A Clinical Guide for Management of

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3085 C000 fm Page i Friday November 10 2006 10 58 PM. A Clinical Guide for,Management of,Overweight and Obese. Children and Adults, 3085 C000 fm Page ii Friday November 10 2006 10 58 PM. CRC Series in,Modern Nutrition Science,Series Editor. Stacey J Bell,Ideasphere Inc,Grand Rapids Michigan. Phytopharmaceuticals in Cancer Chemoprevention,Edited by Debasis Bagchi and Harry G Preuss.
Handbook of Minerals as Nutritional Supplements,Robert A DiSilvestro. Intestinal Failure and Rehabilitation A Clinical Guide. Edited by Laura E Matarese Ezra Steiger,and Douglas L Seidner. Nutrition and Wound Healing,Edited by Joseph A Molnar. A Clinical Guide for Management of Overweight,and Obese Children and Adults. Edited by Caroline M Apovian and Carine M Lenders, 3085 C000 fm Page iii Friday November 10 2006 10 58 PM.
A Clinical Guide for,Management of,Overweight and Obese. Children and Adults,Caroline M Apovian,Carine M Lenders. Boca Raton London New York,CRC Press is an imprint of the. Taylor Francis Group an informa business, 3085 C000 fm Page iv Friday November 10 2006 10 58 PM. Cover design by Sherman Bigornia MS and Wen Guo PhD. Taylor Francis Group,6000 Broken Sound Parkway NW Suite 300.
Boca Raton FL 33487 2742,2007 by Taylor Francis Group LLC. CRC Press is an imprint of Taylor Francis Group an Informa business. No claim to original U S Government works, Printed in the United States of America on acid free paper. 10 9 8 7 6 5 4 3 2 1, International Standard Book Number 10 0 8493 3085 8 Hardcover. International Standard Book Number 13 978 0 8493 3085 8 Hardcover. This book contains information obtained from authentic and highly regarded sources Reprinted. material is quoted with permission and sources are indicated A wide variety of references are. listed Reasonable e orts have been made to publish reliable data and information but the author. and the publisher cannot assume responsibility for the validity of all materials or for the conse. quences of their use, No part of this book may be reprinted reproduced transmitted or utilized in any form by any. electronic mechanical or other means now known or hereafter invented including photocopying. micro lming and recording or in any information storage or retrieval system without written. permission from the publishers, For permission to photocopy or use material electronically from this work please access www.
copyright com http www copyright com or contact the Copyright Clearance Center Inc CCC. 222 Rosewood Drive Danvers MA 01923 978 750 8400 CCC is a not for pro t organization that. provides licenses and registration for a variety of users For organizations that have been granted a. photocopy license by the CCC a separate system of payment has been arranged. Trademark Notice Product or corporate names may be trademarks or registered trademarks and. are used only for identi cation and explanation without intent to infringe. Library of Congress Cataloging in Publication Data. Obesity and overweight a clinical guidebook editor s Caroline M Apovian. Carine M Lenders,p cm CRC series in modern nutrition science. Includes bibliographical references and index,ISBN 13 978 0 8493 3085 8 alk paper. ISBN 10 0 8493 3085 8 alk paper, 1 Obesity I Apovian Caroline M II Lenders Carine M III Series. DNLM 1 Obesity therapy 2 Adolescent 3 Adult 4 Obesity surgery. WD 210 O112185 2006,RC628 O24 2006,616 3 98 dc22 2006018582. Visit the Taylor Francis Web site at,http www taylorandfrancis com.
