T83 Overweight (ICD-10:E66.3)

Introduction

Overweight is a condition characterized by excess body weight, usually resulting from an imbalance between energy intake and energy expenditure. It is a significant health concern as it increases the risk of various chronic diseases, including cardiovascular disease, diabetes, and certain types of cancer^[1]. The aim of this guide is to provide healthcare professionals with a comprehensive overview of the diagnosis and management of overweight.

Codes

• ICPC-2 Code: T83 Overweight
• ICD-10 Code: E66.3 Overweight

Symptoms

• Increased body weight: Patients may have a body mass index (BMI) above the normal range (BMI ≥ 25 kg/m²)^[2].
• Excessive fat accumulation: Patients may have increased waist circumference or waist-to-hip ratio^[3].

Causes

• Poor diet: Consuming a diet high in calories, saturated fats, and added sugars can contribute to weight gain^[4].
• Sedentary lifestyle: Lack of physical activity and prolonged sitting can lead to weight gain^[5].
• Genetics: Some individuals may have a genetic predisposition to overweight^[6].
• Psychological factors: Emotional eating, stress, and depression can contribute to weight gain^[7].

Diagnostic Steps

Medical History

• Obtain a detailed medical history, including information on the patient’s weight history, dietary habits, physical activity levels, and any underlying medical conditions.
• Assess for risk factors associated with overweight, such as a family history of obesity, certain medications (e.g., antidepressants, antipsychotics), and socioeconomic factors^[8].

Physical Examination

• Measure the patient’s weight, height, and calculate the BMI.
• Assess waist circumference using a tape measure placed horizontally midway between the lower rib margin and the iliac crest^[9].
• Evaluate for signs of obesity-related complications, such as acanthosis nigricans (dark, velvety patches of skin), skin tags, and signs of insulin resistance (e.g., acanthosis nigricans, hirsutism).

Laboratory Tests

• Fasting blood glucose: To assess for prediabetes or diabetes.
• Lipid profile: To evaluate lipid levels and assess cardiovascular risk.
• Liver function tests: To screen for non-alcoholic fatty liver disease (NAFLD).
• Thyroid function tests: To rule out hypothyroidism as a cause of weight gain.
• Hormonal evaluation: In certain cases, hormonal imbalances (e.g., polycystic ovary syndrome) may contribute to weight gain^[10].

Diagnostic Imaging

• Dual-energy X-ray absorptiometry (DXA): To assess body composition, including fat mass and lean mass.
• Abdominal ultrasound: To evaluate for fatty liver disease and other abdominal pathologies.

Other Tests

• Psychological assessment: Consider referral to a psychologist or psychiatrist to evaluate for underlying psychological factors contributing to weight gain.
• Sleep study: In patients with suspected obstructive sleep apnea, a sleep study may be warranted.

Follow-up and Patient Education

• Schedule regular follow-up visits to monitor progress, provide support, and adjust treatment plans as needed.
• Provide patient education on healthy eating habits, portion control, regular physical activity, and stress management techniques.
• Offer resources for support groups, nutrition counseling, and behavioral therapy.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Overweight:

1. Orlistat:
   • Cost: $30-$100/month.
   • Contraindications: Chronic malabsorption syndrome, cholestasis.
   • Side effects: Gastrointestinal symptoms (e.g., oily spotting, fecal urgency), headache.
   • Severe side effects: Severe liver injury, allergic reactions.
   • Drug interactions: Cyclosporine, warfarin.
   • Warning: Fat-soluble vitamin supplementation may be necessary.
2. Liraglutide:
   • Cost: $600-$800/month.
   • Contraindications: Personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2.
   • Side effects: Nausea, vomiting, diarrhea.
   • Severe side effects: Pancreatitis, gallbladder disease.
   • Drug interactions: Insulin, sulfonylureas.
   • Warning: Monitor for signs of pancreatitis.
3. Phentermine/Topiramate:
   • Cost: $50-$200/month.
   • Contraindications: Glaucoma, hyperthyroidism, history of drug abuse.
   • Side effects: Dry mouth, constipation, insomnia.
   • Severe side effects: Increased heart rate, psychiatric reactions.
   • Drug interactions: MAO inhibitors, selective serotonin reuptake inhibitors.
   • Warning: Risk of fetal harm, pregnancy prevention measures required.
4. Naltrexone/Bupropion:
   • Cost: $100-$200/month.
   • Contraindications: Uncontrolled hypertension, seizure disorder, eating disorder.
   • Side effects: Nausea, constipation, headache.
   • Severe side effects: Increased heart rate, suicidal thoughts.
   • Drug interactions: MAO inhibitors, opioids.
   • Warning: Monitor for neuropsychiatric reactions.
5. Metformin:
   • Cost: $4-$20/month.
   • Contraindications: Renal impairment, liver disease.
   • Side effects: Gastrointestinal symptoms (e.g., diarrhea, nausea), metallic taste.
   • Severe side effects: Lactic acidosis (rare).
   • Drug interactions: Cimetidine, carbonic anhydrase inhibitors.
   • Warning: Monitor renal function.

