DOCSLIB.ORG

NHLBI Obesity Education Initiative

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
NHLBI Obesity Education Initiative NHLBI Obesity Education Initiative The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults NATIONALNATIONAL INSTITUTESINSTITUTES OFOF HEALTHHEALTH NATIONALNATIONAL HEART,HEART, LUNG,LUNG, ANDAND BLOODBLOOD INSTITUTEINSTITUTE NORTH AMERICAN ASSOCIATION FOR THE STUDY OF OBESITY ACKNOWLEDGMENTS: The Working Group wishes to acknowledge the additional input to the Practical Guide from the following individuals: Dr. Thomas Wadden, University of Pennsylvania; Dr. Walter Pories, East Carolina University; Dr. Steven Blair, Cooper Institute for Aerobics Research; and Dr. Van S. Hubbard, National Institute of Diabetes and Digestive and Kidney Diseases. The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults National Institutes of Health NHLBI Obesity Education Initiative National Heart, Lung, and Blood Institute North American Association for the Study of Obesity NIH Publication Number 00-4084 October 2000 NHLBI Obesity Education Initiative Barbara C. Hansen, Ph.D. David F. Williamson, Ph.D., M.S. Expert Panel on the Identification, University of Maryland School of Medicine Centers for Disease Control and Prevention Evaluation, and Treatment of Millicent Higgins, M.D. G. Terence Wilson, Ph.D. Overweight and Obesity in Adults. University of Michigan Rutgers Eating Disorders Clinic F.Xavier Pi-Sunyer, M.D., M.P.H. James O. Hill, Ph.D. Columbia University College University of Colorado EX-OFFICIO MEMBERS of Physicians and Surgeons Health Sciences Center Clarice D. Brown, M.S. Chair of the Panel Barbara V. Howard, Ph.D. Coda Research Inc. Medlantic Research Institute Karen A. Donato, M.S., R.D.* MEMBERS Robert J. Kuczmarski, Dr.P.H., R.D. Executive Director of the Panel Coordinator, NHLBI Obesity Diane M. Becker, Sc.D., M.P.H. National Center for Health Statistics Education Initiative The Johns Hopkins University Centers for Disease Control and Prevention National Heart, Lung, and Blood Institute Claude Bouchard, Ph.D. Shiriki Kumanyika, Ph.D., R.D., M.P.H. National Institutes of Health Laval University The University of Pennsylvania Nancy Ernst, Ph.D., R.D.* Richard A. Carleton, M.D. R. Dee Legako, M.D. National Heart, Lung, and Blood Institute Brown University School of Medicine Prime Care Canyon Park Family Physicians, Inc. National Institutes of Health Graham A. Colditz, M.D., Dr.P.H. D. Robin Hill, Ph.D.* Harvard Medical School T. Elaine Prewitt, Dr.P.H., R.D. Loyola University Medical Center National Heart, Lung, and Blood Institute William H. Dietz, M.D., Ph.D. National Institutes of Health National Center for Chronic Disease Albert P. Rocchini, M.D. Michael J. Horan, M.D., Sc.M.* Prevention and Health Promotion University of Michigan Medical Center National Heart, Lung, and Blood Institute Centers for Disease Control and Prevention Philip L Smith, M.D. National Institutes of Health John P. Foreyt, Ph.D. The Johns Hopkins Asthma Van S. Hubbard, M.D., Ph.D. Baylor College of Medicine and Allergy Center National Institute of Diabetes and Linda G. Snetselaar, Ph.D., R.D. Robert J. Garrison, Ph.D. Digestive and Kidney Diseases University of Tennessee, Memphis University of Iowa James P. Kiley, Ph.D.* James R. Sowers, M.D. Scott M. Grundy, M.D., Ph.D. National Heart, Lung, and Blood Institute Wayne State University School of Medicine University of Texas Southwestern National Institutes of Health Medical Center at Dallas University Health Center Eva Obarzanek, Ph.D., R.D., M.P.H.* Michael Weintraub, M.D. National Heart, Lung, and Blood Institute Food and Drug Administration National Institutes of Health North American Association for the Susan Fried, Ph.D. *NHLBI Obesity Initiative Task Force Member Study of Obesity Practical Guide Rutgers University CONSULTANT Development Committee Patrick Mahlen O'Neil, Ph.D. Medical University of South Carolina David Schriger, M.D., M.P.H., F.A.C.E.P. Louis J. Aronne, M.D., F.A.C.P. University of California Henry Buchwald, M.D. Cornell University, Chair Los Angeles School of Medicine University of Minnesota MEMBERS George Cowan, M.D. SAN ANTONIO COCHRANE CENTER University of Tennessee Charles Billington, M.D. Elaine Chiquette, Pharm.D. College of Medicine University of Minnesota Robert Brolin, M.D. Cynthia Mulrow, M.D., M.Sc. George Blackburn, M.D., Ph.D. UMDNJ-Robert Wood Johnson V.A. Cochrane Center at San Antonio Harvard University Medical School Audie L. Murphy Memorial Karen A. Donato, M.S., R. D. Veterans Hospital NHLBI Obesity Education Initiative EX-OFFICIO MEMBERS STAFF National Heart, Lung, and James O. Hill, Ph.D. Blood Institute University of Colorado Adrienne Blount, Maureen Harris, M.S., R.D., National Institutes of Health Health Sciences Center Anna Hodgson, M.A., Pat Moriarty, M.Ed., R.D., R.O.W. Sciences, Inc. Arthur Frank, M.D. Edward Bernstein, M.P.H. George Washington University North American Association for the Study of Obesity Table of Contents Foreword ......................................................................................................................................v How To Use This Guide..............................................................................................................vi Executive Summary ....................................................................................................................1 Assessment ..........................................................................................................................1 Body Mass Index...........................................................................................................1 Waist Circumference .....................................................................................................1 Risk Factors or Comorbidities.......................................................................................1 Readiness To Lose Weight............................................................................................2 Management.........................................................................................................................2 Weight Loss ..................................................................................................................2 Prevention of Weight Gain ............................................................................................2 Therapies..............................................................................................................................2 Dietary Therapy.............................................................................................................2 Physical Activity ............................................................................................................3 Behavior Therapy ..........................................................................................................3 Pharmacotherapy..........................................................................................................3 Weight Loss Surgery.....................................................................................................4 Special Situations.................................................................................................................4 Introduction..................................................................................................................................5 The Problem of Overweight and Obesity .............................................................................5 Treatment Guidelines..................................................................................................................7 Assessment and Classification of Overweight and Obesity.................................................8 Assessment of Risk Status ................................................................................................11 Evaluation and Treatment Strategy ....................................................................................15 Ready or Not: Predicting Weight Loss ...............................................................................21 Management of Overweight and Obesity...........................................................................23 Weight Management Techniques .............................................................................................25 Dietary Therapy ..................................................................................................................26 Physical Activity..................................................................................................................28 Behavior Therapy ...............................................................................................................30 Making the Most of the Patient Visit............................................................................30 Pharmacotherapy ...............................................................................................................35 Weight Loss Surgery..........................................................................................................38 Weight Reduction After Age 65 ...............................................................................................41 References .................................................................................................................................42 iii Introduction to the Appendices ...............................................................................................45 Appendix A. Body Mass Index Table..................................................................................46
Load more

Recommended publications
  • Medical Weight Loss New Patient Packet
    Thank you for choosing St. Elizabeth to help you achieve your weight loss goal! This packet will help you prepare for your first visit to get started. If you have not yet scheduled that visit, please call us at 859-212- GOAL (4625). Then review and complete this packet prior to your first appointment. Because this information is critical to successfully creating a personalized program for you, if you arrive at your first appointment without a completed packet, your appointment will be rescheduled. Checklist and survey for your initial visit at the Weight Management Center ¨ Did you complete a patient information session? (Initial and enter date of participation) _____Attended in-person patient information session. Date attended: ____________ _____Watched entire online session with Dr. Schumann and Dr. Catanzaro. Date viewed: ____________ If you have not participated in an in-person or online information session, please note that this free education is required prior to your first visit. It allows us to provide important information to you without charging you for an extensive office visit. ¨ After learning about the options during the information session, which program do you feel is right for you? (Initial your choice below) _____Very Low Calorie Diet (VLCD): meal replacement only program. Low Calorie Diet (LCD) (choose option below) _____Outlook 1: 1 meal and 2+ meal replacements. _____Outlook 2: 2 meals and 1+ meal replacements. _____Outlook 3: all food (no meal replacements). ¨ I understand the financial and follow-up requirements of the program: (Circle) Yes No o Weekly follow-up initially. § If not covered by insurance, $39 self-pay charge for nurse or dietician visit.
