By George A Bray, Claude Bouchard
Discusses present tools and strategies for the assessment, prevention, and remedy of weight problems. information recommendations to control and inhibit weight problems and consuming issues. Considers the type and assessment of the obese sufferer.
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Extra resources for Handbook of obesity: clinical applications
98. National Task Force on the Prevention and Treatment of Obesity. Weight cycling. JAMA 1994; 272:1196– 1202. 99. Williamson DF. S. adults. Ann Intern Med 1993; 119:646–649. 100. NHLBI Obesity Education Initiative Expert Panel on the Identiﬁcation, Evaluation, and Treatment of Overweight and Obesity in Adults. Clinical guidelines on the identiﬁcation, evaluation, and treatment of overweight and obesity in adults-the evidence report. Obes Res 1998; 6(suppl 2):51S–209S. ) 101. National Institutes of Health, National Heart Lung and Blood Institute, North American Association for the Study of Obesity.
Oﬃce chairs of standard width and side arm rests will not comfortably accommodate moderately to severely obese patients. Ideal chairs have no arms so that patients do not have to squeeze themselves Table 1 Oﬃce-Based Obesity Care The physical environment Accessibility and comfort: stairs, doorways, hallways, restrooms, waiting room chairs and space, reading materials and other educational materials Equipment Large adult and thigh blood pressure cuﬀs, large gowns, step stools, weight and height scales, tape measure Materials Educational and behavior promoting handouts on diet, exercise, medications, surgery, BMI, obesity-associated diseases Tools Previsit questionnaires, BMI stamps, food and activity diaries, pedometers Protocols Patient care treatment protocols for return visit schedule, medications, referrals to dietitians and psychologists Staﬃng Team approach to include oﬃce nurse, physician assistant, nurse practitioner, health advocate into predeﬁned ‘‘normal’’ dimensions.
The presence of obesity may suggest the need for mammography on a regular basis. 6 Ultrasound of the Gallbladder The high prevalence of gallstones in obese men and women would suggest the desirability of an ultrasound, especially if there any abdominal complaints of indigestion. D Clinical Plan Once the workup for etiologic and complicating factors is complete, the risk associated with elevated BMI, fat Table 15 Diagnostic Criteria for Diabetes Diagnostic category Normal Impaired glucose tolerance (IGT) Diabetes Fasting glucose 2-hr Value from glucose tolerance test mg/dL <110 110–125 mg/dL >140 140–199 \126 >200 20 Bray Table 16 LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes and Drug Therapy Risk category CHD or CHD risk Equivalents (10-year risk >20% 2+ Risk factors (10-year risk 20%) 0–1 Risk factors LDL goal LDL level at which to initiate therapeutic lifestyle changes LDL level at which to consider drug therapy <100 mg/dL 100 mg/dL 130 mg/dL (100–129 mg/dL: drug optional) <130 mg/dL 130 mg/dL <160 mg/dL >160 mg/dL 10-year risk 10–20% 130 mg/dL; 10-year risk <10% 160 mg/dL 190 mg/dL (160–189 mg/dL: LDL-lowering drugs optional) Figure 6 An algorithm for evaluating when laboratory and clinical testing may be needed and for approaching treatment strategies.