Patient Screening, Assessment, and Expectations
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Beans are also high in fiber and slow to digest. That means you feel full longer, which may stop you from eating more. Start a meal with a cup of soup, and you may end up eating less.
You want to keep the soup to to calories a serving. So skip the dollops of cream and butter. Want to enjoy chocolate between meals? Pick a square or two of dark over the milky version. When Penn State researchers added pureed cauliflower and zucchini to mac and cheese, people seemed to like the dish just as much. But they ate to fewer calories. Those healthy vegetables added low-cal bulk to the tasty dish. A protein-rich breakfast may help you resist snack attacks throughout the day.
The women ate a calorie breakfast that included eggs and a beef sausage patty. The effect of the high-protein breakfast seemed to last into the evening, when the women munched less on fatty, sugary goods than the women who had cereal for breakfast. For a great snack on the run, take a small handful of almonds, peanuts, walnuts, or pecans.
Research shows that when people munch on nuts, they automatically eat less at later meals. Skip the apple juice and the applesauce and opt instead for a crunchy apple. One reason is that raw fruit has more fiber. A Harvard study followed more than , people for a decade or longer. Yogurt, of all the foods that were tracked, was most closely linked to weight loss. Yes, grapefruit really can help you shed pounds, especially if you are at risk for diabetes.
Drinking grapefruit juice had the same results. But grapefruit juice doesn't have any proven "fat-burning" properties -- it may just have helped people feel full. Failure rates based on weight loss are controversial. The overall failure rates for malabsorptive procedures are relatively low, although the need for reversal of the surgery because of resulting adverse effects appears to be relatively high.
Despite the morbidity and mortality risk associated with bariatric surgery, the few reports involving follow-up on patients undergoing these procedures suggest overall improvement in quality of life. Even more convincing than this finding is that most subjects who undergo these procedures, despite their postoperative complications and difficulties, indicate that they would undergo the procedures again if necessary.
Inpatient evaluations of obese patients are important in the immediate postoperative period after antiobesity surgery. In addition, hospitalization may be required for the management of major complications, such as clinically significant respiratory or cardiac compromise. Weight-management programs may be based in an outpatient or inpatient setting. No rigorous evidence suggests that inpatient programs are necessarily superior to outpatient programs of similar structure and content, however.
Inpatient programs may offer the convenience of easy access to patients and ease of monitoring, but they are not only expensive to run and difficult to reimburse, they also generally cause considerable disruption to the patients' regular routine.
In addition, they offer little guarantee of sustained effect. Because of the sheer prevalence of obesity and the anticipated worsening of the pandemic in the next few decades, prevention is by far the most desirable means to curb the medical and economic consequences of this condition.
However, few trials have addressed this issue, and those performed thus far have had mixed results. Given the global proportions of obesity, a concerted approach is needed to address the problem and should involve the development of a massive public health education program aimed at adults and children as a means of changing their eating, activity, and behavioral habits.
Cooperative efforts will also be needed among public health authorities, caterers, the fast food industry, and organizers of sports and outdoor games. Results of some public health education initiatives in Singapore and parts of China that are only now being evaluated suggest, as hoped, that such programs have the potential for reducing the incidence and prevalence of obesity and may also have an impact on the major comorbidities of obesity, such as type 2 diabetes and hypertension.
Until advances in gene therapy permit the alteration of genes that predispose to obesity, such programs are the only preventive options available. In select cases, consultation with a psychiatrist may be indicated.
Psychiatric consultation should be sought for patients with psychiatric disorders and personality disorders eg, severe depression, mania, obsessive disorders that may be worsened by attempts at weight loss if not adequately treated and controlled.
As with the management of other chronic medical conditions eg, diabetes mellitus, hypertension, bronchial asthma , long-term success in the management of obesity is contingent on long-standing follow-up with the weight-loss program.
