And Bethany M Doerfler MS RD

The No Nonsense Teds Fat Melting

Eat More Diet Less

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Contents

1 Introduction

2 Examination of the Obese Patient

3 Treatment

4 Lifestyle Changes

5 Low Carbohydrate Diets: What Does the Science say?

6 Low Carbohydrate Diets: Are They Safe?

7 USDA and IOM Recommendations

8 National Weight Control Registry

9 Pharmacologic Options

10 Surgical Options

11 Conclusion

Summary

Overweight and obesity are the most common medical problems seen in primary care practice, affecting over two-thirds of adults and almost one-fifth of adolescents. Physicians must address and counsel patients to halt this escalating disease. The primary goal of lifestyle treatment is to improve obesity-related co-morbid conditions by relying on safe and effective diet and lifestyle modifications that produce a caloric deficit of 500 to 1000 kcal/day.

Patients with a body mass index (BMI) >30 kg/m2 or with a BMI >27 kg/m2 with concomitant obesity-related diseases should be considered for adjuvant pharmacologic therapy. The two medications

From: Clinical Gastroenterology: Nutrition and Gastrointestinal Disease Edited by: M.H. DeLegge © Humana Press Inc., Totowa, NJ

approved by the FDA for long-term weight loss are sibutramine and orlistat. Surgical intervention is an option for patients with clinically severe obesity (BMI >40 kg/m2 or >35 kg/m2 with co-morbid conditions) judged by experienced clinicians to have a low probability of success with non-surgical measures, as demonstrated by failure in established weight control programs.

KeyWords: Obesity, Lifestyle changes, Pharmacotherapy, Bariatric surgery

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