BASO CONSENSUS

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BASO CONSENSUS
Prof. Dr. E. Muls Department of Endocrinology,
Metabolism and Nutrition University Hospital
Gasthuisberg, Leuven, Belgium
BASO, 5th Update on Obesity, 4th May, 2002
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Obesity in Belgium How many ?
Prevalence () of overweight and obesity among
Belgian working men (40-54 yrs)
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Obesity in Belgium BIRNH
Prevalence () of obesity in BIRNH according to
age and gender
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Obesity in Belgium BEL-STRESS
Prevalence () of overweight and obesity in
BELSTRESS
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Medical management of obesity Guidelines

• Obesity a chronic disease
  ? requires management with
  long term vision
• Treatment individualized and flexible
• Motivation of the patient is critical
• Two steps

II. Treatment A. Initial weight reduction B.
Weight maintenance
I. Evaluation A. Classification B. Risk
assessment
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I. Evaluation A. Classification
Classification by BMI, Waist circumference and
Associated Disease Risk
Disease risk for type 2 diabetes,
hypertension and CVD Increased waist
circumference can also be a marker for increased
risk even in persons of normal weight
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I. Evaluation - B. Risk assessment

• Established Coronary Heart Disease
• Other Atherosclerotic Disease
• Type 2 Diabetes
• Sleep Apnea
• Other Obesity Associated Diseases

• Risk Factors for Atherosclerosis
• Smoking
• Hypertension
• High LDL-C
• Low HDL-C
• Impaired fasting glucose
• Family history of premature CHD
• gt 45 years (M) and gt 55 years (F)

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II. Treatment - A. Goals

• Clinician and patient devise goals
• reduce body weight
• maintain a lower body weight over the long term
• prevent further weight gain

• Initial goal for overweight person
• significantly decrease the severity of
  obesity-associated risk factors

10 reduction in body weight in 6 to 12 months
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II. Treatment - A. Goals
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II. Treatment - B. Strategies

• Treatment strategy in function of co-morbidities
  or risk factors

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Lifestyle ModificationDiet, Physical activity,
Behavior therapy

• Diet
• low calorie diet (LCD) 500-1000 kcal deficit
  
• very low calorie diet (VLCD) lt 800 kcal
• Physical activity
• increase the daily amount of spontaneous physical
  activity
• 30 min. of moderate sport activity, 3 times a
  week
• Behavior therapy

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Pharmacotherapy
Used only as part of a program that includes
diet, physical activity and behavior therapy
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Bariatric surgery

• Consider if other weight loss attempts have
  failed
• Methods
• gastroplasty
• vertical banded
• adjustable banding
• gastric bypass

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Vertical banded Gastroplasty
Adjustable Silicone Gastric Banding
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Gastric Bypass
Bilio-pancreatische Derivatie
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Members of the Working Group

• Caroline Braet André Scheen
• Guy De Backer Wout Van der Borght
• Mieke Hulens Luc Van Gaal
• Jaroslaw Kolanowski Greet Vansant
• Maximilien Kutnowski Myriam Van Winckel
• Erik Muls

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BASO CONSENSUS

• Deze gids is te verkrijgen via
• Secretariaat Endocrinologie
• UZ Gasthuisberg
• Herestraat 49
• 3000 Leuven
• 016/34.45.79
• E-mail
• claire.dignef_at_uz.kuleuven.ac.be