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CHAPTER
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O O O O Obesity: An Overview of Assessment
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a a a and Treatment
Lora E. Burke / Patricia K. Tuite /
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Melanie Warziski Turk
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Obesity is a multifactorial disease involving complex interactions attentiion to obesity as aa hhe lth concern; for example, the Institute of f
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am on g ge ne ti m et ab ol ic en vi ro nm en ta c ul tu ra a nd p sy Medicine publish d criteria for evaluating w i ht-management pro-
among geneticc, metabolic,, environmentall, culturall, and psy-
chosocial factors. Estimates from the 2003–2004 National Health grams and other organizations published guidelines for treat-
and Nutrition Examination Survey (NHANES) indicate that ment. 13,14 In 1998, the National Heart, Lung, and Blood Institute
66.3% of the U.S. population is either overweight (body mass in- (NHLBI) issued the Evidence report, t t 15 which provided empirically
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dex [BMI] 25 to 29.9 kg/m ) or obese (BMI 30 kg/m ), with based guidelines for the identification, evaluation, and treatment of
significant increases in the overweight prevalence among children overweight and obesity in adults. The guidelines are being updated
and adolescents, and obesity prevalence in men between 1999 and by the NHLBI in 2008. Today, other organizations are becoming in-
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2004. In the United States today, obesity has become a pan- volved in this increasing public health concern. America on the
demic, the most common nutritional problem, the second most Move is a national nonprofit online organization whose goal is to
preventable cause of death, a significant contributor to increased improve the health of Americans by advocating small changes in eat-
health care costs, and a condition that lessens life expectancy and ing and physical activity routines to promote weight loss or cessation
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reduces quality of life across the lifespan. This medical condition of weight gain. This organization offers free web-based programs and
is not limited to the United States, and the World Health Orga- tools to individuals, groups, and communities to encourage changes
nization (WHO) has now deemed overnutrition to be a health like decreasing daily caloric intake by 100 cal and increasing daily
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concern. Nearly 2.3 billion adults will be overweight and more physical activity by 2,000 steps. 16 On the international level, the
than 700 million will be obese by 2015 according to estimates by WHO began addressing the issue through the International Obesity
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the WHO. Despite overweight and obesity once being regarded as Task Force. However, despite all the attention given to this serious
a problem of affluent countries, the prevalence of these conditions public health problem, this problem is not being addressed by clini-
is on the increase in low- and middle-income countries, especially cians or policymakers to the extent that previous health threats, such
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in metropolitan areas. See Figure 38-1 for the estimated preva- as the use of tobacco, have been addressed. When patients’ visits to
lence of obesity in several countries. their family physicians were observed, only one in four received any
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Obesity has been linked to a host of chronic disorders associ- nutritional counseling. Health care professionals can help slow the
ated with heart disease, including type 2 diabetes, dyslipidemia, trend of excess weight by educating and counseling their patients
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and hypertension. It is associated with deleterious effects on the about maintaining a healthy weight and how to use healthy lifestyle
heart and circulatory system, contributing to an increased risk of measures to reduce excess weight.
arrhythmia, sudden death, congestive heart failure, and ischemic This chapter draws on the growing volume of empirical litera-
heart disease. 7,8 Moreover, several physiologic parameters that af- ture pertaining to obesity and the evidence-based guidelines to
fect cardiovascular risk factors are associated with obesity, such as provide an overview of treatment of overweight and obesity. It be-
lipoprotein oxidizability, arterial blood pressure, hemostatic or gins with a review of the process of identification and evaluation
fibrinolytic abnormalities, and C-reactive protein, a vascular in- of a patient’s risk status and the selection of appropriate treatment.
flammatory marker. 9,10 Obesity was established as a major risk The major components of treatment are covered: lifestyle modifi-
factor for coronary heart disease (CHD) in 1998. cation, which includes dietary, exercise, and behavioral therapy;
In the midst of the mounting evidence demonstrating the dele- drug therapy; and surgical therapy. Finally, maintenance strategies
terious effects of obesity on health in general, and on the cardio- to enhance long-term adherence to the lifestyle changes that facil-
vascular system in particular, research has demonstrated numerous itated the weight loss are reviewed.
benefits to health by as little as 5% to 10% reduction in initial
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weight. However, survey data show that 33% of men and 46%
of women are attempting to lose and maintain weight but ap- IDENTIFICATION AND
proximately only 20% are using a combination of reduced caloric ASSESSMENT OF THE
intake and at least 150 minutes of weekly physical activity during OVERWEIGHT OR OBESE PATIENT
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leisure time to achieve weight loss. These facts highlight the im-
portance of identifying the patient at risk and implementing an Weight Status
early treatment course that may prevent the development of obesity.
This major health problem began to receive increasing attention In 1998, the United States adopted the cutoff points for the
from the scientific community in the mid-1990s. Indeed, in 1997, a classification of overweight and obesity based on BMI devel-
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paper was published recognizing obesity as a chronic disease. The oped by the WHO. 17 These criteria define normal weight as a
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work of several organizations and policymaking groups helped draw BMI range of 18.50 to 24.99 kg/m , overweight as a BMI of
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