BOOK
Obesity Management in Primary Care, An Issue of Primary Care: Clinics in Office Practice, E-Book
(2016)
Additional Information
Book Details
Abstract
This issue of Primary Care: Clinics in Office Practice, devoted to Obesity Management, is guest edited by Dr. Mark Stephens of the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Articles in this important issue include: Obesity: What Do the Statistics Say?; Economic Impact of Obesity; The Future of Pediatric Obesity; Obesity Prevention and Screening; Behavior Modification in Obesity Management; Nutritional Therapy; Physical Activity: Cornerstone or Roadblock?; Pharmacologic Therapy for Obesity; Surgical Approaches to Obesity; Multidisciplinary Teams and Obesity: Role of the Modern Patient Centered Medical Home (PCMH); Healthcare Systems and National Policy: Role of Leadership in the Obesity Crisis; and Special Populations in Obesity Management.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| CSM_BLANK - Copy (2) | vi | ||
| Contents | vii | ||
| Foreword: Just Eat Less and Exercise More?xiii | vii | ||
| Preface: Obesity: A Plague Upon Our Housesxv | vii | ||
| The Future of Pediatric Obesity1 | vii | ||
| Health Care Systems and National Policy: Role of Leadership in the Obesity Crisis19 | vii | ||
| Obesity Prevention and Screening39 | vii | ||
| Multidisciplinary Teams and Obesity: Role of the Modern Patient-Centered Medical Home53 | viii | ||
| Past, Present, and Future of Pharmacologic Therapy in Obesity61 | viii | ||
| Nutritional Therapy69 | viii | ||
| Economic Impact of Obesity83 | viii | ||
| Impacts of Physical Activity on the Obese97 | ix | ||
| Obesity in Special Populations: Pregnancy109 | ix | ||
| Obesity Statistics121 | ix | ||
| Obesity in Older Adults137 | ix | ||
| Surgical Management of Metabolic Syndrome Related to Morbid Obesity145 | x | ||
| Behavioral Modification for the Management of Obesity159 | x | ||
| CSM_BLANK - Copy (2) | xii | ||
| Just Eat Less and Exercise More? | xiii | ||
| Obesity: A Plague Upon Our Houses | xv | ||
| CSM_BLANK - Copy (2) | xvi | ||
| The Future of Pediatric Obesity | 1 | ||
| Key points | 1 | ||
| INTRODUCTION AND OVERVIEW OF CHILDHOOD OBESITY | 1 | ||
| Providers Struggle with Obesity Treatment | 1 | ||
| Prevalence of Childhood Obesity | 2 | ||
| Trends Among Age Groups | 2 | ||
| Cultural Considerations with Weight | 2 | ||
| Special Considerations in Adolescents | 3 | ||
| A CLINICAL APPROACH TO CHILDHOOD OBESITY | 3 | ||
| Step 1: Engage the Family | 4 | ||
| Step 2: Identify Previous Attempts to Change | 4 | ||
| Step 3: Identify Barriers to Behavior Change | 4 | ||
| Step 4: Help the Patient and Family Define Important Changes | 5 | ||
| History and Physical Examination | 5 | ||
| Body mass index vs waist circumference | 6 | ||
| Waist circumference measurement | 6 | ||