and the CRC Press Web site at,http www crcpress com. 3085 C000 fm Page v Friday November 10 2006 10 58 PM. Introduction Obesity as,Realm for the Physician,Nutrition Specialist. Caroline M Apovian and Carine M Lenders,RATIONALE FOR THIS GUIDEBOOK. Overweight and obesity have approached concerning proportions in both adults and. children in the U S 1 2 and worldwide 3 The trend in prevalence is steadily. rising each year with no plateau in sight While efforts to combat this trend range. from targeting the individual to community and public health programs the clinician. has an important role to play in treating the obese patient as provider and coach. for both medical and surgical treatments Obesity significantly increases the risk of. morbidity and mortality from hypertension dyslipidemia type 2 diabetes heart. failure stroke and coronary artery disease Excess fat mass is strongly linked to. insulin resistance and 70 of diabetes risk in the U S is directly attributed to. increased weight Poor diet and physical inactivity are now second only to smoking. as the leading preventable causes of death in the U S With an estimated 65 of. adults and 31 of children considered overweight and obese an unprecedented. number of individuals are exposed to increased cardiovascular risk. These statistics highlight the fact that obesity is one of the most common chronic. diseases seen by primary care clinicians It is estimated that 11 of the U S. population are seen every month in the primary care office and that overweight or. obese patients are over represented in this patient population 4 6 The U S Pre. ventive Services Task Force recommends periodic height and weight measurements. for all adult patients in addition to counseling to encourage physical activity and. healthy diet practices 7 While the U S Preventive Services Task Force concluded. that the evidence was insufficient to recommend routine screening for overweight. in children and adolescents 8 the American Academy of Pediatrics and the Expert. Committee from the Maternal and Child Health Bureau Health Resources and. Services Administration as well as the Committee on Prevention of Obesity in. Children and Youth from the Institute of Medicine 9 11 do recommend using the. body mass index to follow the weight status of children and adolescents Despite. these recommendations less than 45 of adult and pediatric obese patients received. any prior advice from a physician to lose weight 12 13. An analysis of over 55 000 adult physician office visits sampled in the 1995. 1996 National Ambulatory Medical Care Survey revealed that physicians reported. 3085 C000 fm Page vi Friday November 10 2006 10 58 PM. obesity in only 8 6 of all patient office visits a rate significantly lower than the. 22 7 obesity prevalence rates for the same time period 15 Likewise obesity was. identified by only half of the clinicians in a study of 2515 pediatric visits n 244. 16 The identification of obesity was affected by the age of the patient and the. degree of obesity rates were lowest among preschool children 31 and highest. among adolescents 76 One study also reported that less than 10 pediatric. clinicians followed all recommendations for history and physical examination 17. The low rate of identification and treatment of obesity by physicians appears to. be due to several factors that are commonly noted as barriers to adherence to practice. guidelines These include lack of awareness lack of familiarity lack of agreement. lack of self efficacy lack of outcome expectancy inertia of previous practice and. external factors 18 For example some physicians may believe that counseling. patients to lose weight is futile because long term studies show a high rate of. recidivism in patients who do manage to lose weight In a study of 444 registered. dietitians 202 pediatricians and 293 primary care nurse practitioners pediatric. clinicians were concerned about pediatric obesity and associated complications and. felt that intervention was important although several barriers interfered with treat. ment efforts 18 20 The barriers identified by these clinicians were lack of parent. involvement lack of patient motivation lack of support services and self reported. low proficiency in counseling related skills needed to manage pediatric obesity. effectively Despite the movement towards including more nutrition education in. medical school curricula which led the National Heart Lung and Blood Institute. NHLBI in 1997 to create the Nutrition Academic Award Program NAA 21 it. is still insufficient and physicians may still feel inadequately prepared to offer diet. and physical activity counseling especially in pediatrics and do not feel successful. in helping their patients make these changes 18 20 22 Findings from these studies. provide priorities for training education and advocacy efforts. This book is designed to be a guide for the primary care clinician and the. specialist who are interested in providing a comprehensive weight management. program to their patients in need We do not feel however that this guidebook is all. that is required to combat the nutritional glut this country seems to be in Major. changes in policy are required to modify the toxic environment we live in and to. provide the resources counseling and reimbursement capacity that physicians nurse. practitioners psychologists physical therapists exercise physiologists and dieticians. need to treat obesity, Several authors have called for nutrition as a subspecialty in both adult and. pediatric medicine 23 26 There seems to be no more poignant time than now for. physician nutrition specialists There are too few of us currently to make a difference. however the wheels are in motion with the founding of the Intersociety Professional. Nutrition Education Consortium and the American Board of Physician Nutrition. Specialists 23 27 and the support from societies such as the American Society for. Nutrition and NAASO the Obesity Society We have observed an increase in phy. sicians taking the Nutrition Boards each year and what is lacking to continue this. momentum is the inclusion of more nutrition fellowship training programs in the. U S and eventually recognition by the American Board of Medicine With 65 of. adults and 31 of children considered overweight or obese in the U S many. 3085 C000 fm Page vii Friday November 10 2006 10 58 PM. physicians are interested in learning the tools they need to treat this overwhelming. disease Isn t it time to take another look at a nutrition subspeciality in medicine. and pediatrics,REFERENCES, 1 Flegal K M Carroll M D Ogden C L Johnson C L Prevalence and trends in.
