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Overweight and Obesity in Adults

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Overweight and Obesity in Adults UWS Clinics Conservative Care Pathways Adopted 10/05 Revised 4/15 OVERWEIGHT AND OBESITY IN ADULTS Primary author: Jim Gerber MS, DC Additional contributions made by: Ron LeFebvre DC, Joel Agresta PT, DC Owen T. Lynch DC Edited by: Ron LeFebvre DC Reviewed and Adopted by CSPE Working Group (2014) Amanda Armington DC, Daniel DeLapp DC, DABCO, LAc, ND, Lorraine Ginter DC, Shawn Hatch DC, Ronald LeFebvre DC, Owen T. Lynch DC, Ryan Ondick DC, Joseph Pfeifer DC, Anita Roberts DC, James Strange DC, Laurel Yancey DC Clinical Standards, Protocols, and Education (CSPE) Committee (2005) Shireesh Bhalerao, DC; Daniel DeLapp, DC, DABCO, ND, LAc; Elizabeth Dunlop, DC; Lorraine Ginter, DC; Sean Herrin, DC; Ronald LeFebvre, DC; Owen T. Lynch, DC; Karen E. Petzing, DC; Ravid Raphael, DC, DABCO; Anita Roberts, DC; Steven Taliaferro, DC . UWS care pathways and protocols provide evidence-informed, consensus-based guidelines to support clinical decision making. To best meet a patient's healthcare needs, variation from these guidelines may be appropriate based on more current information, clinical judgment of the practitioner, and/or patient preferences. These pathways and protocols are informed by currently available evidence and developed by UWS personnel to guide clinical education and practice. Although individual procedures and decision points within the pathway may have established validity and/or reliability, the pathway as a whole has not been rigorously tested and therefore should not be adopted wholesale for broader use. Copyright 2015 University of Western States. Do not reprint without permission. Table of Contents BACKGROUND ............................................................................................................. 6 Definitions ..................................................................................................................... 6 Overcoming BMI Limitations ....................................................................................... 6 Abdominal Fat ............................................................................................................. 6 Cardiovascular risk factors .......................................................................................... 6 Epidemiology ................................................................................................................ 7 Natural History .............................................................................................................. 8 Health Correlates of Overweight and Obesity ............................................................ 8 Risk Factors for the Development of Obesity ............................................................ 8 Genetics ...................................................................................................................... 8 Environment ............................................................................................................... 8 Behavioral/psychological variables ............................................................................ 9 Clinical conditions ....................................................................................................... 9 Contraindications and Alternatives to Weight Loss .................................................. 9 Contraindications to weight loss .................................................................................. 9 Alternatives to weight loss ........................................................................................ 10 EVALUATION .............................................................................................................. 11 Evaluation Steps ......................................................................................................... 11 STEP 1: Measure Body Mass Index (BMI) and waist circumference. ....................... 11 STEP 2: Assess for elevated waist circumference and the presence or increased risk of cardiovascular and other obesity-related diseases ........................... 11 STEP 4: Determine need for weight loss. ................................................................. 12 STEP 5: Assess readiness to take on lifestyle changes to achieve long-term success ....................................................................................................... 13 OVERWEIGHT AND OBESITY IN ADULTS PAGE 2 OF 58 MANAGEMENT ........................................................................................................... 14 Overview ..................................................................................................................... 14 Specific Therapeutic Objectives ............................................................................... 14 Management Steps ..................................................................................................... 15 STEP 1: Assess patient’s readiness for making diet and lifestyle changes and consider contraindications to weight loss attempts ..................................... 15 STEP 2: Set realistic initial weight-management goals or other relevant goals. ........ 16 STEP 3: Recommend a comprehensive lifestyle intervention incorporating a calorie-controlled diet, physical activity program, and behavior-change strategies (see steps 4-6 for details) .......................................................... 16 STEP 4: Recommend a diet that will reduce calorie intake ....................................... 18 STEP 5: Recommend a program of physical activity ................................................ 19 STEP 6: Recommend behavior change strategies………...……………………...….. 20 STEP 7: Consider meal replacement products, nutritional and other dietary supplements. ............................................................................................... 21 STEP 8: Consider need for co-management of related disorders …………...……... 25 STEP 9: Reevaluate treatment plan and results at regular intervals and plan for long-term maintenance. .............................................................................. 25 STEP 10: Consider referral for more intensive intervention when weight or health goals have not been met. .......................................................................... 25 APPENDICES .............................................................................................................. 26 Appendix A. Weight History Questionnaire .............................................................. 26 Appendix B: Weight Loss Issues Questionnaire…………………………………….… 28 Appendix C. Daily Eating diary .................................................................................. 30 Appendix D. Weight-Loss Diets ................................................................................ 31 Harvard Healthy Eating Plate .............................................................................. 32 USDA Dietary Guidelines and MyPlate................................................................ 33 Low Glycemic Load Diet ...................................................................................... 34 Atkins Diet .......................................................................................................... 35 Appendix E. Calorie-Dense Foods and Their Alternatives ........................................ 38 OVERWEIGHT AND OBESITY IN ADULTS PAGE 3 OF 58 Appendix F. Pros and Cons of popular diets ............................................................. 39 Appendix G. Prescribing an exercise program ......................................................... 41 Appendix H. Behavior Change Strategies ................................................................ 44 Appendix I. Patient Resources for Group Support, Self Help, and Professional Services ................................................................................................ 46 Appendix J. Resources for Professional Training and Office Procedures ................ 48 Appendix K. Examination Procedures for the Overweight/Obese Patient ................ 49 Appendix L. BMI Chart in Pounds/Inches ................................................................. 50 REFERENCES ............................................................................................................. 51 OVERWEIGHT AND OBESITY IN ADULTS PAGE 4 OF 58 Search Strategy An expert panel review and consensus report, published in 1998,1 and a focused clinical update, published in 2013,2 were used to obtain background information and references on etiology, incidence, diagnosis and prognosis. The same reports, with the addition of recent recommendations from a preventive health authority,3 also provided evaluation and conservative treatment plans that form the backbone of this care pathway. Evidence-based position papers endorsed by professional organizations,4 recent review articles, and newer trials of specific conservative interventions were identified though Medline searches. These articles provided reference lists whereby additional studies could be accessed as needed. Additional conservative therapies and their references were obtained from commercial and public health databases5 6 7 8 on complementary and alternative medicine. OVERWEIGHT AND OBESITY IN ADULTS PAGE 5 OF 58 BACKGROUND Overweight and obesity are disorders of excessive accumulation of body fat associated with increased risk for a number of serious diseases. This care pathway targets assessment and management in adults. Definitions absence of clear definitions of excess body
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