Beans are also high in fiber and slow to digest. Orlistat, a new lipase inhibitor for the management of obesity. The costs of obesity in the workplace. Thyroid hormone - Hyperthyroidism, with its attendant sequelae. Sleeve Gastrectomy BroadcastMed - St. Association between obesity and health-related quality of life in patients with coronary artery disease.
Comorbidities that have been reported to be improved, ameliorated, or resolved through bariatric surgery include the following:. Other reports suggest improved quality of life and fertility after bariatric surgery. Although other outcomes are difficult to demonstrate and are awaiting clear documentation, these procedures may substantially reduce macrovascular complications eg, myocardial infarction , stroke, amputations, obesity-related malignancies, and a predisposition to infection, hernias, and varicose veins.
Although most bariatric procedures were initially developed in the setting of laparotomies, they now are increasingly performed laparoscopically, with reduced postoperative morbidity. The laparoscopic approach to bariatric surgery is particularly well developed in Europe. Available data on the effectiveness of many of these procedures are still relatively scant. However, reports and meta-analyses from large numbers of patients on the most commonly performed procedures gastric restriction and gastric bypass lend veracity to the long-term effectiveness of bariatric surgery.
Guidelines from the American Association of Clinical Endocrinologists, The Obesity Society, and the American Society for Metabolic and Bariatric Surgery endorse sleeve gastrectomy as an effective alternative to gastric banding, gastric bypass, and other types of bariatric surgery, saying that the procedure has advanced beyond the investigational stage. However, the guidelines do not recommend any bariatric procedure as preferable over the others for patients with severe obesity.
Flickinger and associates, in an examination of patients who received a Roux-en-Y gastric bypass, recorded a mean weight loss of 51 kg in 18 months, which was then maintained over 36 months of follow-up. Roux-en-Y and other gastric-bypass procedures generally result in more weight loss than do gastric-restriction procedures. According to a study by Plecka et al, in patients who are morbidly obese, gastric bypass but not restrictive surgery apparently reduces the risk levels for the development of type 2 diabetes and myocardial infarction to those for the general population.
However, the mortality risk in these patients nonetheless remains higher than that in the general population. Improvement in glucose control was unrelated to baseline BMI or overall weight loss. A Norwegian study compared gastric bypass with duodenal switch and determined that duodenal switch surgery was associated with greater weight loss and greater reductions in total and LDL-C levels.
However, duodenal switch surgery was also associated with reductions in concentrations of vitamin A and hydroxyvitamin D, as well as with increased adverse effects. Similarly, a randomized trial from Sweden found greater postoperative weight loss in patients who had duodenal switch surgery than in those who had gastric bypass. Fasting glucose and HgA1c were also lower at 3 years in the duodenal switch group. A study by Schiavon et al indicated that bariatric surgery can lead to a reduction in the number of antihypertensive drugs required by persons with obesity taking multiple blood pressure agents and in some cases can eliminate the need for any such medications.
The investigators found that Emerging data suggest that gastric pacing achieved by using implantable electrodes may have significant weight-loss effects. This outcome was initially discovered with the use of gastric pacemaker devices for gastroparesis in patients with diabetes. Other adjunctive procedures that may be performed but that have an unclear utility include visceral fat removal, omentectomy, subcutaneous fat panniculectomy, and large-volume subcutaneous fat liposuction.
Klein and colleagues indicated that liposuction in itself has no utility in improving cardiac risk factors among patients with obesity. Some procedures, such as jaw wiring and insertion of a gastric balloon or a gastric wrap, are no longer popular because of their poor results compared with those of newer procedures and because of their high complication rates.
Vagotomy has also declined in popularity, as the weight lost is typically regained within a few years. The mortality rate associated with standard bariatric surgical procedures in an experienced center should not exceed 1. The surgical mortality rate is less than 0. In addition, gastric-specific operations can be associated with persistent vomiting and metabolic alkalosis.
These operations are also more commonly associated with weight-loss failure and inadvertent splenectomy than are other surgical methods. Malabsorptive procedures gastric bypass can lead to deficiency of thiamine, iron, vitamin D, and vitamin B Prevalences for adverse events with gastric resection procedures with or without bypass are approximately as follows [ ]:. Patients who receive bypass procedures are particularly prone to micronutrient deficiency states, especially of calcium, vitamin B, folate, and iron, as well as protein malnutrition.
Rare cases of postural hypotension and severe hypoglycemia from nesidioblastosis have been reported. Life-threatening hypoglycemia usually requires partial or total pancreatectomy, while severe postural hypotension that cannot be corrected with fludrocortisone and midodrine requires reversal of the surgery. The following are among the major specific complications associated with malabsorptive operations:. Failure rates based on weight loss are controversial.
