Treating Overweight Pre Adolescents

The goal for treating the overweight pre-adolescent is weight maintenance over time, not weight loss. The pediatric BMI chart guides the physician as to a healthy weight and height for a particular age. Plotting the child's BMI on the pediatric BMI chart identifies how serious the child's excess weight condition is compared to peers and provides guidance regarding a healthy weight for the future. An elevated BMI above the 85th percentile should encourage the parents, at the physician's...

The Cames Approach

The scientific basis for the CAMES approach has already been described. As a brief review, the C stands for cutting the amount of food a person eats. Portion control is central to any weight reduction program. The A represents adding healthy items to a patient's diet. Encouraging patients to eat more fruit, vegetables, fiber, or drinking more water improves the patient's health and reduces the amount of calories ingested from unhealthful foods like trans-fats. The M stands for moving the...

Pharmacotherapy

Patients with chronic diseases like diabetes, hypertension, or hyperlipidemia typically require one or more medications to control the disease. Before starting medication, physicians will commonly encourage patients to make therapeutic lifestyle changes, such as increasing physical activity, improving nutrition, and losing weight, that in some cases result in a delay in initiation of medication or allow a lower dose of medication. Unfortunately, most patients eventually require daily medication...

Various Types of Physical Activity

If physical activity is important for reducing the negative health impact of various chronic diseases, then which type of physical activity should a physician recommend to the patient There are three categories of physical activity to consider work-related, leisure-time physical activity (LTPA), and lifestyle activity. The possible answer to helping reduce the prevalence of obesity, according to a study by Gutierrez-Fisac et al., may not be found in the workplace. His study was based on data...

Surgical Procedures

Surgeons in various locations in Europe and America began performing jejuno-ileal bypass surgery on obese patients in the 1950s. Then in the 1960s, jejuno-colic bypass surgery was performed, but unacceptable side effects of frequent diarrhea, dehydration, and electrolyte imbalance, resulted in discontinuance of the procedure. Late in the 1960s, Dr Edward Mason of the University of Iowa developed the Roux-en-Y gastric bypass procedure, and in the early 1980s Dr Mason pioneered the vertical...

Importance of the Second Appointment

When a patient returns for the second weight management appointment, the physician should be optimistic about the patient's prospects for losing weight. The possibility for long-term weight loss success is high for such a patient for a couple of reasons. First, by returning for the second appointment, the patient has agreed to the goal of the program 10 weight loss over 6 months. Patients with an unreasonable expectation for weight loss do not accept this goal. They want the scales to show...

The PASS Behavioral Prescription

Patients want practical, commonsense behavioral advice that fits their lifestyle to help lose weight and to keep it off long-term. Suggestions like drinking an 8 oz glass of water before each meal as a way to fill up the stomach may work for some patients some of the time but will not work for every patient all of the time. Other suggestions like chewing food 10 times before swallowing or putting the fork or spoon down between each bite will only work for some patients. In making suggestions...

Daily Caloric Deficit

Weight gain, which for most is the result of consuming excess calories, is a gradual but cumulative process. Patients do not become obese in one day of excessive eating no matter how many calories are consumed. Eating 6000 calories in one day may lead to a net weight gain of about 2 lb that day, but it does not take a patient from a healthy weight to obesity. It is the consumption of an extra 100 to 300 calories per day on a regular basis that results in an extra weight gain of 10lb in one...

References

Centers for Disease Control and Prevention. Physical activity and health - adults. 1996. Available at http www.cdc.gov nccdphp sgr adults.htm. Accessed July 3, 2004. 2. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993 270 2207-2212. 3. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005 293 1861-1867. 4. Healthy People 2010. Available at objectives 03-10.htm....

Low Carbohydrate Versus Low Fat Diets

Patients often ask which kind of diet they should follow in order to lose weight low carbohydrate or low fat Representing the low-carbohydrate approach are books like Atkins for Life, which advocates consumption of animal foods such as meat, bacon, poultry, fish, cheese, butter, and eggs, and severely limits carbohydrates to 20 g per day during the first phase of the diet. Dr Atkins attributed weight gain to consumption of what he called bad carbohydrates like rice, potatoes, pasta, or anything...

Pre Adolescent Obesity

If genetic and medical conditions are not the cause of a child's obesity, then family and environmental factors must play an important role. Parents are role models and make decisions that directly impact the types and amount of food eaten by pre-adolescent children 16,17 . Obesigenic family clusters are a risk for young girls to have a higher BMI parents in such family clusters have a greater intake of dietary fat and are less physically active than parents in non-obesigenic family clusters 18...

CAMES Approach to Caloric Deficit

After reviewing the Battle in the Mind and the patient's food diary, the physician introduces the CAMES approach to creating a caloric deficit. The physician guides the patient through the concept by showing the example provided (Figure 9.1). The physician explains what each letter means, with special emphasis on the letters C and E. The example in the workbook shows the letter C is applied to 7 out of 10 items, which means the individual can continue to eat most foods eaten in the past but in...

Challenges to Overcome for Long Term Success

Obese patients who qualify for bariatric surgery have major challenges to conquer to achieve long-term weight loss success. Not every patient who initially wants the surgery should have it. Patients must address a lot of issues before the surgery and a number of changes after the surgery. Prior to surgery, patients must evaluate their perceptions as to how dramatic weight loss will impact their life. The physician should frankly discuss whether a patient is capable of handling the experience of...

Substituting Foods

Dr Howard Shapiro has helped many people by pointing out to them how they can substitute certain foods, reduce calories, and lose weight. I like to show people his book, Picture Perfect Weight Loss, to show how making dietary substitutions like eating natural fruit desserts rather than canned or frozen ones can save hundreds of calories 26 . Patients understand the concept immediately. When highlighting this point, I say something like, So you're at a restaurant and you want to have a sweet...