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Abstract
Get a quick, expert overview of the many key facets of obesity management with this concise, practical resource by Dr. Jolanta Weaver. Ideal for any health care professional who cares for patients with a weight problem. This easy-to-read reference addresses a wide range of topics – including advice on how to "unpack" the behavioral causes of obesity in order to facilitate change, manage effective communication with patients suffering with weight problems and future directions in obesity medicine.
- Features a wealth of information on obesity, including hormones and weight problems, co-morbidities in obesity, genetics and the onset of obesity, behavioral aspects and psychosocial approaches to obesity management, energy and metabolism management, and more.
- Discusses pharmacotherapies and surgical approaches to obesity.
- Consolidates today’s available information and guidance in this timely area into one convenient resource.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Practical Guide to Obesity Medicine | i | ||
| Practical Guide to Obesity Medicine | iii | ||
| Copyright | iv | ||
| List of Contributors | v | ||
| Preface: Does “Benign Obesity” Exist? | ix | ||
| Contents | xi | ||
| I - THE SIZE OF THE PROBLEM | 1 | ||
| 1 - The Global Problem of Obesity | 1 | ||
| INTRODUCTION | 1 | ||
| DEFINITION OF OBESITY | 1 | ||
| OBESITY RATES WORLDWIDE | 1 | ||
| THE OBESITY EPIDEMIC AND URBANIZATION | 2 | ||
| CHILDHOOD OBESITY | 5 | ||
| THE BARKER HYPOTHESIS AND OBESITY | 5 | ||
| LEAST DEVELOPED COUNTRIES AND OBESITY | 6 | ||
| CONCLUSION | 6 | ||
| REFERENCES | 7 | ||
| 2 - Health Economics of Obesity | 9 | ||
| BACKGROUND | 9 | ||
| INDIVIDUAL CHOICES AND BEHAVIOR | 9 | ||
| COSTS OF OBESITY | 10 | ||
| Individual Level | 11 | ||
| Societal Level | 11 | ||
| Healthcare System | 12 | ||
| PREDICTIONS AND MODELING | 12 | ||
| POLICY IMPLICATIONS | 13 | ||
| Prevention Versus Treatment | 14 | ||
| CONCLUSIONS | 14 | ||
| REFERENCES | 14 | ||
| II HORMONES AND WEIGHT PROBLEMS | 17 | ||
| 3 - Glucagon-Like Peptide 1 and Human Obesity | 17 | ||
| INTRODUCTION | 17 | ||
| GLUCAGON-LIKE PEPTIDE 1 PHYSIOLOGY | 17 | ||
| Synthesis Secretion and Degradation | 17 | ||
| Role in Energy Balance | 18 | ||
| GLUCAGON-LIKE PEPTIDE 1 AND THE REGULATION OF ENERGY BALANCE IN MAN | 21 | ||
| Mediators of Glucagon-Like Peptide 1–Induced Negative Energy Balance in Man | 21 | ||
| Gastric mechanoreceptors | 22 | ||
| Incretin effect | 22 | ||
| Ghrelin | 22 | ||
| Interactions with central controllers of the energy balance equation | 23 | ||
| GLUCAGON-LIKE PEPTIDE 1 IN THE PATHOPHYSIOLOGY OF CLINICAL OBESITY | 23 | ||
| Functional Glucagon-Like Peptide 1 Deficits as a Risk Factor Toward the Obesity Phenotype | 23 | ||
| Monogenic obesity | 23 | ||
| Polygenic obesity | 23 | ||
| Obesity as a Risk Factor Toward Functional Glucagon-Like Peptide 1 Deficits | 23 | ||
| Post–oral glucose tolerance test glucagon-like peptide 1 secretory responses | 24 | ||
| In vivo neuroimaging and self-assessments of appetite | 24 | ||
| Target organ hyposensitivity | 24 | ||
| Interactions with peripheral efferents of the energy balance equation | 24 | ||
| Insulin. The most extensively studied of physiologic role of GLP-1 is as an insulin secretagogue (reviewed in Ref. 80). Hyperins... | 25 | ||
