Excercise and Diet

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Individualize Obesity Treatment with Realistic Goals

Obesity cannot be managed like other diseases because treatment depends on the patient's level of acceptance and commitment. Five categories of obese patients have been identified.

  1. Patients who do not recognize that weight affects their health,
  2. Patients who recognize the health risk involved, but are unclear on a proper response,
  3. Patients who are ready for action and need concrete suggestions,
  4. Patients who are already active and want to know how to keep going,
  5. Patients who have started on a program and relapsed, but want to get started again.

The first line for treatment should begin with diet and exercise counseling with a 24-hour diet and exercise recall. For patients who are ready to diet, both foods that are low in caloric density and regular mealtimes are recommended. A support group also helps to build on healthy eating habits. Patients need to be ready to add physical activity to their lives and to avoid frustration, it should be recommended incrementally.

Obesity drugs are considered a secondary strategy. Available drugs include orlistat (Xenical, Hoffmann-LaRoche), which inhibits fat absorption by about 50% by delivering fat to distal parts of the bowel. The Food and Drug Administration has approved it without any specific restrictions. Sibutramine (Meridia, BASF) has displayed 20-year safety and efficacy data, although patients should take it after one year of treatment only with a doctor's supervision. The primary side effect is hypertension, which can become severe in some cases. Surgery is about 70% effective a reducing weight by 30% or more and maintaining it for up to 15 year. Surgery, however, should only be recommended for patients with BMI > 40 because associated mortality can be high.

Adapted from Bessesen D. How do we treat? Presented at the American Heart Association Scientific Sessions November, 2000, New Orleans, LA


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