Items in AFP with MESH term: Obesity, Morbid
ABSTRACT: Obesity is a complex, multifactorial condition in which excess body fat may put a person at health risk. National data indicate that the prevalence of obesity in the United States is increasing in children and adults. Reversing these trends requires changes in individual behavior and the elimination of societal barriers to healthy lifestyle choices. Basic treatment of overweight and obese patients requires a comprehensive approach involving diet and nutrition, regular physical activity, and behavioral change, with an emphasis on long-term weight management rather than short-term extreme weight reduction. Physicians and other health professionals have an important role in promoting preventive measures and encouraging positive lifestyle behaviors, as well as identifying and treating obesity-related comorbidities. Health professionals also have a role in counseling patients about safe and effective weight loss and weight maintenance programs. Recent evidence-based guidelines from the National Heart, Lung, and Blood Institute, as well as recommendations from the American Academy of Pediatrics, American Association of Clinical Endocrinologists/American College of Endocrinology, American Obesity Association, U.S. Clinical Preventive Services Task Force, Institute of Medicine, and World Health Organization can be consulted for information and guidance on the identification and management of overweight and obese patients.
ABSTRACT: More than 60 percent of adults in the United States are overweight or obese, and obese persons are more likely to be ill than those who are not. Obesity presents challenges to physicians and patients and also has a negative impact on health status. Some patients who are obese may delay medical care because of concerns about disparagement by physicians and health care staff, or fear of being weighed. Simple accommodations, such as providing large-sized examination gowns and armless chairs, as well as weighing patients in a private area, may make the medical setting more accessible and more comfortable for obese patients. Extremely obese patients often have special health needs, such as lower extremity edema or respiratory insufficiency that require targeted evaluation and treatment. Although physical examination may be more difficult in obese patients, their disproportionate risk for some illnesses that are amenable to early detection increases the priority for preventive evaluations. Physicians can encourage improvements in healthy behaviors, regardless of the patient's desire for, or success with, weight loss treatment.
ABSTRACT: Bariatric surgery leads to sustainable long-term weight loss and may be curative for such obesity-related comorbidities as diabetes and obstructive sleep apnea in severely obese patients. The Roux-en-Y gastric bypass has become the most common procedure for patients undergoing bariatric surgery. The procedure carries a mortality risk of up to 1 percent and a serious complication risk of up to 10 percent. Indications include body mass index of 40 kg per m2 or greater, or 35 kg per m2 or greater with serious obesity-related comorbidities (e.g., diabetes, obstructive sleep apnea, coronary artery disease, debilitating arthritis). Pulmonary emboli, anastomotic leaks, and respiratory failure account for 80 percent of all deaths 30 days after bariatric surgery; therefore, appropriate prophylaxis for venous thrombo-embolism (including, in most cases, low-molecular-weight heparin) and awareness of the symptoms of common complications are important. Some of the common short-term complications of bariatric surgery are wound infection, stomal stenosis, marginal ulceration, and constipation. Symptomatic cholelithiasis, dumping syndrome, persistent vomiting, and nutritional deficiencies may present as long-term complications.
What Others Take for Granted - Close-ups
Predicting Mortality Risk in Patients Undergoing Bariatric Surgery - Point-of-Care Guides
A "Hopeless" Patient - Curbside Consultation
Obesity and Daytime Sleepiness - Photo Quiz
Bariatric Surgery: Too Many Unanswered Questions - Editorials
Determining Eligibility for Gastric Bypass Surgery - Curbside Consultation