Experience obtained from the lifestyle intervention group of patients in the Diabetes Prevention Program and information drawn from the ongoing Diabetes Prevention Program Observation study have borne out the importance of regular follow-up. Patient visits may not need to occur as frequently during follow-up as during the initial weight-loss phase. Nevertheless, they are paramount if the lessons learned regarding diet, exercise habits, and behavioral patterns are to be maintained.
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Obesity and chronic kidney disease: Serve d as a director, officer, partner, employee, advisor, consultant or trustee for: Receieved consulting fee Sanofi Aventis for teaching.
Received salary from Medscape for employment. Sign Up It's Free! If you log out, you will be required to enter your username and password the next time you visit. Share Email Print Feedback Close. Approach Considerations Treatment of obesity starts with comprehensive lifestyle management ie, diet, physical activity, behavior modification , which should include the following [ 10 ]: Self-monitoring of caloric intake and physical activity. Electrolyte derangements - Hypokalemia is the most important of these.
Why - Identify specific reasons for or purpose or benefits of the goal. Weight-Loss Goals In general, body weight and body fat are tenaciously regulated.
Weight-Loss Maintenance Evidence from the National Weight Control Registry NWCR , which tracks indices and predictors in individuals who have lost at least 30 pounds and have maintained that loss for at least 1 year, suggests that patterns associated with successful weight maintenance include the following: Treatment of Childhood Obesity In cases of childhood obesity, [ 93 , 94 , 95 ] the goal is not to cause weight loss, but to reduce the rate of weight gain to fit normal growth curves.
The basic principles of management include the following: Reducing time spent in sedentary activities - Eg, watching television.
Energy Expenditure and Weight Loss Achieving a caloric deficit is still the most important component in achieving sustained weight loss. Conventional Diets Conventional diets can be broadly classified into 2 categories: The latter include the following: Low-fat diets - Eg, the Ornish diet.
Protein intake of 0. Adequate micronutrients and macronutrients based on the RDAs. Clinically significant cardiac, renal, hepatic, psychiatric, or cerebrovascular disease. Water Drinking Dennis et al found that in overweight and obese middle-aged and older adults on a hypocaloric diet, drinking water before each main meal aided weight loss.
Exercise Programs Before prescribing an intensive exercise program, clinicians should screen patients for cardiovascular and respiratory adequacy. Behavioral Changes Behavioral modification for weight loss addresses learned behaviors that contribute to excessive food intake, poor dietary choices or habits, and sedentary activity habits. Antiobesity Medications Few medications are available for the treatment of obesity.
Thyroid hormone - Hyperthyroidism, with its attendant sequelae. Phenylpropanolamine - Increased risk of myocardial infarction and stroke. Fat Substitutes One strategy to prevent obesity that is being explored in the dietary industry involves the use of fat substitutes.
Bariatric Surgery Surgical therapy for obesity bariatric surgery is the only available therapeutic modality associated with clinically significant and relatively sustained weight loss in subjects with morbid obesity associated with comorbidities. Anastomotic leaks with a potential for mediastinitis or peritonitis. Blind-loop syndrome - Includes enteritis, arthropathy, and liver cirrhosis. Inpatient Care Inpatient evaluations of obese patients are important in the immediate postoperative period after antiobesity surgery.
Deterrence and Prevention Because of the sheer prevalence of obesity and the anticipated worsening of the pandemic in the next few decades, prevention is by far the most desirable means to curb the medical and economic consequences of this condition. Consultations The following consultations are recommended in the treatment of obesity: Long-Term Monitoring As with the management of other chronic medical conditions eg, diabetes mellitus, hypertension, bronchial asthma , long-term success in the management of obesity is contingent on long-standing follow-up with the weight-loss program.
Central nervous system neurocircuitry for satiety and feeding cycles. What would you like to print? Print this section Print the entire contents of Print the entire contents of article. This website also contains material copyrighted by 3rd parties. How to Diagnose and Treat an Epidemic.
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