การดูแลผู้ป่วยโรคอ้วนในเวชปฏิบัติ

.. 2557 ( 25 ./..)

1.9 ( 30 ./..) 600

39 (1)

.. 2552(2) 57

9 30 -35 ./..

2-4 40-50 ./.. 8-10

22.5-25 ./..

(obesity-related comorbidity)

/

> 20 > 30

CONTENT

574

DEXA scan

= ()

()

= x 703

[ ()]2 [ ()]

2

(abdominal fat)

(metabolic syndrome)

(waist circumference)

1. (3, 4) *

() ()

/2 /2 **

< 18.5 < 18.5

18.5 -24.9 18.5 -22.9

25.0-29.9 23.0-24.9

1 30.0-34.9 25.0-29.9

2 35.0-39.9 30

3 40.0 _

*

** > 102 > 88

** > 94 > 80

** > 90 > 80

1. (5)

.. 2557 ( 25 ./..)

1.9 ( 30 ./..) 600

39 (1)

.. 2552(2) 57

9 30 -35 ./..

2-4 40-50 ./.. 8-10

22.5-25 ./..


/

> 20 > 30

574

DEXA scan

= ()

()

= x 703

[ ()]2 [ ()]

2

(abdominal fat)

(metabolic syndrome)

(waist circumference)

1. (3, 4) *

() ()

/2 /2 **

< 18.5 < 18.5

18.5 -24.9 18.5 -22.9

25.0-29.9 23.0-24.9

1 30.0-34.9 25.0-29.9

2 35.0-39.9 30

3 40.0 _

*

** > 102 > 88

** > 94 > 80

** > 90 > 80

1. (5)

CONTENT

575

( 2)

/

2.

binge eating disorder, bulimia nervosa

2.


(iliac crest) National Institute of Health (iliac crest)

CONTENT

576

3.

polysomnography (sleep test) ()

(cardiopulmonary fitness) maximal treadmill

exercise test

4. (lifestyle

modification) 3(3)

3.

(./..)

25-26.9 27-29.9 30-34.9 35-39.9 40

+ + +

+ + +

+

4.1 (lifestyle modification) 4.1.1

(1-2 ) ::

2-3

575

( 2)

/

2.

binge eating disorder, bulimia nervosa

2.


(iliac crest) National Institute of Health (iliac crest)

576

3.

polysomnography (sleep test) ()

(cardiopulmonary fitness) maximal treadmill

exercise test

4. (lifestyle

modification) 3(3)

3.

(./..)

25-26.9 27-29.9 30-34.9 35-39.9 40

+ + +

+ + +

+

4.1 (lifestyle modification) 4.1.1

(1-2 ) ::

2-3

CONTENT

577

500 -1000 kcal/ deficit 500 -1,000

0.5-1

( 45-65% 20-35% 10-35% )

portion size

(caloric dense diet)

(meal replacement)

1-2 (skip meal)

500 -1,000

Low calorie diets (LCDs) 800-1,200

Very low calorie diets (VLCDs) 800

LCDs VLCDs 1-1.5 ./

ideal body weight VLCDs 2-3 ( 20-30 .)

(CPAP) 1.5 ./

4.1.2 (physical activity therapy)

(maintenance of weight loss)

(moderate intensity) 300

CONTENT

578

1. /(5)

4. /

(light < 3 METs) (moderate 3-6 METs) (vigorous > 6 METs)

4.8 ./ . 7.2 ./ .

>8 ./ .

15-18 ./ . >18 ./ .

() ()

METs: ratio of work metabolic rate to resting metabolic rate

577

500 -1000 kcal/ deficit 500 -1,000

0.5-1

( 45-65% 20-35% 10-35% )

portion size

(caloric dense diet)

(meal replacement)

1-2 (skip meal)

500 -1,000

Low calorie diets (LCDs) 800-1,200

Very low calorie diets (VLCDs) 800

LCDs VLCDs 1-1.5 ./

ideal body weight VLCDs 2-3 ( 20-30 .)

(CPAP) 1.5 ./

4.1.2 (physical activity therapy)

(maintenance of weight loss)

(moderate intensity) 300

578

1. /(5)

4. /

(light < 3 METs) (moderate 3-6 METs) (vigorous > 6 METs)

4.8 ./ . 7.2 ./ .

>8 ./ .

15-18 ./ . >18 ./ .

() ()

METs: ratio of work metabolic rate to resting metabolic rate

CONTENT

579

( 1 4)

4.1.3 (behavioral therapy)(5) (self-monitoring)

()

(stimulus control)

4.2 (pharmacotherapy)

30 ./.. 27 ./.. (

5-10 6-12 ) ( ) 5 5-10 3-6

fenfluramine

dexfenfluramine rimonabont sibutramine

CONTENT

580

5.

Phentermine

() sympathomimethic

Diethylpropion

() sympathomimethic

Orlistat

Lorcaserin

selective serotonin receptor agonist

Phentermine/ Topiramate ER Paresthesia

topiramate

Bupropion/Naltrexone

dopamine and norepinephrine

reuptake inhibitor /opioid antagonist

Liraglutide GLP-1 agonist

() delayed gastric

emptying 4.3 (bariatric surgery)

/

morbid obesity 40 ./..

35 ./..

30 ./..

30 ./..

(6)

laparoscopic adjustable gastric banding

(LAGB) , laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic biliopancreatic diversion (BPD) BPD with duodenal switch

(BPD-DS)

579

( 1 4)

4.1.3 (behavioral therapy)(5) (self-monitoring)

()

(stimulus control)

4.2 (pharmacotherapy)

30 ./.. 27 ./.. (

5-10 6-12 ) ( ) 5 5-10 3-6

fenfluramine

dexfenfluramine rimonabont sibutramine

580

5.

Phentermine

() sympathomimethic

Diethylpropion

() sympathomimethic

Orlistat

Lorcaserin

selective serotonin receptor agonist

Phentermine/ Topiramate ER Paresthesia

topiramate

Bupropion/Naltrexone

dopamine and norepinephrine

reuptake inhibitor /opioid antagonist

Liraglutide GLP-1 agonist

() delayed gastric

emptying 4.3 (bariatric surgery)

/

morbid obesity 40 ./..

35 ./..

30 ./..

30 ./..

(6)

laparoscopic adjustable gastric banding

(LAGB) , laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic biliopancreatic diversion (BPD) BPD with duodenal switch

(BPD-DS)

CONTENT

581

RYGB

BPD/BPD-DS 50-70 1-2

2

1. World Health Organization media care. Obesity and overweight Fact sheet [Online]. 2015 [cited 2015 Apr 17]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/

2. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative

analyses of 57 prospective studies. Lancet 2009;373:1083-96.3. NHLBI Obesity Education Initiative.The Practical Guide : Identification,Evaluation,

and Treatment of Overweight and Obesity in Adults [Online]. 2000 [cited 2015 Apr 17]. Available from: http://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.

pdf4. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome--a new worldwide definition.

Lancet 2005;366:1059-62.5. Kushner R. Clinical Management of the Obese Individual. In: Kushner R, Lawarence

V, Kumar S, editors. Practical Manual of Clinical Obesity: Wiley-Blackwell; 2013.

p. 51-108.6. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et

al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring, Md).

2013;21 Suppl 1:S1-27.

CONTENT

Button 605: Button 606: Button 607: Button 608: Button 609: Button 610: Button 611: Button 612: Button 613:

Documents

การดูแลผู้ป่วยโรคอ้วนในเวชปฏิบัติ