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patients with obesity
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Obesity has long been associated with health risks. While the specific mechanisms linking obesity to health risks are not fully understood, recent research focusing on genes that express only in fat tissue has shown promise. These genes code for hormones associated with insulin resistance and cardiovascular plaques.
A useful definition of obesity is "excess fat mass resulting in mechanical or hormonal stress on the cardiovascular system, organs, and muscular-skeletal system."
Diagnostic Criteria
Body Mass Index (BMI) of 30 or greater.
or
Fat Mass greater than 25 percent for males or greater than 30 percent for females.
Mechanical Reduction
We recommend a two-step approach to normal function. The first step is weight reduction to relieve mechanical stress on body systems.
| 1. | Prescribe a healthy diet. |
| 2. | Measure Basal Metabolic Rate (BMR). |
| 3. | Estimate total daily caloric expenditure = BMR * 1.2. |
| 4. | Set dietary intake = caloric expenditure - 700 calories per day. |
| 5. | Continue diet until BMI = 30. |
Note: The initial dietary intake for obese patients will appear to be very
high. For example, a patient weighing 300 lb with 40 percent body fat will
have a basal metabolic rate of 2550 calories, a total caloric expenditure of
3060 calories, and a dietary intake of 2360 calories per day.
Hormonal Reduction
The second step is to decrease the ratio of fat mass to fat-free mass to reduce the incidence of fat related hormones.
| 1. | Continue with a healthy diet. |
| 2. | Add exercise. |
| 3. | Measure basal metabolic rate and fat-free mass. |
| 4. | Estimate caloric expenditure = BMR * 1.2. |
| 5. | Set dietary intake = caloric expenditure - 500 calories per day. |
| 6. | Continue until percentage fat mass reaches optimal level. |
| Patient's Age |
Optimal Fat Levels |
| |
< |
20 |
15 |
19 |
| 20 |
- |
29 |
16 |
20 |
| 30 |
- |
39 |
17 |
21 |
| 40 |
- |
49 |
18 |
22 |
| 50 |
- |
59 |
19 |
23 |
| 60 |
+ |
|
20 |
24 |
Note: Exercise is important here because weight loss from dieting alone is
comprised of 45 percent fat-free mass and 55 percent fat mass per pound.
Exercise can alter this ratio to 25 percent fat-free mass and 75 percent fat
mass.
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