- Two clinical measures of excess body fat, regardless of sex, are the body mass index (BMI) and the waist circumference (WC). BMI and WC provide a better assessment of total body fat than weight alone and are independent predictors of obesity-related disease risk.
- Excessive central adiposity increases risk for development of type 2 diabetes, hypertension, and dyslipidemia.
- Weight loss of as little as 5% of total body weight can significantly improve blood pressure, lipid levels, and glucose tolerance in overweight and obese patients. Sustained, large weight losses (i.e., after bariatric surgery) are associated with long-term improvements in many of the complications associated with obesity and a lower risk of both myocardial infarction and death.
- Pharmacotherapy may be considered in patients with a BMI ≥30 kg/m2 and/or a WC ≥40 inches (≥ 102 cm) for men or 35 inches (89 cm) for women, or BMI of 27 to 30 kg/m2 with concurrent risk factors if 6 months of diet, exercise, and behavioral modification fail to achieve weight loss.
- There is a high probability of weight regain when obesity pharmacotherapy is discontinued.
- The FDA does not regulate labeling of herbal and food supplement diet agents, and content is not guaranteed.
Upon completion of this chapter, the reader will be able to:
- 1. Describe current differences in the prevalence of overweight and obesity based on patient age, sex, and racial/ethnic group.
- 2. Discuss current theories regarding genetic and environmental issues pertinent to the development of obesity.
- 3. Compute a patientâs body mass index (BMI) and determine his or her degree of overweight or obesity.
- 4. Identify common comorbidities and health risks associated with excess weight.
- 5. Outline the overall treatment approach currently recommended for obesity and discuss the role of diet, physical activity, and behavioral modification.
- 6. List the benefits and risks associated with bariatric surgery.
- 7. Describe clinically important differences between prescription medications indicated for the long-term management of obesity.
- 8. Design an appropriate pharmacologic treatment plan for an obese patient based on patient-specific factors.
- 9. Discuss the safety and efficacy concerns related to the use of alternative therapies for weight loss.
- 10. Recommend appropriate monitoring and follow-up for a patient undergoing weight loss therapy.
It is now estimated that more than 140 million or approximately two out of every three adults are overweight or obese in the United States.1 Additionally, the number of children and adolescents who are overweight has been increasing at an alarming rate in the last 40 years,2 with one out of every three adolescents currently considered overweight or obese.3 Based on the national trend, this epidemic is projected to affect ∼80% of the U.S. adults by 2020, and the prevalence of overweight among children is expected to double by 2030.4 The presence of obesity and overweight is associated with a significantly increased risk for the development of many diseases (Table 154–1),5–...