Clinical Obesity

Dr. Salah Darwish, BCNSP

Clinical Nutrition specialist
Sports Nutrition practitioner
Obesity management specialist

Pro Academy 01098484656 1

Diabetes Classification
• Type1 DM
• Type2 DM
• Gestational DM
• Prediabetic conditions
• Stress induced hyperglycemia

Pro Academy 01098484656 2

Measurement of Glycaemia

Fasting glucose • Hepatic production

Post-pradial • Meal glucose
glucose
HbA1C • Monitoring over 1-2
months

Pro Academy 01098484656 3

 Medication
Cateogries Active ingred. Brand
Insulin Sulphonyl-ureas Glyburide Gluokan
secretagogues Glimepiride Dolcyl
Glipizide Minidiab
Meglitinldes Repaglinide Novonorm
Nateglinide Starlidine
Enhance Glucagon-like Exenatide Byetta
insulin peptide-I Liraglutide Victoza
secretion
DPP inhibitors that Sitagliptin Januvia
under
inhibit degradation of Saxagliptin Janumet
conditions of
endogenously
rising glucose Linagliptin Trajenta
producedProGLP-1
Academy 01098484656 4
 Medication

Drugs that act primarily to Long acting insulin

restrain hepatic glucose
Metformin
production
Lowers glucose by enhancing Thiazolidinedione Pioglitazone
insulin sensitivity Rosiglitazone
Slows gut absorption of Inhibiting Acarbose
carbohydrates enzymatic
digestion by
alpha- Miglitol
glucosidases
Slowing gastric Pramlintide
emptying
Pro Academy 01098484656 5
 Total daily insulin dose

Sensitive 0.3 U/kg – 0.5 U/kg

Basal Average 0.5 U/kg – 0.8 U/kg
Resistant 0.9 U/kg – 1.5 U/kg
Nutritional 1 unit for every 10 g of
carbohydrate

Pro Academy 01098484656 6

 Diabetes Complication

diabetic Hyperglycemic
ketoacidosis hyperosmolar
(DKA) syndrome (HHS)

Hypoglycemia
Pro Academy 01098484656 7
Pro Academy 01098484656 8
Dietary management

Pro Academy 01098484656 9

Dietary management

Pro Academy 01098484656 10

Dietary management

Pro Academy 01098484656 11

Dietary management

Pro Academy 01098484656 12

Dietary management

Pro Academy 01098484656 13

Dietary management

Pro Academy 01098484656 14

• Breakfast
– 1 Cup Skimmed Milk, 1 Orange (medium), 1 Cup oat
• Morning Snack
– 1 Cup Cantaloupe Melon
• Lunch
– Grilled Shrimp, 1 Whole-Wheat Bread (small), salad
• Afternoon Snack
– 2 Tablespoons Prepared Hummus, 3 Ounces Celery Sticks
• Dinner
– 1/2 Cup Cooked Brown Rice, Carrots, Tomato, 1/2 Banana (small)

Pro Academy 01098484656 15

• Breakfast
– 1 Cup Skimmed Milk, 1 Orange (large), 1 Cup oat
• Morning Snack
– 1 Cup Cantaloupe Melon, low fat cheese (cottage)
• Lunch
– Grilled chicken, 1 Whole-Wheat Bread (small), salad
• Afternoon Snack
– 4 Tablespoons Prepared Hummus, 4 Ounces Celery Sticks
• Dinner
– 3/4 Cup Cooked Brown Rice, 1 cup of spinach, Carrots, Tomato, 1/2
Banana (small)

Pro Academy 01098484656 16

 Conclusion
• Long-term weight reduction
• Exercise types, strength & intensity
• Change Macro-nutrients
• Adjust diabetic medications

Pro Academy 01098484656 17

Children obesity

Dr. Salah Darwish, BCNSP

Clinical Nutrition specialist
Sports Nutrition practitioner
Obesity management specialist

Pro Academy 01098484656 18

 Statistics

USA Australia

• One third of • 1 of every 4

children in the children is
U. S. obese in
is overweight or Australia
obese

Pro Academy 01098484656 19

Differences in BMI

Pro Academy 01098484656 20

 History
• Obesity history (onset and development)
• Previous intervention
• Current and previous diet
• Impact on child & family
• Complication history
– Sleep, Knee pain
• Family history
– Obesity , heart disease, diabetes, BMI of family

Pro Academy 01098484656 21

 Life style assessment
• TV & screen history
• Dietary history
– Snacks, sneaking foods, breakfast, sweetened
drinks, fast foods
• Physical activity
– School transport, after school, weekend activites,
• Sleep
– Days v.s weekends, duration, routines

Pro Academy 01098484656 22

Acanthosis nigricans

Pro Academy 01098484656 23

Management
• Prevention is the Key
• Team work
• Individualized goal of wt loss
• Components:
– Education & motivation
– Diet modification
– Increased activity
– Parents are role models
– Medicines & surgery
Pro Academy 01098484656 24
Principle of management

Pro Academy 01098484656 25

 Nutrition intervention
Meal pattern Regular meals
Eat together
Decrease portion size
Eat breakfast
Dietary intake Nutrient low energy, low glycemic index
Increase fruits and vegetables
Healthy snacks
Drink water
Reduction in sugary snacks
Whole-family life Eat similar foods
style intervention Recommendation suitable for all family
Engagement of who buys of make foods
Pro Academy 01098484656 26
Scree time

Pro Academy 01098484656 27

 Key behaviors change

Traget goal • Change snacks to healthy

• Leave children at hoem while shopping
• Not buying soda & junk
Stimulus control • Not eating in front of TV
• No screens at bedroom
• Small spoons & small plates
• Not storing unhealthy food choices in
house
Self-monitoring • Food diary
• Tv use diary
• Weekly weighing

Pro Academy 01098484656 28

 Pharmacotherapy
• No sibutramine
• Use of
– Metformin (insulin resistance)
– Orlistat (side effects intolerance)
• Fat replacement
– Olean

Pro Academy 01098484656 29

Elderly obesity

Dr. Salah Darwish, BCNSP

Clinical Nutrition specialist
Sports Nutrition practitioner
Obesity management specialist

Pro Academy 01098484656 30

Elderly cases
• Sarcopenia
– Decline in skeletal muscle mass, strength, and
function associated with age
– Treated by Resistance training
• Frailty
– Lossof muscle mass and strength
– slow walking speed
– weakness (grip strength)

Pro Academy 01098484656 31

Waist circumference

Pro Academy 01098484656 32

Fatty infiltration

Pro Academy 01098484656 33

Obesity consequences

Pro Academy 01098484656 34

Macro & micro-nutrients

Pro Academy 01098484656 35

 Thanks
Name: Dr. Salah Darwish, BCNSP
E-mail: Dr.salahdarwish@gmail.com
Phone: 010-653 96 906
Facebook page: nutrition by ahmed and salah

Pro Academy 01098484656 36