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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