| More About Barriers: Media Influence and Pediatric Obesity | 8 | ||
| Technology as a Tool Against Obesity: Social Marketing | 9 | ||
| Technology as a Tool Against Obesity: Wearable Technology and Applications | 9 | ||
| Technology as a Tool Against obesity: The Use of Social Media | 10 | ||
| Treatment Stages | 10 | ||
| Medications for Childhood Obesity | 13 | ||
| Surgical Treatment of Obesity in Adolescents | 14 | ||
| SUMMARY | 14 | ||
| REFERENCES | 14 | ||
| CSM_BLANK - Copy (2) | 18 | ||
| Health Care Systems and National Policy | 19 | ||
| Key points | 19 | ||
| THE OBESITY CHALLENGE: EPIDEMIOLOGY | 19 | ||
| RESPONSE TO OBESITY EPIDEMIC | 21 | ||
| Federal Government | 21 | ||
| The Office of the President | 21 | ||
| The Office of the Surgeon General | 22 | ||
| Department of Health and Human Services | 22 | ||
| The Office of Disease Prevention and Health Promotion | 23 | ||
| Centers for Medicare and Medicaid Services obesity management coverage | 23 | ||
| The Center for Medicare/Medicaid Innovation | 24 | ||
| Medicaid and Children’s Health Insurance Program Payment and Access Commission | 24 | ||
| Public Health Service Agencies | 24 | ||
| National Institutes of Health | 24 | ||
| Centers for Disease Control and Prevention | 24 | ||
| Agency for Healthcare Research and Quality | 25 | ||
| Health Resources and Services Administration | 25 | ||
| Substance Abuse and Mental Health Services Administration | 25 | ||
| US Department of Agriculture | 26 | ||
| Food and Drug Administration | 26 | ||
| State Governments | 28 | ||
| Private Foundations | 29 | ||
| Robert Wood Johnson Foundation | 29 | ||
| Aetna Foundation | 29 | ||
| W.K. Kellogg Foundation | 29 | ||
| Dr Robert C. and Veronica Atkins Foundation | 29 | ||
| New Balance Foundation | 29 | ||
| Voluntary Health Organizations | 29 | ||
| American Diabetes Association | 29 | ||
| American Heart Association | 30 | ||
| American Cancer Society | 30 | ||
| Health Care and Hospital Systems | 30 | ||
| Grass Roots Leadership and Change from the Ground Up: Life in Primary Care Practices | 30 | ||
| MEDICAL MANAGEMENT OF OBESITY: MERGING INDIVIDUALS AND SYSTEMS | 31 | ||
| Lifestyle Modification | 31 | ||
| FUTURE OPPORTUNITIES | 32 | ||
| Research | 32 | ||
| Policy | 32 | ||
| SUMMARY | 33 | ||
| ACKNOWLEDGMENTS | 33 | ||
| REFERENCES | 33 | ||
| CSM_BLANK - Copy (2) | 38 | ||
| Obesity Prevention and Screening | 39 | ||
| Key points | 39 | ||
| INTRODUCTION | 39 | ||
| SCREENING AND PREVENTION | 40 | ||
| INFANTS (BIRTH–12 MONTHS), TODDLERS (1–3 YEARS), AND PRESCHOOLERS (3–5 YEARS) | 40 | ||
| Screening Tools | 40 | ||
| Communicating with Parents | 41 | ||
| Prevention | 41 | ||
| SCHOOL-AGED CHILDREN (AGES 5–12 YEARS) | 41 | ||
| Screening | 41 | ||
| Communication | 43 | ||
| Prevention | 44 | ||
| ADOLESCENTS (AGES 13–18 YEARS) | 44 | ||
