazindol)
-> affecting hypothalamic seratoninergic pathway (fenfluramine, dexfenfluramine)

2.newer drugs:

•Orlistat – inhibits pancreatic and gastric lipases and thereby decreases hydrolysis of ingested triglycerides. This produces 30% reduction in dietary fat absorption which can contribute to caloric deficit of 200kcal/24 hrs.
•Sibutramine – reduces food intake through B-adrenergic and serotoninergic receptor activity.

Surgical management (bariatric surgery)

Two procedures have traditionally dominated surgical practice:

1.Vertical band gastroplasty- involves a construction of a small stomach pouch fashioned by vertical stapling to restrict both gastric outlet and size.

2.Gastric bypass – involves fashioning a pouch of low volume by stapling across the stomach and then connecting a limb of small intestine as a conduit for food, bypassing distal stomach, duodenum and upper jejunum.
Published: 2008-02-21

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there are certain things in this world which are never lost.being a doctor i always realised one thing" knowledge can never be lost and experience can never be replaced".by writing articles it has just given me a wider perspective to approach medicine and its been a kind of challenge i always wanted.

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