Obesity

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Contents

Classification

Etiology

  • secondary causes of obesity
  • pharmaceutical agents

Epidemiology

  • 24-25% of American males [20]
  • 27-33% of non- pregnant American females [20]
  • 75% of obesity begins after childhood
  • prevalence is increasing [8]; 42% of Americans by 2030 [32]
  • women may be less likely than men to suffer complications from the same degree of obesity

Pathology

Genetics

Clinical-manifestations

  • >1 in men & >0.8 in women indicates upper body obesity
  • increase risk of cardiovascular complications

Laboratory

  • none required for diagnosis
  • baseline testing prior to initiating dietary therapy

Diagnostic-procedures

Complications

  • renal
  • other
  • increased mortality [22] ( RR=1.9 for men 50-71, BMI= 35-40)
  • children who are overweight or obese, then became nonobese as adults have similar risks as those who were never obese [31]

Management

  • even a modest weight reduction (5-15%) may lead to significant improvement in medical problems
  • pharmaceutical agents
  • diet therapy
  • primary mode of therapy
  • begin with 1200 kcal/day
  • very low calorie diet
  • use commercial formulas
  • 800 kcal/day
  • 60-90 g of protein/day
  • 100% of daily vitamins & minerals
  • need to see patient weekly
  • monitor
  • diet alone without restricted access to food is unlikely to produce sustained weight reduction
  • most men lose weight on < 1300 kcal/day
  • most women lose weight on < 1000 kcal/day
  • stop high- fructose corn syrup-containing carbonated beverages [12]
  • diet & excercise better than either alone [28]
  • weight gain associated with potatoes, sugar-sweetened beverages & meat [29]
  • weight reduction associated with vegetables, whole grains, fruits, nuts, yogurt [29]
  • exercise
  • indications: [3]
  • avoid activities associated with overeating, i.e. watching televison
  • keeping a record of eating may be helpful
  • meal planning is advisable
  • require patient to get up & get food for himself/herself
  • don't bring food to (serve) the patient
  • keep food in another room
  • getting up to get food includes second helpings
  • follow-up
  • majority of patients regain lost weight
  • non-compliance with diet & exercise programs are common
  • prognosis

More General Terms

Additional Terms

Internet Database

OMIM: 601665
OMIM: 603188
OMIM: 602025
OMIM: 607447

References

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  2. Journal Watch, Mass Med Soc 19(23):187 (Dec) 1999
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
  4. Journal Watch, Mass Med Soc 20(17):138 (Sept) 2000 Balsiger BM et al Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity. Mayo Clin Proc 75:673, 2000 PMID: [1]
  5. Journal Watch, Mass Med Soc 20(18):143 (Sept) 2000 Wiesner et al Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications. Radiology 216:389, 2000 PMID: &dopt=Abstract
  6. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 244
  7. Journal Watch 22(16):126, 2002 McGill HC et al Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation 105:2712, 2002 PMID: &dopt=Abstract
  8. Journal Watch 22(23):176, 2002 Flegal KM et al Prevalence and trends in obesity among US adults, 1999-2000. JAMA 288:1723, 2002 PMID: [2]
  9. Journal Watch 23(4):29, 2003 Peeters A et al Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 138:24, 2003 PMID: &dopt=Abstract
  10. Journal Watch 24(2):18, 2004 US Preventive Services Task Force, Ann Intern Med 139:930, 2003 [3] McTigue KM et al, Ann Intern Med 139:933, 2003 [4] PMID: [5]
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  21. O'Brien PE et al, Treatment of mild to moderate obesity with laparascopic adjustable gastric banding or an intensive medical program: A randomized trial. Ann Intern Med 2006; 144:625 PMID: [21]
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  26. Tang W et al White fat progenitor cells reside in the adipose vasculature. Science. 2008 Oct 24;322(5901):583-6. Epub 2008 Sep 18. PMID: [28]
  27. Gabbert C et al Adenovirus 36 and Obesity in Children and Adolescents Pediatrics published online September 20, 2010 <PubMed> PMID: [29] <Internet> [30]
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  32. Physician's First Watch Massachussetts Medical Society, May 8, 2012
    - CDC Weight of the Nation Press Briefing Monday, May 7, 2012 Centers for Disease Control and Prevention [44]
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  33. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation Institute of Medicine 2012 [46]
  34. Management of overweight and obesity (VHA/DoD) [47]
  35. National Guideline Clearinghouse
    - Prevention and management of obesity (mature adolescents and adults). (ICSI) ngc-guideline: [48]
    - Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. National Collaborating Centre for Primary Care ngc-guideline: [49]
    - Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. ngc-guideline: [50]
    - Screening for obesity in children and adolescents: U.S. Preventive Services Task Force recommendation statement. ngc-guideline: [51]
    - Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. American Heart Association ngc-guideline: [52]
    - Overweight children and adolescents: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. (North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition) ngc-guideline: [53]
    - Treatment of obesity. Finnish Medical Society Duodecim ngc-guideline: [54]
    - Management of overweight and obesity in the adult. Michigan Quality Improvement Consortium ngc-guideline: [55]
    - Prevention and identification of childhood overweight and obesity. Michigan Quality Improvement Consortium ngc-guideline: [56]
    - Treatment of childhood overweight and obesity. Michigan Quality Improvement Consortium ngc-guideline: [57]
    - Active healthy living: prevention of childhood obesity through increased physical activity. (American Academy of Pediatrics) ngc-guideline: [58]
    - Identifying and preventing overweight in childhood. Clinical practice guideline. National Association of Pediatric Nurse Practitioners ngc-guideline: [59]
    - Rimonabant for the treatment of overweight and obese adults. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [60]
    - VA/DoD clinical practice guideline for screening and management of overweight and obesity. Veterans Health Administration ngc-guideline: [61]
    - Prevention and treatment of pediatric obesity: an Endocrine Society clinical practice guideline. ngc-guideline: [62]
    - Management of obesity. A national clinical guideline. Scottish Intercollegiate Guidelines Network (SIGN) ngc-guideline: [63]
    - World Gastroenterology Organisation Global Guideline: obesity. ngc-guideline: [64]
    - Best evidence statement (BESt). Initial screening and referral for comorbidities in pediatric obese patients. Cincinnati Children's Hospital Medical Center ngc-guideline: [65]
    - OVERWEIGHT AND OBESITY IN CHILDREN AND ADOLESCENTS: ASSESSMENT, PREVENTION, AND MANAGEMENT [66] The Overweight and Obesity in Children and Adolescents [67]
    - ASSESSMENT AND TREATMENT OF OBESITY AND OVERWEIGHT IN ADULTS [68] Updated guideline synthesis on Assessment and Treatment of Obesity and Overweight in Adults [69] Overweight and obesity in children and adolescents [70]
    - Prevention of childhood obesity through increased physical activity (American Academy of Pediatrics) [71] . National Guideline Clearinghouse Guideline syntheses
    - Assessment and Management of Obesity and Overweight in Adults ngc-guideline-synthesis: 25323

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