Alternative Drugs:

• Lorcaserin: A selective serotonin 2C receptor agonist.
• Bupropion/Naltrexone: Combination therapy targeting reward pathways.
• Phentermine: A sympathomimetic amine used for short-term weight loss.
• Sibutramine: A serotonin-norepinephrine reuptake inhibitor (withdrawn from the market in some countries due to cardiovascular risks).
• Liothyronine: A thyroid hormone used in certain cases of hypothyroidism.

Surgical Procedures:

• Bariatric surgery: Various procedures, such as gastric bypass or sleeve gastrectomy, may be considered in severe cases of obesity. Cost: $20,000-$35,000.

Alternative Interventions

• Acupuncture: May help reduce appetite and promote weight loss. Cost: $60-$120 per session.
• Hypnotherapy: Uses hypnosis techniques to modify eating behaviors and promote weight loss. Cost: $75-$150 per session.
• Mindfulness-based interventions: Techniques such as mindful eating can help individuals develop a healthier relationship with food. Cost: Varies depending on the program.
• Herbal supplements: Some herbal supplements, such as green tea extract and Garcinia cambogia, are marketed for weight loss. Cost: Varies depending on the specific supplement.
• Yoga: Combines physical activity, mindfulness, and stress reduction techniques. Cost: $10-$20 per class.

Lifestyle Interventions

• Dietary modifications: Encourage a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Cost: Varies depending on food choices.
• Regular physical activity: Recommend at least 150 minutes of moderate-intensity aerobic activity per week. Cost: Varies depending on the chosen activity (e.g., gym membership, exercise equipment).
• Behavioral therapy: Helps individuals identify and modify unhealthy eating behaviors. Cost: $75-$150 per session.
• Weight loss programs: Commercial programs, such as Weight Watchers or Jenny Craig, provide structured support for weight loss. Cost: Varies depending on the program.
• Support groups: Offer a supportive environment for individuals to share experiences and receive guidance. Cost: Varies depending on the group (some may be free).

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – T83 Overweight (ICD-10:E66.3)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Overweight effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Overweight. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. World Health Organization. (2021). Obesity and overweight. Retrieved from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
2. Centers for Disease Control and Prevention. (2021). Defining Adult Overweight & Obesity. Retrieved from https://www.cdc.gov/obesity/adult/defining.html
3. National Heart, Lung, and Blood Institute. (2021). Assessing Your Weight and Health Risk. Retrieved from https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm
4. Harvard T.H. Chan School of Public Health. (2021). Diet Review: Ketogenic Diet for Weight Loss. Retrieved from https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/
5. Owen, N., Sparling, P. B., Healy, G. N., Dunstan, D. W., & Matthews, C. E. (2010). Sedentary behavior: emerging evidence for a new health risk. Mayo Clinic Proceedings, 85(12), 1138-1141.
6. Herrera, B. M., & Lindgren, C. M. (2010). The genetics of obesity. Current Diabetes Reports, 10(6), 498-505.
7. Luppino, F. S., de Wit, L. M., Bouvy, P. F., Stijnen, T., Cuijpers, P., Penninx, B. W., & Zitman, F. G. (2010). Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry, 67(3), 220-229.
8. Hruby, A., & Hu, F. B. (2015). The epidemiology of obesity: a big picture. Pharmacoeconomics, 33(7), 673-689.
9. World Health Organization. (2011). Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8-11 December 2008.
10. Pasquali, R., Casanueva, F., Haluzik, M., van Hulsteijn, L., Ledoux, S., Monteiro, M. P., … & Yumuk, V. (2020). European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity. European Journal of Endocrinology, 182(1), G1-G32.