| Screening | 44 | ||
| Communication | 44 | ||
| CSM_BLANK - Copy (2) | 52 | ||
| Multidisciplinary Teams and Obesity | 53 | ||
| Key points | 53 | ||
| INTRODUCTION | 53 | ||
| The Patient-Centered Medical Home Model: A Personal Physician for Everyone | 54 | ||
| The Patient-Centered Medical Home: The Important Role of Behavioral Health | 55 | ||
| The Patient-Centered Medical Home: Where Does Nutrition Fit in? | 55 | ||
| Physical Activity: Help from the Medical Home? | 55 | ||
| OTHER PLAYERS ON THE PATIENT-CENTERED MEDICAL HOME TEAM | 55 | ||
| Pharmacologic Monitoring Within the Patient-Centered Medical Home | 56 | ||
| Case Management in the Patient-Centered Medical Home Setting | 56 | ||
| Asynchronous Communication: Patient Centered to Keep Everyone in the Loop | 56 | ||
| Group Visits | 56 | ||
| CLINICAL CORRELATION | 56 | ||
| SUMMARY/DISCUSSION | 57 | ||
| REFERENCES | 58 | ||
| CSM_BLANK - Copy (2) | 60 | ||
| Past, Present, and Future of Pharmacologic Therapy in Obesity | 61 | ||
| Key points | 61 | ||
| THE PAST: A BRIEF HISTORY | 61 | ||
| THE PRESENT: WHAT IS CURRENTLY AVAILABLE | 62 | ||
| Fat Blockers | 62 | ||
| Antidepressants | 63 | ||
| Stimulants | 63 | ||
| Diethylpropion (tenuate) | 63 | ||
| Lorcaserin (belviq) | 64 | ||
| Phendimetrazine (bontril) and phentermine (adipex and suprenza) | 64 | ||
| Phentermine/topiramate (qsymia) | 64 | ||
| Diabetes Medications | 65 | ||
| Liraglutide (victoza , saxenda) | 65 | ||
| THE FUTURE | 65 | ||
| Beloranib | 65 | ||
| Mirabegron | 66 | ||
| Gelesis 100 | 66 | ||
| SUMMARY | 66 | ||
| REFERENCES | 66 | ||
| CSM_BLANK - Copy (2) | 68 | ||
| Nutritional Therapy | 69 | ||
| Key points | 69 | ||
| INTRODUCTION | 69 | ||
| SUCCESSFUL WEIGHT LOSS | 70 | ||
| NUTRITION THERAPY: THE BASICS | 70 | ||
| NUTRITION, DIET FADS, AND TRENDS | 72 | ||
| THE QUICK FIX | 72 | ||
| NUTRITION THERAPY: WHAT DOES THE EVIDENCE SUGGEST? | 72 | ||
| CREATING A CALORIE DEFICIT | 75 | ||
| SUGAR AND FAT: LIMIT SUGAR, TRANS FATS, AND SATURATED FATS | 76 | ||
| Mifflin-St Jeor | 76 | ||
| Institute of Medicine | 76 | ||
| TOOLS FOR SUCCESS | 77 | ||
| Plant-based Food Approach | 77 | ||
| Registered dietitian nutritionists | 77 | ||
| Meal Replacements | 78 | ||
| Journaling | 78 | ||
| Planning Menus and Graphing Weight | 78 | ||
| ADDITIONAL THERAPIES AND THE INTERDISCIPLINARY TEAM | 79 | ||
| FOLLOW-UP SESSION TOPICS | 79 | ||
| NUTRITION MANAGEMENT FOLLOWING BARIATRIC SURGERY | 79 | ||
| SUCCESSFUL WEIGHT LOSS: LESSONS LEARNED | 80 | ||
| SUMMARY | 80 | ||
| REFERENCES | 80 | ||
| CSM_BLANK - Copy (2) | 82 | ||
| Economic Impact of Obesity | 83 | ||
| Key points | 83 | ||
| INDIVIDUAL OBESITY SPENDING | 84 | ||
| NATIONAL OBESITY SPENDING | 84 | ||
| Key Points | 84 | ||
| DIRECT AND INDIRECT COSTS OF OBESITY | 85 | ||
