Philippine Association for the Study of

Overweight and Obesity (PASOO)

Rm. 362 Third Circular, Makati Medical Center, Makati City
Tel. No. 810-2897

Officers and Board of Trustees

President Augusto D. Litonjua, M.D.

Vice President Sanirose S. Orbeta, M.S., R.D.
Secretary Mary Anne Lim-Abrahan, M.D.
Treasurer Rosa Allyn G. Sy , M.D.

Board of Trustees Josefino A. Regalado, M.D.

Rodolfo F. Florentino, M.D., Ph.D.
Edgardo L. Tolentino, M.D.
Ramon F. Abarquez, Jr., M.D.
Celeste C. Tanchoco, M.Ph., R.N.D.
Gerard Lalande, M.D.


CPM 3RD EDITION weight REDUCTION program

Algorithm for the Healthy and Safe Weight

Management Program

Overweight/Obese
Individual

2


Assess Body Fat:

Determine BMI and
Waist Circumference

3 4


•Overweight
BMI Y BMI 23-24.9
≥ 23.0? •Obese
BMI ≥ 25
N
5 6


Healthy Start Weight

(BMI nlt 18.6- Reduction
22.9) Regimen


7 8 9 10





Behavior Drug
Diet Exercise
Modification Therapy

FIGURE 1

* BMI values are those proposed by the ASIA-Pacific Guidelines


weight REDUCTION program cpm 3RD eDITION
Guidelines for a Healthy and Safe Weight Management
Program: PASOO Recommendations
I. Definition of Terminologies
Overweight - increased body weight in relation to
height
Obesity - increased amount of body fat or
adipose tissue:
men : more than 25% body fat
women : more than 33-35% body fat
How to assess body fat:
1. Body mass index: Correlates closely with total body
fat in relation to height and weight. However, this
does not compensate for frame size and does not
indicate fat distribution and cannot be adjusted for
age. It is determined by:
Weight in kgs/Height in meter2.
Based on Asia-Pacific Obesity Guidelines
Underweight = < 18.5
Healthy = 18.6 - 22.9
Overweight = > 23.0
At risk 23 - 24.9
Obese I 25 - 29.9
Obese II > 30
2. Waist circumference: Many agree that the waist
circumference alone is an accurate measure of the
amount of visceral fat.
Clinical thresholds: Men <90 cm
Women <80 cm
To measure the waist, the subject should be unclothed
at the waist, and standing with abdomen relaxed,
arms at the sides, feet together. Use nonstretchable
tape measure and do not compress the skin.
II. Overview of Current Perspective
It is known that increasing body weight increases risk of
health. The risk from obesity is related to both the BMI as
measurement of the magnitude of obesity and the waist
circumference for the distribution of body fat. Thus, the
distribution of that excess weight should be a primary
consideration. The amount of intraperitoneal or visceral
fat has been shown to be directly related to the morbidity
and mortality of fatness. Therefore, it is recommended
that the measurement of the waist circumference be
utilized clinically for the calculation of added risk. (It
is known that the most accurate means of determining
excess body fat and its distribution is CT scan or MRI.)
Obesity arises from a variety of causes, which demand
chronic attention. Drastic weight reduction is not
encouraged because obesity can only be palliated, but
never cured - thus weight management is a lifetime