    [Show full text]
  • 7 Live Lean Nutrition Laws Brad Gouthro
    7 Live Lean Nutrition Laws Brad Gouthro Host, Living Lean With The Ultimate Body Press Certified Trainer & Nutrition Specialist Live Lean Nutrition Law #1 Set A Measurable & Realistic Goal Most people come to me and say… “Brad, I need to lose 10 lbs before summer in 2 months.” That's a great start. You have a set measurable goal… 10 lbs in 8 weeks. But is this realistic (and healthy)? Typically, a healthy fat loss plan will allow you to lose 1-2 pounds of fat per week with exercise and a nutrition plan that puts you in a caloric deficit. A caloric deficit simply means you're burning more calories than you're eating. However, everyone's calorie requirements are different based on your current body composition and activity levels. Lets take a closer look. How many calories should I be eating to lose fat? Going into a severe calorie deficit through dieting alone IS NOT the most effective approach. Not only is this crash diet unhealthy and unsustainable, your body will also go into starvation mode. This means it’ll end up storing fat and burning your muscle for fuel. This loss of muscle slows your metabolism and adds up to a “lighter” but fatter version of your current self. Heard of the term “skinny fat”…well that’s what happens on crash diets. The two healthiest ways to create a calorie deficit is by following a diet that puts you in a modest caloric deficit AND THEN follow that up with an intense exercise program to create an even higher caloric deficit.
    [Show full text]
  • Weight Management Guideline: Children and Adolescents
    Weight Management in Children and Adolescents Screening and Intervention Guideline Prevention ........................................................................................................................................ 2 Nutrition ........................................................................................................................................ 2 Healthy eating behaviors .............................................................................................................. 2 Physical activity ............................................................................................................................ 3 Screening ......................................................................................................................................... 3 Diagnosis.......................................................................................................................................... 3 Interventions ..................................................................................................................................... 4 Goals ............................................................................................................................................ 4 Strategies to help with weight loss ............................................................................................... 5 Behavior change counseling using the 5A approach ................................................................... 5 Lifestyle modifications .................................................................................................................
    [Show full text]
  • Weight Management Program Welcome to the Foundation Weight
    Welcome to the Foundation Weight Management Program! Foundation Weight Management Program We are glad you have decided to take the first step toward improving your health and look forward to working with you to design an individualized treatment plan that helps you achieve your long term weight loss goals. This program promotes a supportive and nonjudgemental environment and is designed for highly motivated individuals who are truly ready to lose weight and maintain an overall healthy lifestyle. What to Expect: Enclosed you will find new patient paperwork, which includes a detailed intake form. This form asks questions regarding your weight and general medical history. Please answer these questions as honestly as possible. Your answers will help our team design the best and safest treatment plan for your lifestyle and medical history. In addition to the completed forms, please bring a list of all medications and over the counter supplements to your initial visit. We also encourage patients to check with their insurance plan regarding coverage for registered dieticians (nutritionists) before their initial consultation. Our dietician has extensive experience in the field of weight management and is a valuable asset to our program. Please note: if you have Medicare, a visit with a registered dietician will only be covered if you have diabetes or kidney disease. Your initial consultation will last approximately 60 minutes. Our nurse will review your current medications and take your vital signs, including your height, weight, blood pressure, and waist circumference. Your provider will ask you detailed questions regarding your weight, your general medical history, and any surgeries you may have had.
