Overweight - Obesity

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• Guidelines
• Internet Sites
• Overweight - Obesity Risks
• Risk Factors
• Treatment - Daily Report

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Overweight - Obesity

NIH - Medical Encyclopedia Obesity

"Obesity is also defined as a BMI (body mass index) over 30 kg/m2. Patients with a BMI between 25 and 29.9 are considered overweight, but not obese. … Obesity increases a person's risk of illness and death due to diabetes, stroke, coronary artery disease, hypertension, high cholesterol, and kidney and gallbladder disorders. Obesity may increase the risk for some types of cancer. It is also a risk factor for the development of osteoarthritis and sleep apnea. Genetic factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight."

Highlighted Article

[Lifestyle intervention in the treatment of severe obesity.] (Ugeskr Laeger. 2006)

"CONCLUSION: After 15 weeks of intensive lifestyle intervention, there were significant improvements in aerobic fitness and metabolic risk parameters, and the observed weight loss was equivalent to that obtained by surgical treatment. Decisive in the choice of obesity treatment will continue to be the extent of success in permanent weight loss."

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Overweight - Obesity

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Behavior Therapy and Cognitive-Behavioral Therapy of Obesity: Is There a Difference? (J Am Diet Assoc. 2007) "Current practice guidelines for management of overweight and obesity recommend a program of diet, exercise, and behavior therapy for all persons with a body mass index (calculated as kg/m(2)) of at least 30 (and those with body mass index >/=25 plus two weight-related comorbidities). In this tripartite treatment-often referred to as lifestyle modification-behavior therapy provides a structure that facilitates meeting goals for energy intake and expenditure. Although standard behavior therapy reliably induces mean weight losses of approximately 10% of initial weight, these reductions are difficult to maintain. Some authors argue that a shift in focus from behavior change to cognitive change will improve long-term results of lifestyle modification programs."

Device Therapy

Drug Side-Effects and Interactions

Drugs

All About Alli, the Weight Loss Pill

Weight Loss and Quality of Life Improvement in Obese Subjects Treated with Sibutramine: A Double-Blind Randomized Multicenter Study. (Ann Nutr Metab. 2007)

Drug treatments for obesity: orlistat, sibutramine, and rimonabant. (Lancet. 2007)

Pharmacological characterization of a new antimuscarinic agent, solifenacin succinate, in comparison with other antimuscarinic agents. (Biol Pharm Bull. 2007)

Effect of Orlistat on Weight Regain and Cardiovascular Risk Factors Following a Very-Low-Energy Diet in Abdominally Obese Patients (Diabetes Care 2007) "CONCLUSIONS—The addition of orlistat to lifestyle intervention was associated with maintenance of an extra 2.4 kg weight loss after VLED for up to 3 years in obese subjects. The combination of orlistat and lifestyle intervention was associated with a reduced occurrence of type 2 diabetes."

Exercise

Fish-Oil Supplements Plus Regular Aerobic Exercise Benefit Overweight Patients " 'FO [fish oil] supplements and regular exercise both reduce body fat and improve cardiovascular and metabolic health," the authors write. "Increasing intake of n-3 FAs could be a useful adjunct to exercise programs aimed at improving body composition and decreasing cardiovascular disease risk.' "

A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials. (Int J Obes (Lond). 2007) "Conclusion:These results suggest that at least 10 METs.h/w in aerobic exercise, such as brisk walking, light jogging or stationary ergometer usage, is required for visceral fat reduction, and that there is a dose-response relationship between aerobic exercise and visceral fat reduction in obese subjects without metabolic-related disorders."

Exercise is an effective intervention in overweight and obese patients. (Am Fam Physician. 2007) "Reviewers' Conclusions: The results of this review support the use of exercise as a weight loss intervention, particularly when combined with dietary change. Exercise is associated with improved cardiovascular disease risk factors even if no weight is lost."

General Information

Lifestyle modification for the management of obesity. (Gastroenterology. 2007) "In summary, lifestyle modification induces clinically significant weight loss that is associated with the prevention or amelioration of cardiovascular risk factors."

Management and prevention of obesity in adults and children.