The overall failure rates for malabsorptive procedures are relatively low, although the need for reversal of the surgery because of resulting adverse effects appears to be relatively high. Despite the morbidity and mortality risk associated with bariatric surgery, the few reports involving follow-up on patients undergoing these procedures suggest overall improvement in quality of life.
Even more convincing than this finding is that most subjects who undergo these procedures, despite their postoperative complications and difficulties, indicate that they would undergo the procedures again if necessary. Inpatient evaluations of obese patients are important in the immediate postoperative period after antiobesity surgery. In addition, hospitalization may be required for the management of major complications, such as clinically significant respiratory or cardiac compromise.
Weight-management programs may be based in an outpatient or inpatient setting. No rigorous evidence suggests that inpatient programs are necessarily superior to outpatient programs of similar structure and content, however. Inpatient programs may offer the convenience of easy access to patients and ease of monitoring, but they are not only expensive to run and difficult to reimburse, they also generally cause considerable disruption to the patients' regular routine.
In addition, they offer little guarantee of sustained effect. Because of the sheer prevalence of obesity and the anticipated worsening of the pandemic in the next few decades, prevention is by far the most desirable means to curb the medical and economic consequences of this condition. However, few trials have addressed this issue, and those performed thus far have had mixed results. Given the global proportions of obesity, a concerted approach is needed to address the problem and should involve the development of a massive public health education program aimed at adults and children as a means of changing their eating, activity, and behavioral habits.
Cooperative efforts will also be needed among public health authorities, caterers, the fast food industry, and organizers of sports and outdoor games. Results of some public health education initiatives in Singapore and parts of China that are only now being evaluated suggest, as hoped, that such programs have the potential for reducing the incidence and prevalence of obesity and may also have an impact on the major comorbidities of obesity, such as type 2 diabetes and hypertension.
Until advances in gene therapy permit the alteration of genes that predispose to obesity, such programs are the only preventive options available. In select cases, consultation with a psychiatrist may be indicated. Psychiatric consultation should be sought for patients with psychiatric disorders and personality disorders eg, severe depression, mania, obsessive disorders that may be worsened by attempts at weight loss if not adequately treated and controlled.
As with the management of other chronic medical conditions eg, diabetes mellitus, hypertension, bronchial asthma , long-term success in the management of obesity is contingent on long-standing follow-up with the weight-loss program. Experience obtained from the lifestyle intervention group of patients in the Diabetes Prevention Program and information drawn from the ongoing Diabetes Prevention Program Observation study have borne out the importance of regular follow-up.
Patient visits may not need to occur as frequently during follow-up as during the initial weight-loss phase. Nevertheless, they are paramount if the lessons learned regarding diet, exercise habits, and behavioral patterns are to be maintained. Obesity in the Early Childhood Years: State of the Science and Implementation of Promising Solutions: Prevalence of obesity and trends in the distribution of body mass index among US adults, Comorbidities of obesity in school children: Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, Body mass index, effect modifiers, and risk of pancreatic cancer: Adiposity and cancer at major anatomical sites: Association between obesity and health-related quality of life in patients with coronary artery disease.
Int J Obes Lond. Am J Clin Nutr. Lifestyle modification for obesity: Cawley J, Meyerhoefer C. The medical care costs of obesity: The costs of obesity in the workplace. J Occup Environ Med.
Weight Loss Markets for Products and Services. A New Name for Obesity?. Healthy percentage body fat ranges: Segmental bioelectrical impedance analysis: Appropriate BMI for Asian populations. Definition of metabolic syndrome: Adolescent BMI trajectory and risk of diabetes versus coronary disease.
N Engl J Med. Association of changes in body mass index during earlier adulthood and later adulthood with circulating obesity biomarker concentrations in middle-aged men and women. Gastric bypass for treating severe obesity.
Effects of increased intra-abdominal pressure in severe obesity. Surg Clin North Am. Obesity and the risk of stillbirth: Am J Obstet Gynecol. Estimating the risk of type-2 diabetes using obese-years in a contemporary population of the Framingham Study. Impact of obesity and knee osteoarthritis on morbidity and mortality in older Americans.
Proteinuria and focal segmental glomerulosclerosis in severely obese adolescents. Kasiske BL, Napier J. Glomerular sclerosis in patients with massive obesity. Glomerulomegaly and focal segmental glomerulosclerosis associated with obesity and sleep-apnea syndrome. Am J Kidney Dis. Sleep duration and five-year abdominal fat accumulation in a minority cohort: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite.
Obesity due to melanocortin 4 receptor MC4R deficiency is associated with increased linear growth and final height, fasting hyperinsulinemia, and incompletely suppressed growth hormone secretion.