    [Show full text]
  • Behavioral Approach to Weight Loss
    Pennington Nutrition Series Healthier lives through education in nutrition and preventive medicine Body Mass Index (BMI) is a way to define over- The distribution of body fat is important from a weight and obesity. The index is a mathematical formula in chronic disease perspective. Those who have more which a person’s body weight in kilograms is divided by body fat in the abdominal area have an increased risk the square of his or her height in meters [kg/m2]. The BMI for elevated triglycerides, high blood pressure and is more highly correlated with body fat than any other glucose intolerance. Waist circumference correlates mathematical ratio of height and weight; however, athletes well with chronic disease risk. A waist circumference and individuals with a high percentage of muscle may of 40 inches (102 cm) or more in men or a waist have a BMI in the overweight range because of the higher circumference of 35 inches (88cm) or more in women density of muscle compared to fat. puts one at greater risk of insulin resistance and the chronic diseases associated with it. A BMI of 18 to 25 is considered normal weight. Individuals with a BMI of 25 to 29.9 are When someone is a few pounds overweight and considered overweight, and those with a BMI of is motivated to lose weight, there are safe and effec- 30 or more are considered obese. tive methods to lose a few pounds and to maintain a Overweight is defined as increased weight in weight loss. relation to height. Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass.
    [Show full text]
  • Using Surgery to Remove Fat Has Long Been a Quest Of
    I have these deposits offat where I really hate them, especially on my thighs. Dieting hasn't helped. -Ginny, 34, secretary sing surgery to remove fat has long been a quest of Ucosmetic surgeons, but the journey toward that dream has been slow until recently. About twenty years ago, physicians in Italy scraped out fat through a relatively small incision using a sharp, circular-ended knife called a curette. Because severe complications often resulted, this technique did not gain widespread acceptance. Seizing on that idea, doctors in France began using a blunt-ended canula, a metal tube with openings along the sides that looks a bit like an oversized straw, to remove fat more gently while preserving the important connections between the skin and muscle. This fat-removal method minimized the chances of damage to surrounding tissue. In a variation on the technique, doctors began infusing into the fat small amounts of saline (salt water), which was identical in composition to the water in our body. This helped break up the fat globules, making them easier to remove. © Copyright 2000, David J. Leffell. MD. All rights reserved. 172 Look Your Best After the technique was introduced to the United States in 1982, lipo­ suction rapidly gained popularity, though the potential for complications, many related mostly to the use of general anesthesia, remained. Three years later, American dermatologist Jeffrey Klein introduced tumescent anesthesia. The tumescent technique involves injecting low-concentration anesthetic solution (lidocaine) into the fat combined with epinephrine (to reduce bleeding and prolong the anesthetic effect) and saline. Large vol­ umes of this solution are injected into the fat before surgery, thus swelling the area to approximately two to three times its normal size.