Weight loss maintenance in severely obese adults after an intensive lifestyle intervention: 2- to 4-year follow-up. (Obesity (Silver Spring). 2007) "DISCUSSION: Weight loss camps are a relatively new commercial approach in treating severely obese subjects. However, the results demonstrate that even with a multidisciplinary intensive setting with focus on diet, exercise, and psychological counseling, only 28% had maintained a weight loss above 10% after 4 years. This emphasizes that obesity is a chronic condition that needs additional strategies after a weight loss intervention in the efforts to maintain a sufficient weight loss."

Guidelines

NGC - Management of overweight and obesity in the adult. (2007)

Synopsis of the 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children.

2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. "Obesity should no longer be viewed as a cosmetic or body-image issue. There is compelling evidence that overweight people are at increased risk of a variety of health problems, including type 2 diabetes, hypertension, dyslipidemia, coronary artery disease, stroke, osteoarthritis and certain forms of cancers. It has recently been estimated that about 1 in 10 premature deaths among Canadian adults 20–64 years of age is directly attributable to overweight and obesity."

NGC - Treatment of obesity. (2006)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Effect of weight reduction on quality of life and eating behaviors in obese women. (Menopause. 2007) "CONCLUSIONS:: Our study shows that a short-term weight-reducing program combining caloric restriction and physical activity has a favorable impact on women's body composition, physical condition, health-related quality of life, and eating behaviors irrespective of their menopausal status."

Other

Other Treatments

Intragastric balloon for obesity. (Cochrane Database Syst Rev. 2007)

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Fish-Oil Supplements Plus Regular Aerobic Exercise Benefit Overweight Patients

Surgery

Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass: a primary care experience. (Am J Surg. 2008)

Pathophysiology of Obesity: Why Surgery Remains the Most Effective Treatment. (Obes Surg. 2007)

Allergic Reaction to Contrast Medium following Gastric Band Adjustment. (Obes Surg. 2007)

[A new treatment: bariatric surgery; a new complication: Wernicke-Korsakoff encephalopathy.] (Presse Med. 2007)

[Gastric band erosion as complication of bariatric surgery. Case report and review of the literature.] (Gastroenterol Hepatol. 2007)

Higher-Than-Expected Suicide Rate Following Bariatric Surgery "Extremely obese Pennsylvania residents undergoing weight loss surgery over a 10-year period had a higher-than-expected mortality rate from suicide, according to a new study appearing in the October issue of Archives of Surgery. The study also uncovered an excess of deaths due to coronary heart disease among these surgery patients. … Bariatric surgery among patients with class 3 obesity is associated with higher mortality than the general population, with higher rates of suicide and coronary heart disease as causes. Among patients with a BMI of 40 kg/m2 or more, higher mortality after bariatric surgery is associated with male sex, black race, and older age. "

Weight loss helpful before gastric bypass "People undergoing gastric bypass surgery for obesity can significantly reduce the length of their hospital stay if they lose 5 percent to 10 percent of their excess body weight before the procedure. In addition, the amount of weight they shed subsequently is likely to be greater, new research shows."

One In Five Bariatric Surgery Candidates Not Psychologically Cleared For Surgery

Bone loss: an emerging problem following obesity surgery. (Orthop Nurs. 2007) " … these procedures may be associated with the development of bone loss and skeletal fragility because of altered nutrient metabolism. Despite the threat of skeletal fragility and fracture, there is limited data addressing the effects of bariatric surgery on bone metabolism and bone loss."

Roux-en-Y gastric bypass: major complications. (Abdom Imaging. 2007)

Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects (NEJM 2007) "Conclusions Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality."

Long-Term Mortality after Gastric Bypass Surgery (NEJM 2007) "Conclusions Long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, heart disease, and cancer. However, the rate of death from causes other than disease was higher in the surgery group than in the control group."

Long-Term Mortality after Gastric Bypass Surgery (NEJM 2007)

Surgical treatment of obesity. (Nat Clin Pract Endocrinol Metab. 2007)

Change in mental symptoms in extreme obesity patients after gastric banding, Part II: Six-year follow up. (Int J Psychiatry Med. 2007)

Surgical Treatment of Obesity (Nat Clin Pract Endocrinol Metab. 2007) "Results of bariatric surgery in large case-series followed for at least 10 years consistently demonstrate amelioration of components of the insulin-resistance metabolic syndrome and other comorbidities, significantly improving quality of life. Furthermore, bariatric surgery has convincingly been demonstrated to reduce mortality compared with nonoperative methods. This surgery requires substantial preoperative and postoperative evaluation, teaching, and monitoring to optimize outcomes. In the absence of effective societal changes to restore a healthy energy balance, bariatric surgery is an important tool for treating a very serious disease."