J Clin Endocrinol Metab. The role of adipose tissue as an endocrine gland. Expert Rev Cardiovasc Ther. Acute, short-term hyperinsulinemia increases olfactory threshold in healthy subjects.
Plasma leptin levels and incidence of heart failure, cardiovascular disease, and total mortality in elderly individuals. Behavioral and neuroendocrine characteristics of the night-eating syndrome. Reduced appetite and body mass index with delayed puberty in a mother and son: Facts about Physical Activity. Centers for Disease Control and Prevention.
Relative hypocortisolism is associated with obesity and the metabolic syndrome in recurrent affective disorders.
The response to long-term overfeeding in identical twins. Preventing and treating childhood obesity: Common genetic variation near MC4R is associated with waist circumference and insulin resistance. Frayling TM, Ong K. Piecing together the FTO jigsaw.
Common variants near MC4R are associated with fat mass, weight and risk of obesity. Genome-wide association scan shows genetic variants in the FTO gene are associated with obesity-related traits.
Developments in obesity genetics in the era of genome-wide association studies. Leptin concentrations are a predictor of overweight reduction in a lifestyle intervention. Int J Pediatr Obes. Melanocortins and body weight: Melanocortin-4 receptor mutations are a frequent and heterogeneous cause of morbid obesity.
Obesity as a neuroendocrine disease: Congenital leptin deficiency due to homozygosity for the DeltaG mutation: Plasma procalcitonin is associated with obesity, insulin resistance, and the metabolic syndrome. Perceived weight status, overweight diagnosis, and weight control among US adults: Prevalence of obesity and trends in body mass index among US children and adolescents, Am J Public Health.
Neighborhoods, obesity, and diabetes--a randomized social experiment. National, regional, and global trends in body-mass index since The "thrifty genotype" in BMI was right all along: Association of adolescent obesity with risk of severe obesity in adulthood. Annual deaths attributable to obesity in the United States. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: Health hazards of obesity.
Endocrinol Metab Clin North Am. Excess deaths associated with underweight, overweight, and obesity. Association between body-mass index and risk of death in more than 1 million Asians. Body-mass index and mortality among 1. General and abdominal obesity and risk of death among black women. Obesity as a Risk Factor for Prostatic Enlargement: A Retrospective Cohort Study in Korea. Normal body mass index rather than obesity predicts greater mortality in elderly people: J Am Geriatr Soc.
BMI and all-cause mortality among Japanese older adults: Child and adolescent fast-food choice and the influence of calorie labeling: Interventions for preventing obesity in children. Cochrane Database Syst Rev. J Am Coll Cardiol. New US obesity guidelines. Treat the weight first. Pharmacological management of obesity: Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial.
Medications for weight reduction. Med Clin North Am. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diets with high or low protein content and glycemic index for weight-loss maintenance. Two patterns of adipokine and other biomarker dynamics in a long-term weight loss intervention.
Long-term persistence of hormonal adaptations to weight loss. Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real-world clinical practice: Proimos J, Sawyer S.
Obesity in childhood and adolescence. Body composition and childhood obesity. Older Adults and the Elderly. Rome, October It may be an option if you cannot lose weight through diet and exercise or have serious health problems caused by obesity. There are different types of weight loss surgery. They often limit the amount of food you can take in. Some types of surgery also affect how you digest food and absorb nutrients. All types have risks and complications, such as infections, hernias, and blood clots.
Many people who have the surgery lose weight quickly, but regain some weight later on. If you follow diet and exercise recommendations, you can keep most of the weight off. Those healthy vegetables added low-cal bulk to the tasty dish. A protein-rich breakfast may help you resist snack attacks throughout the day. The women ate a calorie breakfast that included eggs and a beef sausage patty. The effect of the high-protein breakfast seemed to last into the evening, when the women munched less on fatty, sugary goods than the women who had cereal for breakfast.
For a great snack on the run, take a small handful of almonds, peanuts, walnuts, or pecans. Research shows that when people munch on nuts, they automatically eat less at later meals. Skip the apple juice and the applesauce and opt instead for a crunchy apple. One reason is that raw fruit has more fiber. A Harvard study followed more than , people for a decade or longer. Yogurt, of all the foods that were tracked, was most closely linked to weight loss.
Yes, grapefruit really can help you shed pounds, especially if you are at risk for diabetes. Drinking grapefruit juice had the same results. But grapefruit juice doesn't have any proven "fat-burning" properties -- it may just have helped people feel full. You cannot have grapefruit or grapefruit juice if you are on certain medications, so check the label on all your prescriptions , or ask your pharmacist or doctor.