    [Show full text]
  • Obesity and Its Relation to Mortality Costs Report
    Obesity and its Relation to Mortality and Morbidity Costs DECEMBER 2010 SPONSORED BY PREPARED BY Committee on Life Insurance Research Donald F. Behan, PhD, FSA, FCA, MAAA Society of Actuaries Samuel H. Cox, PhD, FSA, CERA University of Manitoba CONTRIBUTING CO-AUTHORS: Yijia Lin, Ph.D. Jeffrey Pai, Ph.D, ASA Hal W. Pedersen, Ph.D, ASA Ming Yi, ASA The opinions expressed and conclusions reached by the authors are their own and do not represent any official position or opinion of the Society of Actuaries or its members. The Society of Actuaries makes no representation or warranty to the accuracy of the information. © 2010 Society of Actuaries, All Rights Reserved Obesity and its Relation to Mortality and Morbidity Costs Abstract We reviewed almost 500 research articles on obesity and its relation to mortality and morbidity, focusing primarily on papers published from January 1980 to June 2009. There is substantial evidence that obesity is a worldwide epidemic and that it has a significant negative impact on health, mortality and related costs. Overweight and obesity are associated with increased prevalence of diabetes, cardiovascular disease, hypertension and some cancers. There also is evidence that increased weight is asso- ciated with kidney disease, stroke, osteoarthritis and sleep apnea. Moreover, empirical studies report that obesity significantly increases the risk of death. We used the results to estimate costs due to overweight and obesity in the United States and Canada. We estimate that total annual economic cost of overweight and obesity in the United States and Canada caused by medical costs, excess mortality and disability is approximately $300 billion in 2009.
    [Show full text]
  • Weight Management Screening and Intervention Guideline
    Weight Management Screening and Intervention Guideline Summary of Changes as of August 2018 ..................................................................................................... 2 Background ................................................................................................................................................... 2 Screening ...................................................................................................................................................... 2 Diagnosis....................................................................................................................................................... 3 Weight Goals ................................................................................................................................................. 4 Interventions .................................................................................................................................................. 5 Behavior change counseling .................................................................................................................. 5 Lifestyle modification resources ............................................................................................................. 6 Diets and commercial weight-loss programs .......................................................................................... 6 Bariatric surgery.....................................................................................................................................
    [Show full text]
  • Childhood Obesity During the 1960S Are Available for Certain Age Groups
    NATIONAL CENTER FOR HEALTH STATISTICS SEPTEMBER Health E-Stats 2018 Prevalence of Overweight, Obesity, and Severe Obesity Among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 Through 2015–2016 by Cheryl D. Fryar, M.S.P.H., Margaret D. Carroll, M.S.P.H., and Cynthia L. Ogden, Ph.D., Division of Health and Nutrition Examination Surveys Results from the 2015–2016 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that an estimated 18.5% of U.S. children and adolescents aged 2–19 years have obesity, including 5.6% with severe obesity, and another 16.6% are overweight. Body mass index (BMI), expressed as weight in kilograms divided by height in meters squared (kg/m2), is commonly used to classify obesity among adults and is also recommended for use with children and adolescents. Cutoff criteria are based on the sex-specific BMI-for-age 2000 CDC Growth Charts for the United States (available from: https://www.cdc.gov/growthcharts/cdc_charts.htm). Based on current recommendations from expert committees, children and adolescents with BMI values at or above the 95th percentile of the growth charts are categorized as having obesity. This differs from previous years in which children and adolescents above this cutoff were categorized as overweight. This change in terminology reflects the category labels used by organizations such as the National Academy of Medicine and the American Academy of Pediatrics. For more information, see “Changes in Terminology for Childhood Overweight and Obesity,” available from: https://www.cdc.gov/nchs/data/nhsr/nhsr025.pdf.