obesity among US adults 1999 2000 JAMA 288 1723 1727 2002. 2 Hedley A A Ogden C L Johnson C L Carroll M D Curtin L R Flegal K M. Prevalence of overweight and obesity among US children adolescents and adults. 1999 2002 JAMA 291 2847 2850 2004, 3 Kim S Popkin B M Commentary understanding the epidemiology of overweight. and obesity a real global public health concern Int J Epidemiol 35 60 67 2006. 4 Green L A Fryer G E Jr Yawn B P Lanier D Dovey S M The ecology of. medical care revisited N Engl J Med 344 2021 2025 2001. 5 Noel M Hickner J Ettenhofer T Gauthier B The high prevalence of obesity in. Michigan primary care practices An UPRNet study Upper Peninsula Research Net. work J Fam Pract 47 39 43 1998, 6 Orzano A J Scott J G Diagnosis and treatment of obesity in adults an applied. evidence based review J Am Board Fam Pract 17 359 369 2004. 7 McTigue K M Harris R Hemphill B Lux L Sutton S Bunton A J Lohr. K N Screening and interventions for obesity in adults summary of the evidence for. the U S Preventive Services Task Force Ann Intern Med 139 11 933 949 2003. 8 U S Preventive Services Task Force Screening and interventions for overweight in. children and adolescents recommendation statement Pediatrics 116 1 205 209. 9 American Academy of Pediatrics Overweight and Obesity AAP recommendations. Elk Grove Village IL American Academy of Pediatrics 2003 Available at. www aap org obesity recommendations htm Accessed April 1 2006. 10 Barlow S E Dietz W H Obesity evaluation and treatment Expert Committee. recommendations Pediatrics 102 29 40 1998 Available at www pediatrics org cgi. content full 102 3 e29 Accessed April 1 2006, 11 Koplan J P Liverman C T Kraak V I Preventing Childhood Obesity Health in. the Balance 2005 National Academies Press Washington DC Available at. http www iom edu id 25048 Accessed April 1 2006, 12 Galuska D A Will J C Serdula M K Ford E S Are health care professionals. advising obese patients to lose weight JAMA 282 1576 1578 1999. 13 Sciamanna C N Tate D F Lang W Wing R R Who reports receiving advice to lose. weight Results from a multistate survey Arch Intern Med 160 2334 2339 2000. 14 Barlow S E Trowbridge F C Klish W J Dietz W H Treatment of children and. adolescent obesity reports from pediatricians pediatric nurse practitioners and reg. istered dietitians Pediatrics 110 229 235 2002, 15 Stafford R S Farhat J H Misra B Schoenfeld D A National patterns of physi.
cian activities to obesity management Arch Fam Med 9 631 638 2000. 16 O Brien S H Holubkov R Reis E C Identification evaluation and management. of obesity in an academic primary care center Pediatrics 114 2 e154 e159 2004. 17 Barlow S E Dietz W H Klish W J Trowbridge F L Medical evaluation of. overweight children and adolescents reports from pediatricians pediatric nurse prac. titioners and registered dietitians Pediatrics 110 1 Pt 2 222 228 2002. 3085 C000 fm Page viii Friday November 10 2006 10 58 PM. 18 Story M T Neumark Stzainer D R Sherwood N E Holt K Sofka D Trow. bridge F L Barlow S E Management of child and adolescent obesity attitudes. barriers skills and training needs among health care professionals Pediatrics 110. Caroline M Apovian Carine M Lenders A Clinical Guide for Management of Overweight and Obese Children and Adults CRC Press is an imprint of the Taylor amp Francis Group an informa business Boca Raton London New York 3085 C000 fm Page iii Friday November 10 2006 10 58 PM

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