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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the underlying causes of overweight and obesity.

  2. Identify parameters used to diagnose obesity and other objective information that indicates the severity of disease.

  3. Identify desired therapeutic goals for patients who are overweight or obese.

  4. Recommend appropriate nonpharmacologic and pharmacologic therapeutic interventions for overweight or obese patients.

  5. Implement a monitoring plan that will assess both the efficacy and safety of therapy initiated.

  6. Educate patients about the disease state and associated risks, appropriate lifestyle modifications, drug therapy, and surgical options necessary for effective treatment.

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KEY CONCEPTS

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  • Image not available. Body mass index (BMI), waist circumference, comorbidities, and readiness to lose weight are used in the assessment of overweight or obese patients.

  • Image not available. The presence of comorbidities (coronary heart disease [CHD], atherosclerosis, type 2 diabetes mellitus, and sleep apnea) and cardiovascular risk factors (cigarette smoking, hypertension, elevated low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, impaired fasting glucose, family history of premature CHD, and age) requires identification and aggressive management for overall effective treatment of the overweight or obese patient.

  • Image not available. The treatment goals for overweight and obesity are to prevent additional weight gain, reduce and maintain a lower body weight, and control related risks.

  • Image not available. Weight loss is indicated for patients with a BMI of 25 to 29.9 kg/m2 or a high-risk waist circumference with two or more comorbidities or for any patient with a BMI of 30 kg/m2 or greater.

  • Image not available. Weight maintenance occurs after successful achievement of weight loss.

  • Image not available. Treatment of obesity includes lifestyle changes (e.g., dietary modification, enhanced physical activity, and behavioral therapy), pharmacologic treatment, surgical intervention, or a combination of modalities.

  • Image not available. Pharmacotherapy, in addition to lifestyle modifications, is reserved for patients with a BMI of 30 kg/m2 or greater or a BMI of 27 kg/m2 or greater with other obesity-related risk factors.

  • Image not available. Weight likely will be regained if lifestyle changes are not continued indefinitely.

  • Image not available. Surgery is warranted when other treatment attempts have failed in severely obese patients (BMI of 40 kg/m2 or greater, or 35 kg/m2 or greater with other obesity-related risk factors).

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Overweight and obesity are terms used to describe weight measurements greater than what is considered healthy for a given height.1 Image not available. Body mass index (BMI), waist circumference, comorbidities, and readiness to lose weight are used in the assessment of overweight or obese patients. The primary modality in defining overweight and obesity is the BMI, a measure of body fat based on height and weight that applies to both adult men and women. BMI does not reflect distribution of body fat; therefore, the measurement of waist circumference is a more practical method to evaluate abdominal fat before and during weight loss treatment. Abdominal fat poses a greater health risk over peripheral fat and may be an independent risk predictor when BMI is not elevated significantly.2,3 Both BMI and waist circumference ...

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