| DIRECT COSTS OF OBESITY | 85 | ||
| Key Points | 85 | ||
| INDIRECT COSTS OF OBESITY | 86 | ||
| Key Points | 86 | ||
| LOST PRODUCTIVITY | 86 | ||
| EMPLOYMENT/INSURANCE CLAIMS | 86 | ||
| QUALITY OF LIFE | 86 | ||
| IS OBESITY MORE EXPENSIVE THAN SMOKING? | 87 | ||
| Key Points | 87 | ||
| COMORBIDITY COSTS | 87 | ||
| Key Point | 87 | ||
| Cardiovascular Disease | 88 | ||
| Type 2 Diabetes | 88 | ||
| FUTURE TRENDS | 88 | ||
| CSM_BLANK - Copy (2) | 96 | ||
| Impacts of Physical Activity on the Obese | 97 | ||
| Key points | 97 | ||
| REGIONAL VARIATIONS IN OBESITY TRENDS | 101 | ||
| EXERCISE PHYSIOLOGY: A BRIEF REVIEW | 102 | ||
| Cardiovascular Response to Physical Activity | 102 | ||
| Physical Activity and Glucose Metabolism | 102 | ||
| Physical Activity and Chronic Disease Reduction | 102 | ||
| INCREASING PHYSICAL ACTIVITY: CAN IT BE DONE? | 103 | ||
| PHYSICAL ACTIVITY—IS IT A ROADBLOCK? | 103 | ||
| RESISTANCE TRAINING VERSUS AEROBIC TRAINING | 104 | ||
| PEDIATRICS | 104 | ||
| ADDITIONAL RESOURCES | 104 | ||
| SUMMARY | 105 | ||
| REFERENCES | 105 | ||
| CSM_BLANK - Copy (2) | 108 | ||
| Obesity in Special Populations | 109 | ||
| Key points | 109 | ||
| PERINATAL COMPLICATIONS ASSOCIATED WITH MATERNAL OVERWEIGHT/OBESITY | 109 | ||
| MANAGEMENT OF OBESITY IN PREGNANCY | 111 | ||
| RECOMMENDATIONS | 116 | ||
| SUMMARY | 117 | ||
| REFERENCES | 117 | ||
| Obesity Statistics | 121 | ||
| Key points | 121 | ||
| INTRODUCTION | 121 | ||
| DISEASE DESCRIPTION | 122 | ||
| RISK FACTORS | 124 | ||
| Genetics | 124 | ||
| Physical Activity | 125 | ||
| Caloric Intake | 125 | ||
| Socioeconomic Status | 125 | ||
| Miscellaneous Risk Factors | 125 | ||
| Risk in Children and Adolescents | 126 | ||
| PREVALENCE/INCIDENCE IN THE UNITED STATES | 126 | ||
| WORLDWIDE/REGIONAL INCIDENCE | 126 | ||
| MORBIDITY AND MORTALITY | 128 | ||
| COSTS OF OBESITY | 130 | ||
| SUMMARY | 130 | ||
| REFERENCES | 130 | ||
| CSM_BLANK - Copy (2) | 136 | ||
| Obesity in Older Adults | 137 | ||
| Key points | 137 | ||
| INTRODUCTION | 137 | ||
| BODY COMPOSITION CHANGES WITH AGE | 137 | ||
| BODY MASS INDEX AS A MEASURE FOR OBESITY AND A PROGNOSTIC INDICATOR | 138 | ||
| THE RELATIONSHIP BETWEEN BODY MASS INDEX AND MORTALITY | 138 | ||
| POTENTIAL EXPLANATIONS FOR IMPROVED SURVIVABILITY IN THE OBESE ELDER | 139 | ||
| BODY MASS INDEX AND MORBIDITY IN OLDER ADULTS | 140 | ||
| OBESITY-RELATED RISKS THAT MATTER: IMPAIRED PHYSICAL FUNCTION AND FRAILTY | 141 | ||
| WEIGHT LOSS FOR OLDER ADULTS: KEY MANAGEMENT POINTS | 141 | ||
| LIFESTYLE INTERVENTIONS FOR ELDERLY PATIENTS | 141 | ||
| PHARMACOLOGIC MANAGEMENT | 142 | ||
| SURGICAL MANAGEMENT | 142 | ||
| SUMMARY | 142 | ||
| REFERENCES | 143 | ||
| Surgical Management of Metabolic Syndrome Related to Morbid Obesity | 145 | ||
| Key points | 145 | ||
| INTRODUCTION | 145 | ||
