Office-based strategies for the management of obesity.
Roughly two thirds of U.S. adults are overweight or obese. Obesity increases the risk of hypertension, type 2 diabetes mellitus, hyperlipidemia, heart disease, pulmonary disease, hepatobiliary disease, cancer, and a number of psychosocial complications. Physicians often feel unprepared to handle this important problem. Practical office-based strategies include: (1) making recommendations for assisted self-management, including guidance on popular diets, (2) advising patients about commercial weight-loss programs, (3) advising patients about and prescribing medications, (4) recommending bariatric surgery, and (5) supplementing these strategies with counseling about lifestyle changes using a systematic approach. Family physicians should provide basic information about the effectiveness and safety of popular diets and commercial weight-loss programs, and refer patients to appropriate information sources. Sibutramine and orlistat, the only medications currently approved for the long-term treatment of obesity, should only be prescribed in combination with lifestyle changes. Bariatric surgery is an option for adults with a body mass index of 40 kg per m2 or higher, or for those with a body mass index of 35 kg per m2 or higher who have obesity-related comorbidities such as type 2 diabetes. The five A's behavioral counseling paradigm (ask, advise, assess, assist, and arrange) can be used as the basis for a systematic, practical approach to the management of obesity that incorporates evidence for managing common obesity-related behaviors.
Rao
Goutham
G
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. raog@upmc.edu
D000328:Adult; D019440:Anti-Obesity Agents / Q000627:therapeutic use; D050110:Bariatric Surgery; D015992:Body Mass Index; D002648:Child; D003376:Counseling; D003503:Cyclobutanes / Q000627:therapeutic use; D004038:Diet, Reducing; D005260:Female; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D008297:Male; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D000077403:Orlistat; D012307:Risk Factors
D019440:Anti-Obesity Agents; D003503:Cyclobutanes; D007783:Lactones; D000077403:Orlistat; C058254:sibutramine