Diagnosis, monitoring, and treatment process for obesity (BMI 30 and above) and metabolic syndrome involving insulin resistance, hypertension, and dyslipidemia.
Indication
- Obesity with body mass index (BMI) of 30 kg/m² or higher
- Patients with BMI 25-29.9 kg/m² and elevated waist circumference (≥80 cm in women, ≥94 cm in men)
- Metabolic syndrome per IDF criteria (3 of 5 criteria positive: waist circumference, fasting glucose, triglycerides, HDL, blood pressure)
- Prediabetic patients at high risk of type 2 diabetes (HbA1c 5.7-6.4)
- Fatty liver (steatosis/NAFLD) accompanied by additional metabolic disorders
- Polycystic ovary syndrome (PCOS) requiring weight management
- Obesity-related sleep apnea, joint pain, or increased cardiovascular risk
Preparation
- 8-12 hours of fasting before the initial evaluation (for blood tests)
- Bringing the current medication list and previous medical reports
- Preparing a one-week diet and physical activity diary
- Avoiding caffeine and smoking for 30 minutes prior to blood pressure and pulse measurements
How it's performed
- Detailed medical and family history (diabetes, heart disease, thyroid)
- Measurement of height, weight, BMI, waist-to-hip ratio, and body fat percentage
- Tests including fasting blood glucose, HbA1c, lipid profile, liver and kidney function, TSH, uric acid, and insulin
- Blood pressure monitoring and 24-hour ambulatory blood pressure monitoring if needed
- ECG, abdominal ultrasound, and sleep apnea screening as indicated
- Nutrition plan, physical activity prescription, and pharmacotherapy adjustment when needed
Post-procedure
- Monthly check-ups for the first 3 months, then every 3 months
- Serial measurements of weight, waist circumference, and blood pressure
- Repeat blood tests every 6 months (HbA1c, lipids, liver enzymes)
- When needed, multidisciplinary follow-up with a dietitian, physiotherapist, and psychologist
- Multidisciplinary council evaluation in patients considered for bariatric surgery
Risks
- Gallstone formation due to rapid weight loss
- Muscle loss and fatigue with very low-calorie diets
- Transient side effects when starting antidiabetic or antihypertensive therapy
- Worsening of metabolic parameters with poor adherence to the nutrition plan
- Complications when comorbidities (cardiac, renal) are present and the treatment plan is not individualized
FAQ
How is metabolic syndrome diagnosed?
According to International Diabetes Federation (IDF) criteria, the diagnosis is established when increased waist circumference is accompanied by at least two more of the following: high triglycerides, low HDL, high blood pressure, and high fasting glucose (3 criteria total).
Can obesity be treated by diet alone?
In mild and moderate obesity, dietary changes and physical activity can produce lasting results. However, if BMI is very high or comorbidities are present, drug therapy or surgical options may be considered.
Which lab tests should be monitored during weight loss?
Fasting blood glucose, HbA1c, lipid profile, liver and kidney function, vitamin B12 and D, and thyroid hormones are monitored at regular intervals.
Are obesity medications appropriate for everyone?
No. Drug therapy is initiated by physician decision based on BMI thresholds, comorbidities, and contraindications.
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