AR
ACTION PLAN for obesity







Action plan

Assessment of Risk Status
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Cigarette smoking & Age.
Age ≥ 45 years for men or age ≥ 55 years for women (or postmenopausal).
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Hypertension
systolic blood pressure of ≥140 mm Hg or diastolic blood pressure ≥ 90 mm Hg) or current use of antihypertensive agents.
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Low high-density lipoprotein
cholesterol (serum concentration < 35 mg/dL).
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Impaired fasting glucose
IFG) (fasting plasma glucose between 110 and 125 mg/dL). IFG is considered by many authorities to be an independent risk factor for cardiovascular (macrovascular) disease, thus justifying its inclusion among risk factors contributing to high absolute risk. IFG is well established as a risk factor for type 2 diabetes
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High risk low density lipoprotein (LDL)
cholesterol (serum concentration ≥ 160 mg/dL). A borderline high-risk LDL-cholesterol (130 to 159 mg/dL) plus two or more other risk factors also confers high risk.
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Family history of premature CHD
Family history of premature CHD (myocardial infarction or sudden death experienced by the father or other male first-degree relative at or before 55 years of age, or experienced by the mother or other female first-degree relative at or before 65 years of age).

Action plan

Identify patients at very high absolute risk
Patients with the following diseases have a very high absolute risk that triggers the need for intense risk-factor modification and management of the diseases present:
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Established coronary heart disease (CHD)
Established coronary heart disease (CHD), including a history of myocardial infarction,angina pectoris (stable or unstable), coronary artery surgery, or coronary artery procedures (e.g., angioplasty).
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Presence of other atherosclerotic diseases
Presence of other atherosclerotic diseases, including peripheral arterial disease, abdominal aortic neurysm, or symptomatic carotid artery disease.
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Type 2 diabetes
Type 2 diabetes (fasting plasma glucose ≥ 126 mg/dL or 2-h postprandial plasma glucose ≥ 200 mg/dL) is a major risk factor for CVD. Its presence alone places a patient in the category of very high absolute risk.
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Sleep apnea
Symptoms and signs include very loud snoring or cessation of breathing during sleep, which is often followed by a loud clearing breath, then brief awakening.

Action plan

Identify other obesity-associated diseases
Obese patients are at increased risk for several conditions that require detection and appropriate management but that generally do not lead to widespread or life-threatening consequences. These include gynecological abnormalities (e.g., menorrhagia, amenorrhea), osteoarthritis, gallstones and their complications, and stress incontinence. Although obese patients are at increased risk forgallstones, the risk of this disease increases during periods of rapid weight reduction.


jjExclusion From Weight Loss Therapy

Patients for whom weight loss therapy is not appropriate are most pregnant or lactating women, persons with a serious uncontrolled psychiatric illness such as a major depression, and patients who have a variety of serious illnesses and for whom caloric restriction might exacerbate the illness. Patients with active substance abuse and those with a history of anorexia nervosa or bulimia nervosa should be referred for specialized care.