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LEARNING OBJECTIVES

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 indicate the severity of disease.

  3. Identify desired therapeutic goals for patients with obesity.

  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, comprehensive lifestyle interventions, drug therapy, and surgical options necessary for effective treatment.

INTRODUCTION

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 (WC), comorbidities, and readiness to lose weight are used in the assessment of overweight or obese patients. BMI should be used to identify adults at increased risk for cardiovascular disease (CVD) and other obesity-related disorders. Evaluation of the patient’s risk status involves not only calculation of the BMI but also the measurement of WC. Image not available. The presence of comorbidities (CVD, 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) requires identification and aggressive management for overall effective treatment of the overweight or obese patient to reduce their risk of mortality. 2 Obesity contributes to some of the leading causes of preventable death including hypertension, dyslipidemia, diabetes mellitus, CVD, stroke, sleep apnea, gallbladder disease, osteoarthritis, and certain cancers.2 Obesity is officially recognized as a disease by the American Medical Association with a pathophysiological basis for metabolic and biochemical dysfunctions.

ETIOLOGY AND EPIDEMIOLOGY

Obesity is a multifactorial, complex disease that occurs because of an interaction between genotype and the environment. Although the etiology is not completely known, it involves overlapping silos of social, behavioral, hormonal, and genetic influence.3 The majority of overweight or obese individuals are adults, but overweight or obesity is also prevalent in children between 2 and 19 years of age. Just over 1/3rd of US adults 20 years of age and older are currently considered obese. The prevalence of obesity in men and women of various racial and ethnic origins differs. Thirty-six percent of non-Hispanic white adults are obese, whereas approximately 40% of Hispanics and 50% of non-Hispanic blacks are obese.4

Thirty-two percent of children and adolescents aged 2 to 19 years are overweight or obese. Overweight children typically become overweight adults, but most obese adults were not overweight as children.2,5,6,7 Psychosocial functioning also may be hindered because obese patients may be at risk for discrimination as well as higher risk of low self-esteem and depression.2

PATHOPHYSIOLOGY

The key factor in the development of overweight and obesity is the imbalance that occurs between ...

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