[Sustained weight loss 2 years after laparoscopic adjustable gastric banding for morbid obesity] (Ned Tijdschr Geneeskd. 2007)

Checkups key to success of obesity surgery "Seriously overweight people who undergo gastric bypass surgery to shed pounds should try to make as many scheduled post-op doctors appointments as possible, according to a new study. It shows that follow-up care is a key component of the long-term success of the weight-loss surgery."

Assessment of comorbid conditions in veteran patients after Roux-en-Y gastric bypass. (Am J Surg. 2007)

Anastomotic leak following antecolic versus retrocolic laparoscopic Roux-en-Y gastric bypass for morbid obesity. (Obes Surg. 2007) "BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most commonly performed operation for the treatment of morbid obesity in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation (antecolic versus retrocolic), although this remains controversial. The aim of this study was to analyze our experience with anastomotic leaks following LRYGBP with an antecolic- versus retrocolic-routed Roux limb."

Prospective randomized trial of banded versus nonbanded gastric bypass for the super obese: early results. (Surg Obes Relat Dis. 2007)

Band erosion following gastric banding: how to treat it. (Obes Surg. 2007) "BACKGROUND: Intragastric band migration is an unusual but major long-term complication of gastric banding: its frequency ranges from 0.5-3.8% and always requires removal of the band. Different laparoscopic, laparotomic or endoscopic methods are currently used for band removal."

Bariatric surgery: a review of procedures and outcomes. (Gastroenterology. 2007)

[Nutritional deficiencies associated with bariatric surgery.] (Gastroenterol Clin Biol. 2007) "Morbidly obese patients often have nutritional deficiencies, particularly in fat-soluble vitamins, folic acid and zinc. After bariatric surgery, these deficiencies may increase and others can appear, especially because of the limitation of food intake in gastric reduction surgery and of malabsorption in by-pass procedures. The latter result inmore important weight loss but also increase the risk of more severe deficiencies. The protein deficiency associated with a decrease in the fat-free mass has been described in both procedures. It can sometimes require an enteral or parenteral support."

Severe chronic cough after Lap-Band gastric surgery. (Can Respir J. 2007)

Factors Affecting Morbidity and Mortality of Roux-en-Y Gastric Bypass for Clinically Severe Obesity: An Analysis of 1,000 Consecutive Open Cases by a Single Surgeon. (J Gastrointest Surg. 2007) "CONCLUSION: Perioperative mortality after RYGB appears to be affected by sex, BMI, age, CAD, and sleep apnea. Strategies employing risk stratification should be developed for bariatric surgery."

What to Expect in the Excluded Stomach Mucosa after Vertical Banded Roux-en-Y Gastric Bypass for Morbid Obesity. (J Gastrointest Surg. 2007) "Histological findings indicated high prevalence of atrophy and intestinal metaplasia in this selected population."

Effect of weight loss on predicted cardiovascular risk: change in cardiac risk after bariatric surgery. (Obesity (Silver Spring). 2007) "Weight loss predicts a major, 10-year reduction in cardiovascular events and deaths. Bariatric surgery should be considered as an alternative approach to reduce cardiovascular risk in patients with Class II to III obesity."

Postmortem findings in morbidly obese individuals dying after gastric bypass procedures. (Hum Pathol. 2007)

Efficacy of gastric bypass in the treatment of obesity-related comorbidities. (Nutr Clin Pract. 2007)

Nutrition and gastrointestinal complications of bariatric surgery. (Nutr Clin Pract. 2007) " … all of these procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract. This fact, along with postoperative dietary changes, makes these patients vulnerable to a multitude of potential complications. As more and more patients undergo these procedures, an increasing number of clinicians will be asked to care for them. It is therefore imperative that all clinicians have a general understanding of the operative procedures and the potential problems these patients may develop"

Maladaptive eating patterns after weight-loss surgery. (utr Clin Pract. 2007) "This paper describes clinical responses we have observed in our bariatric practice. Several case studies are presented to highlight problems we have encountered when following bariatric surgery patients in the early postoperative period, as well as in a long-term setting. Recommendations are made for screening and follow-up of at-risk patients."

Transplantation

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