    [Show full text]
  • Clinical Policy: Bariatric Surgery Reference Number: NH
    Clinical Policy: Bariatric Surgery Reference Number: NH. CP.MP.37 Coding Implications Effective Date: 06/09 Revision Log Last Review Date: 04/18 See Important Reminder at the end of this policy for important regulatory and legal information. Description There are two categories of bariatric surgery: restrictive procedures and malabsorptive procedures. Gastric restrictive procedures include procedures where a small pouch is created in the stomach to restrict the amount of food that can be eaten, resulting in weight loss. The laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) are examples of restrictive procedures. Malabsorptive procedures bypass portions of the stomach and intestines causing incomplete digestion and absorption of food. Duodenal switch is an example of a malabsorptive procedure. Roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and biliopancreatic diversion with gastric reduction duodenal switch (BPD-GRDS) are examples of restrictive and malabsorptive procedures. LAGB devices are currently not FDA approved for adolescents less than 18 years, but an industry- sponsored prospective study is in progress, and numerous retrospective studies of adolescents have been published with favorable results. Policy/Criteria It is the policy of NH Healthy Families that the bariatric surgery procedures LAGB, LSG, and laparoscopic RYGB for adolescents and adults and laparoscopic BPD-DS/BPD-GRDS for adults are medically necessary when meeting the following criteria under section I through III: I. Participating providers that are MBSAQIP (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program for the American College of Surgeons) accredited have demonstrated a commitment to excellence in ethics, quality and patient care.
    [Show full text]
  • Obesity Medicine and Bariatric Surgery
    Obesity Medicine Your MOVE TIME Bariatric TEAM! • Obesity Medicine Physicians • Bariatric Surgeons • Behavioral Medicine/Psychologists • Dietitians • Physical Therapists • Nursing and Clerical staff Goals of the MOVE TIME Clinic • To help you lose weight, live a healthy lifestyle and improve your quality of life – Medical management to help those not interested in surgery or not surgical candidate – Medically optimize obesity-related comorbid conditions – Surgical management for those interested in weight-loss surgery Medical Evaluation: What do we do? • Evaluate causes of obesity • Evaluate/treat obesity-related conditions • Offer medical treatments for obesity – Weight loss medications • Pre-operative evaluation • Post-operative care Common Causes of Obesity • Inactivity- computer, gaming, TV time, commuting, desk work • Excess caloric intake- large portions, liquid calories (alcohol/sodas), unhealthy food choices Medical Causes of Obesity • Untreated Sleep Apnea (OSA) • Insomnia/Poor sleep • Hormone related- Hypothyroidism, Polycystic Ovarian Syndrome, Low Testosterone, Cushings • Depression, anxiety, PTSD, sexual trauma, stress • Medications- e.g. psychiatric medications, insulin for diabetes • Genetics/Epigenetics • Traumatic Brain Injuries Medical conditions related to Obesity • Diabetes • Heart Failure • High Blood Pressure • Kidney disease • High Cholesterol • Inflammation • Sleep Apnea • Blood Clots • Heart Burn/Reflux • Cancers • Joint • Infertility pain/Osteoarthritis • Urinary Incontinence • Fatty liver and cirrhosis • Hormone
    [Show full text]
  • Underweight Vs. Overweight/Obese: Which Weight Category Do We Prefer? Dissociation of Weight#Related Preferences at the Explicit and Implicit Level
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Harvard University - DASH Underweight vs. overweight/obese: which weight category do we prefer? Dissociation of weight#related preferences at the explicit and implicit level The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Marini, M. 2017. “Underweight vs. overweight/obese: which weight category do we prefer? Dissociation of weight#related preferences at the explicit and implicit level.” Obesity Science & Practice 3 (4): 390-398. doi:10.1002/osp4.136. http://dx.doi.org/10.1002/osp4.136. Published Version doi:10.1002/osp4.136 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:34651998 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Obesity Science & Practice doi: 10.1002/osp4.136 ORIGINAL ARTICLE Underweight vs. overweight/obese: which weight category do we prefer? Dissociation of weight-related preferences at the explicit and implicit level M. Marini1,2,3, 1Center for Translational Neurophysiology, Summary Istituto Italiano di Tecnologia, Ferrara, Italy; Objective 2Department of Neurobiology, Harvard Medical School, Boston, MA, USA; 3Department of Psychology, Harvard Although stigma towards obesity and anorexia is a well-recognized problem, no research University, Cambridge, MA, USA has investigated and compared the explicit (i.e. conscious) and implicit (i.e. unconscious) preferences between these two conditions.
    [Show full text]