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Vertically
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Diagnosis
and Vertically Integrated Management of Obesity Slide 8-1. Common reasons given by physicians for failing to recognize and treat obesity as a medical problem in their offices include lack of time, lack of knowledge, and economic factors. Slide 8-2. Arguments for the physician taking a primary role in the management of obesity include 1) studies showing that the physician is a more effective agent of behavior change than allied health professionals 2) evidence that time efficient methods including meal replacements and portion-controlled meals can be effective in the office setting and 3) billing for co-morbid conditions, cost-savings and increased patient satisfaction result from successful management of obesity in the office setting. Slide 8-3. The office visit for obesity includes a determination of body mass index, co-morbid conditions, communication of physician concern to the patient, counseling on trigger foods, the prescription of meal replacements and portion-controlled meals, and provision for follow-up and lifestyle change. Slide 8-4. The presence of co-morbid conditions (hypertension, hyperlipidemia, diabetes mellitus, sleep apnea) or elevated waist-to-hip ratio (or simply waist circumference) influence the effects of body mass index (weight divided by height squared) on disease risk. The diagnosis of obesity must be considered in the context of co-morbid diseases and weight reduction used as a part of the therapy of these conditions. Body mass index can be defined using widely available charts or calculated as the weight in pounds multiplied by the factor 705 and divided by the height in inches squared. Slide 8-5. If body mass index is fixed at an arbitrary level (about 27) to diagnose the presence or absence of obesity in the population as was done in the National Health and Nutrition Examination Survey shown here, then there was a real 30% increase in the average incidence of obesity from 24 to 32 percent of the US population in the last decade. The reasons for this increased incidence are not fully understood. In some ethnic groups (Hispanic and African-American women) the incidence of obesity approaches 50%. Slide 8-6. A similar and disturbing increase in adolescent obesity was seen in the same surveys. These changes in body fat during adolescence are being studied to determine their effects on lifetime risks of chronic disease. However, there has already been an increase in Type II Diabetes Mellitus in adolescents and even pre-adolescents in certain ethnic groups. The prevention and treatment of adolescent obesity is a major public health objective at present.
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Nutrition
101 - Natural
Remedies - Weight
Management - Physician
Education |
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