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I.
The problem of obesity
A. Definition of obesity
1. Body Mass Index (BMI)
2. Waist to hip ratio
3. Body Fat
B. Prevalence in America vs. global obesity
C. The cost of obesity
D. Acceleration of age related disease
E. Central obesity
II.
How did obesity become such a problem?
A. Cultural evolution
1. TV
2. Fast Food
3. Computer games
B. Dietary changes
1. Increased sugar intake
2. Increased fat intake
3. Decreased fresh fruits and vegetables
4. Processed foods
C. Exercise and its impact
1. Aerobic
2. Resistance/weight training
D. Risk factors for obesity
1. Socio-economic status
2. Educational level
3. Smoking status
4. Race
5. Hereditary factors
6. Gender
7. Age
8. Activity level
9. Food preferences
10. Medications
11. Sexual abuse
12. Bottle vs. Breast feeding
13. Gestational diabetes
III.
Systemic conditions associated with obesity
A. Endocrine system/Diabetes
B. Cardiovascular
1. Hypertension
2. Dislipidemia
3. Coronary Heart disease
C. Cerebrovascular Disease
D. Respiratory
1. Pickwickian syndrome
2. Obesity Hypoventilation Syndrome
3. Sleep Apnea
E. Gastrointestinal
F. Genitourinary
1. Pregnancy
2. Menstrual irregularities
3. Stress incontinence
4. Prolapsed uterus
5. Prostatitis
6. Erectile dysfunction
G.
H.
I.
J.
K.
L.
M.
N.
Musculoskelatal - Osteoarthritis
Foot problems
Hepatic
Cancer
Mental Health
Periodontitis
Gallbladder disease
Premature death
IV.
Ocular Conditions associated with obesity
A. Diabetes and diabetic complications
B. Intraocular pressure
C. Cataracts
D. Floppy Lid Syndrome
E. Papilledema
F. Pseudotumor cerebri
G. NAION
H. AMD
V.
How to communicate with the obese patient
A. Diagnose obesity
B. Patient Recognition
C. Motivation
D. Develop Strategies
E. Find useful resources
F. Creating a facilitative environment
G. Giving advice
1. Each visit
2. Specific and brief
3. Include health risks
4. Capitalize on teachable moments
VI.
Referral and co-management resources
A. Dietician
B. Mental Health
C. Primary Care provider
D. Bariatric surgeon
E. Exercise Physiologist/Fitness Center
F. Social Work
G. Patient education materials
VII.
Summary
A. Recognizing risk factors
B. Public Health issues
C. Incorporating into primary eye care practice
D. Special physical considerations for the eye exam