Prevention

A reduction in TV watching by children is associated with a smaller gain in BMI. In children, studies reveal that when the consumption of sugar-sweetened beverages, primarily soft drinks, is decreased, there is slower weight gain than when children are randomly assigned to soft drinks that do not contain sugar [2]. In addition, the youth in the upper half of the body weight range did not reduce calorie intake sufficiently to compensate for the beverage calories—thus, the beverage calories were partially “invisible” to these adolescents. In adults, there are unfortunately few successful programs that prevent obesity, but some individuals do lose weight and maintain it as demonstrated by the National Weight Control Registry of individuals who are “successful” weight losers for at least a year.

Treatment

Realities of Treatment

The Guidelines for Obesity provide an algorithm for evaluating the overweight patient [22]. It is a useful framework on which to hang the information that is collected during the evaluation of obese patients (Fig. 8.3).

Realism is one important aspect of treatment for obesity. For most treatments, including behavior therapy, diet, and exercise, the weight loss (measured as percentage loss from the baseline weight) plateaus after a loss of <10%. For many patients, this is a frustrating experience as their dream weight requires a weight loss of nearly 30%. A loss of <17% can be a disappointment to women entering a weight-loss program. It is thus important for the patient and physician to recognize that an initial weight loss of 10% is a success that will produce health benefits [22].

Diet

 
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