endeavor. Management of obesity should be sought for,
because reducing weight is the only way to reduce the
ill-effects of too much weight, as well as, to improve the
quality of life of the obese person.
III. Treatment Modalities Recommended by PASOO
A. Scientifically-based and Acceptable
1. Diet
The diet must be supervised, well balanced and
hypocaloric. In the morbidly obese, supervised
modified fasts or very low calorie diet (VLCD)
may be allowed for certain periods of time.
PASOO disapproves unsupervised or unbalanced
VLCDs, fat diets and quick loss regimen such as
untested food mixes, and slimming teas which
are faulty weight loss aids.
a. Use the basic Filipino Pyramid Food Guide
for today's lifestyle as the healthy way to
lose weight. Eating the pyramid food way
gives balance, variety, moderation and
proportionality.
b. Mineral and vitamin supplements are
not necessary unless dictated by specific
deficiencies. Adequate diet equates to
adequate vitamins and minerals.
2. Exercise
Aerobic exercise programs, formal or functional,
are recommended. The guidelines modified from
the proposals of AS Leon, WD McArdie and MM
Toner are:
a. Medical clearance should be obtained for
those above 40 years as well as those below
40 years with known risk factors which could
compromise health. A graded exercise test
should be included.
b. Sessions should begin and end with
5-10 minutes of light aerobic/flexibility
activities.
c. Aerobic exercises should be performed at
least three times a week and once during
weekends.
d. The duration of exercise should be that which
would expend at least 300 kcal per session
(average of 30-60 minutes/session.)
e. Maximum oxygen consumption should be
40-80%, which is equivalent to about 60-90%
of the maximum heart rate. (220 - age)
f. Weave more physical activity into daily
routines - stairs instead of elevators, walk
instead of ride to work, etc.
g. Chronic strenuous exercises should be
done with caution. Recent studies suggest a
CPM 3RD EDITION weight REDUCTION program
suppression of the immune system brought classification of the degree of risk from the BMI and the
about by the decrease in the natural killer waist circumference:
cells.
Classification BMI Risk of Co-Morbidities
3. Behavior Modification - is an integral part of
the weight reducing regimen with personal or Waist Circumference
professional supervision. < 90 cm > 90 cm
(men) (men)
Behavioral approaches to obesity should help < 80 cm > 80 cm
patients make lifelong changes in diet and (women) (women)
exercise behaviors. Interventions which focus Underweight < 18.5 Low, but Average
on decreasing sedentary activities, rather than increased
increasing physical activity maybe a way for risk of
obese persons to adhere to prescribed exercise other
programs. clinical
problems
Following the Activity Pyramid Guide of PASOO Normal 18.6 - 22.9 Average Increased
may be helpful in starting the program. range
Overweight: > 23
Encouraging restrictions of dietary fats and At risk 23 - 24.9 Increased Moderate
refined sugar as well as of total calories should Obese I 25 - 29.9 Moderate Severe
be of immense value. The earlier the intervention Obese II > 30 Severe Very Severe
to modify behavior, the better the outcome. (R.R.
Wing, Current Opinion in Endocrinology and
Diabetes, 1996). PASOO adopts and recommends this classification of
treatment for obesity based on risk:
4. Drug Therapy - should be an adjunct to diet,
exercise and behavior modification and not the Calorie Intake/Day
primary means to weight reduction.
Risk <800* >800 Exercise Drugs Surgery
The characteristics of an ideal weight loss drug
are (G.A. Bray, Obesity Research, 1995): Low 3 2 1 NA NA
a. orally active
b. few or no side effects Moderate 2 1-2 1 3 NA
c. dose-dependent reduction in body fat
d. reduces visceral fat High 1 2 1 2 NA
e. inexpensive
f. long-acting Very High 1 1 3 1 1-2
g. non-toxic
Legend: NA = not appropriate
The choice of the drug should have as many of * very low caloric diet
the characteristics of the ideal drug as possible. 1 = 1st choice
2 = 2nd choice
B. Questionable Modalites 3 = 3rd choice

PASOO does not encourage certain modalities purported
to reduce body fat which are not scientifically based.

Who to treat?

Recommended or Preventive Strategies

1. Match your healthy weight to a good BMI of below
23.0
2. Measured waist circumference not to exceed 90 cm
for males or 80 cm for females.
3. Weight maintenance is emphasized more than weight
loss alone.
4. Exercise is part of the weight loss therapy.
5. Go and seek for behavior therapy if having difficulty
managing yourself.

PASOO adopts and recommends this functional