This document provides an overview of the Programi-Care holistic weight management program led by Dr. Lee Oi Wah. It defines obesity and discusses its prevalence and health consequences. The program focuses on assessment, dietary therapy including calorie counting and step I diets, physical activity goals of 30-45 minutes per week burning 1000+ calories, and behavioral strategies like journaling and goal setting. Regular medical monitoring and emphasis on health benefits are also discussed. The goal is 4-6 months of weight loss followed by maintenance.

1. PROGRAMI-CARE A HOLISTIC APPROACH TO WEIGHT MANAGEMENT BY DR LEE OI WAH PENGARAH HCM

3. Overview Definition, Prevalence & Consequences of Obesity Healthy Lifestyles Assessment of Obesity Treatments for Obesity

4. Definition Obesity is an abnormal accumulation of body fat, usually 20 percent or more over an individual's ideal body weight.

5. Calculating BMI Calculate Body Mass Index (BMI) = weight (kg) height squared (meters) Or… weight (pounds) x 703 height squared (inches)

6. Definition of Overweight & Obesity Using BMI

10. Sex – women more susceptible .

11. Activity – lack of physical activity.

13. Alcohol – problem drinking.

14. Smoking – cessation smoking.

16. Weight Gain: Energy In 3500 calories = 1 pound 100 calories extra per day = 36,500 extra per year = 10.4 lbs weight gain Question: How much is 100 calories? Answer: Not very much! 1 glass skim milk, or 1 banana, or 1 slice cheese, or 1 tablespoon butter

17. Health Consequences of Obesity Major cause of preventable death Increase in mortality from all causes Increase in risk for these cancers Endometrium Breast Prostate Colon Increase in risk of: Hypertension Dyslipidemia Diabetes type 2 Coronary artery disease Stroke Gallbladder disease Osteoarthritis Sleep apnea & respiratory problems

19. Health Consequences of Obesity Still doing nothing about that extra flab? Major cause of preventable death Increase in mortality from all causes Increase in risk for these cancers Endometrium Breast Prostate Colon Increase in risk of: Hypertension Dyslipidemia Diabetes type 2 Coronary artery disease Stroke Gallbladder disease Osteoarthritis Sleep apnea & respiratory problems

20. Rosalie Bradford -200LBS The longtime binge-eater weighed an astounding 1,199 lb, having spent 8 years immobile in bed. She holds Guinness World Record for most weight lost by a woman.

21. I-CARE : WHAT DO WE DO?

23. Assessment Assess the patient's readiness and willingness to lose weight: Unfortunately those who are most concerned about their weights are not necessarily those who are at the highest health risk. Those who are unable or unwilling to embark on a weight reduction program, but they are willing to take steps to avoid further weight gain or perhaps to work on other risk factors such as cigarette smoking, and they should be encouraged to do so.

24. Assessment Is he overweight? Obese? What are his key health issues?

25. Assessment Measure BMI Measure waist circumference “Apple shape” body is higher risk for DM, CVD, HTN Waist larger than 40 inches for men Waist larger than 35 inches for women

27. Existing high risk disease:

28. coronary heart disease; other atherosclerotic diseases; type 2 diabetes; sleep apnea

29. Diseases associated with obesity

30. Gynecological problems; osteoarthritis; gallstones; stress incontinence

31. Cardiovascular risk factors (3 or more = high risk)

32. Cigarette smoking; Hypertension; LDL >130; HDL <35; fasting glucose = 110 to 125; family history of premature CHD; men age > 45; women age > 55

33. Other risk factors

34. Physical inactivity; elevated serum triglycerides

36. Treatment Approach Aim for 4 - 6 months of weight loss effort Most people will lose 20 to 25 pounds After 6 months, weight loss is more difficult Changes in resting metabolic rate Energy requirements decrease as weight decreases Diet adherence wavers Set goals for weight maintenance for next 6 months, then reassess.

37. Dietary Therapy Weight reduction with dietary treatment is in order for virtually all patients with a BMI 25-30 who have comorbidities and for all patients over BMI 30. Strategies of dietary therapy include teaching about calorie content of different foods, food composition (fats, carbohydrates, and proteins), reading nutrition labels, types of foods to buy, and how to prepare foods.

38. Low-Calorie Step I Diet

39. Weight Maintenance: How Much Should People Eat? Varies widely Some averages, below

41. Physical activity alone is less successful than a combined diet & exercise program

43. Recommend Physical Activity What does it take to burn 1000 calories per week? Gardening 5 hours Cycling 22 miles Running 11 miles Walking 12 miles Dancing 3 hours

45. Behavioral Strategies Keep a journal of diet & activity Very powerful intervention! Set specific goals re: behaviors Eating Activity Related behaviors Track improvement Weigh & measure on a regular basis

47. Plan meals & activity

48. Develop reminder systems

49. Anticipate temptations & plan resistance

50. Reward yourself

51. Limit quantities, but do not deprive yourself

52. Have confidence in your ability to succeed

54. Thank You and Good Luck!