Nonsurgical Management of Obesity in Adults

Nonsurgical Management of Obesity in Adults

* content.nejm.org/cgi/content/full/358/18/1941

A 44-year-old woman desires weight reduction. Her history is notable
for hypertension, snoring, daytime somnolence, and osteoarthritis. Her
father was obese and had type 2 diabetes. On physical examination, her
weight is 215 lb (98 kg), her body-mass index (BMI) (the weight in
kilograms divided by the square of the height in meters) 32.7, her
waist circumference 40 in. (102 cm), and her blood pressure 140/92 mm
Hg. The stigmata of Cushing's syndrome are not present. The fasting
glucose level is 112 mg per deciliter (6.2 mmol per liter). The
fasting cholesterol level is 205 mg per deciliter (5.3 mmol per
liter), triglyceride level 224 mg per deciliter (2.5 mmol per liter),
high-density lipoprotein (HDL) cholesterol level 40 mg per deciliter
(1.0 mmol per liter), and low-density lipoprotein (LDL) cholesterol
level 120 mg per deciliter (3.1 mmol per liter). The thyrotropin level
is normal. What would you advise?

The Clinical Problem

Overweight (BMI 25) or obesity (BMI 30) now affects almost two thirds
of Americans. The National Health and Nutrition Examination Survey,
2003 to 2004, showed prevalences of obesity in U.S. men and women of
31.1% and 33.2%, respectively, with particularly high rates among non-
Hispanic black Americans and Mexican Americans.1 Overweight and
obesity are associated with multiple coexisting conditions, including
hypertension, glucose intolerance, dyslipidemia, and obstructive sleep
apnea. Moreover, obesity is associated with an increased risk of death
from cardiovascular disease, diabetes, kidney disease, and obesity-
related cancers (colon, breast, esophageal, uterine, ovarian, kidney,
and pancreatic).2

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It remains smart to simply eat less, down to the right amount:

* HeartMDPhD . com /BeSmart

Here is a simple parable given in hopes of promoting greater
understanding:

* HeartMDPhD . com /Parable

Life is industrialized nations is life in blessed feedlots.

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* HeartMDPhD . com /HolySpirit/Counsels