- 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 (e.g., 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.
- Bariatric surgery may be considered in patients with extreme obesity with a BMI ≥ 40 kg/m2 or ≥ BMI ≥ 35 kg/m2 with significant comorbidities.
- 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.
- Long-term pharmacotherapy with centrally acting appetite suppressants should be discontinued if weight loss of at least 5% is not achieved after 12 weeks of maximum-dose therapy.
- There is a high probability of weight regain when obesity pharmacotherapy is discontinued.
- The Food and Drug Administration does not regulate labeling of herbal and food supplement diet agents, and content is not guaranteed.
On completion of the chapter, the reader will be able to:
Describe current differences in the prevalence of overweight and obesity based on patient age, sex, and racial or ethnic group.
Discuss current theories regarding genetic and environmental issues pertinent to the development of obesity.
Compute a patient's body mass index and determine his or her degree of overweight or obesity.
Identify common comorbidities and health risks associated with excess weight.
Outline the overall treatment approach currently recommended for obesity and discuss the roles of diet, physical activity, and behavioral modification.
Recommend appropriate lifestyle modifications for weight loss.
List factors affecting adherence for a patient on nonpharmacologic therapy for weight loss.
List the benefits and risks associated with bariatric surgery.
List the nutritional and medication considerations for patients after bariatric surgery.
Describe clinically important differences between prescription medications indicated for the long-term management of obesity.
Design an individualized pharmacologic treatment plan for an obese patient based on patient-specific factors.
Formulate appropriate counseling information for an obese patient based on the prescribed pharmacologic therapy.
List factors affecting adherence for a patient on pharmacologic therapy for weight loss.
Discuss the safety and efficacy concerns related to the use of alternative therapies for weight loss.
Recommend appropriate monitoring and follow-up for a patient undergoing weight loss therapy.
It is now estimated that more than 140 million or two of every three adults are ...