| PRESURGERY MEDICAL EVALUATION | 146 | ||
| PRESURGERY NUTRITIONAL ASSESSMENT AND EDUCATION | 147 | ||
| PRESURGERY PSYCHOLOGICAL ASSESSMENT | 148 | ||
| WHY MEDICALLY SUPERVISED TREATMENT FAILS | 149 | ||
| MECHANISMS OF ACTION OF METABOLIC SURGERY | 150 | ||
| METABOLIC SURGERY OUTCOMES | 150 | ||
| SURGICAL TREATMENT OPTIONS | 151 | ||
| Roux-en-Y Gastric Bypass | 151 | ||
| Vertical Sleeve Gastrectomy | 151 | ||
| Adjustable Gastric Banding | 153 | ||
| Biliopancreatic Diversion with Duodenal Switch | 153 | ||
| SURGICAL COMPLICATIONS | 154 | ||
| POSTOPERATIVE CARE | 155 | ||
| Acute Phase (24–48 hours) | 155 | ||
| Chronic Phase (1 month to 2 years) | 155 | ||
| SUMMARY/DISCUSSION | 155 | ||
| REFERENCES | 156 | ||
| Behavioral Modification for the Management of Obesity | 159 | ||
| Key points | 159 | ||
| INTRODUCTION: NATURE OF THE PROBLEM | 159 | ||
| Placing the Behavioral Management of Obesity in the Larger Context | 159 | ||
| Weight Stigma | 160 | ||
| An Ecological Model for Understanding Obesity: Understanding Microsystem and Macrosystem Factors to Produce Change | 160 | ||
| Cultural Competency in the Behavioral Management of Obesity | 162 | ||
| BEHAVIORAL MODIFICATION FOR OBESITY MANAGEMENT | 163 | ||
| Treatment Basics | 163 | ||
| Collaborative goal setting | 163 | ||
| Accountability | 163 | ||
| Nutrition consultation and meal planning | 163 | ||
| Self-monitoring food intake, weight, and activity | 163 | ||
| Stimulus control | 164 | ||
| Problem solving | 164 | ||
| Problem solving: troubleshooting specific eating situations | 165 | ||
| Social eating and eating outside of the home | 165 | ||
| Emotional eating | 165 | ||
| Relapse prevention | 165 | ||
| Slips | 166 | ||
| Physical activity example: planning for an exercise slip | 166 | ||
| RESEARCH REVIEW: PROTOTYPICAL PROGRAMS FOR BEHAVIORAL MODIFICATION IN THE MANAGEMENT OF OBESITY | 167 | ||
| CHANGING LIFESTYLES FOR LONG-TERM WEIGHT MANAGEMENT: BACKGROUND ON NONDIETING BEHAVIORAL MODIFICATION APPROACHES | 167 | ||
| A FEASIBLE ALTERNATIVE: FEATURES OF NONDIET APPROACHES TO WEIGHT MANAGEMENT | 167 | ||
| Intuitive Eating | 168 | ||
| Nondieting Approach: Behavioral Choice Treatment | 168 | ||
| RESEARCH REVIEW: BEHAVIORAL CHOICE TREATMENT | 168 | ||
| PRIMARY CARE PLAN OF ACTION: FRAMEWORK FOR BUILDING A CLINICAL PROGRAM IN THE BEHAVIORAL MODIFICATION IN THE MANAGEMENT OF ... | 169 | ||
| A COLLABORATIVE APPROACH: PRIMARY CARE PHYSICIANS AND BEHAVIORAL HEALTH SPECIALISTS | 169 | ||
| Motivational Interviewing | 169 | ||
| Tips for Motivational Interviewing | 170 | ||
| RESEARCH REVIEW: MOTIVATIONAL INTERVIEWING | 170 | ||
| BEHAVIORAL CHOICE TREATMENT WITH A FAMILY COMPONENT | 170 | ||
| SUMMARY | 171 | ||
| DISCLAIMER | 172 | ||
| FUNDING/SUPPORT | 172 | ||
| REFERENCES | 172 | ||
| CSM_BLANK - Copy (2) | 176 |