| Leptin. Leptin acts as a satiety signal governing long-term energy balance. Increased BMI has been shown to be positively correl... | 25 | ||
| Ghrelin. Released preprandially, the orexigenic hormone ghrelin promotes meal initiation and increases food intake. It has also ... | 25 | ||
| Interactions with the central controllers of energy balance | 25 | ||
| GLUCAGON-LIKE PEPTIDE 1 IN THE PHARMACOTHERAPY OF CLINICAL OBESITY | 25 | ||
| Glucagon-like peptide 1 agonists | 25 | ||
| Roux-en-y gastric bypass | 27 | ||
| Liraglutide 3mg | 27 | ||
| Glucagon-Like Peptide 1 Agonism in the Clinic | 28 | ||
| Cost-benefit of 3mg liraglutide as an antiobesity agent | 28 | ||
| Treatment period. Follow-up period (FUP) assessments in the SCALE Maintenance144,145 and SCALE Diabetes146 trials suggest that w... | 28 | ||
| Reducing indirect healthcare costs of obesity and overweight. Being overweight or obese is the main modifiable risk factor for T... | 29 | ||
| Adverse drug events | 29 | ||
| In-treatment period. The safety and efficacy of liraglutide 3mg has been evaluated in five phase III double-blind placebo-contro... | 29 | ||
| Follow-up period assessment and postmarketing surveillance. Although generally well tolerated in the acute setting, safety conce... | 30 | ||
| CONCLUSIONS AND FUTURE PERSPECTIVE | 30 | ||
| REFERENCES | 31 | ||
| 4 - Obesity, Cortisol Excess, and the Hypothalamic–Pituitary–Adrenal Axis | 37 | ||
| INTRODUCTION | 37 | ||
| GLUCOCORTICOIDS—STEROID HORMONES ESSENTIAL FOR LIFE | 37 | ||
| GLUCOCORTICOID REGULATION OF ADIPOSE TISSUE FUNCTION AND DISTRIBUTION | 38 | ||
| Glucocorticoids and White Adipose Tissue | 39 | ||
| Glucocorticoids and Brown Adipose Tissue | 39 | ||
| Glucocorticoid Regulation of Adipose Tissue Mass and Distribution | 39 | ||
| HYPOTHALAMIC–PITUITARY–ADRENAL AXIS FUNCTION IN THE OBESE | 39 | ||
| Experimental Models of Obesity | 41 | ||
| Clinical Studies | 41 | ||
| OBESITY IN GLUCOCORTICOID EXCESS | 41 | ||
| Obesity in Glucocorticoid Excess: Pathophysiology | 42 | ||
| Obesity in Glucocorticoid Excess: Cushing’s Syndrome | 42 | ||
| Obesity in Glucocorticoid Excess: Iatrogenic Steroid Excess | 42 | ||
| Pseudo Cushing’s Syndrome | 43 | ||
| III CO-MORBIDITIES IN OBESITY71 | 71 | ||
| 7 - The Role of Human Gut Microbiota in Obesity | 71 | ||
| INTRODUCTION | 71 | ||
| EXPERIMENTAL MODELS OF OBESITY | 71 | ||
| HUMAN STUDIES | 73 | ||
| SUMMARY | 74 | ||
| 8 - Obesity and Cardiovascular Disease Prevention | 77 | ||
| DEFINITIONS AND ABBREVIATIONS | 77 | ||
| INTRODUCTION | 77 | ||
| PATHOPHYSIOLOGY OF CARDIOVASCULAR DISEASE IN OBESITY | 77 | ||
| Limitation of Using Body Mass Index as Predictor of Cardiovascular Risk | 77 | ||
| Is Cardiovascular Risk Mediated by Obesity Itself or by Risk Factors? | 78 | ||
| The Risk Continuum: Overweight, Obesity, Metabolic Syndrome, and Diabesity | 78 | ||
| The Obesity Paradox in Cardiovascular Disease | 79 | ||
| Genes, Gene-Lifestyle Interactions and Obesity | 80 | ||
| THERAPEUTIC STRATEGIES TO REDUCE CARDIOVASCULAR RISK IN OBESITY | 80 | ||
| Lifestyle Strategies to Reduce Weight and Cardiovascular Risk—Evidence | 80 | ||
| Lifestyle Strategies—Recommendations | 81 | ||
| Diet Alone—Evidence | 82 | ||
| Dietary Strategies—Recommendations | 82 | ||
| Pharmacotherapy—Evidence | 83 | ||
| Pharmacotherapy—Recommendations | 83 | ||
| Subjects with uncomplicated obesity | 83 | ||
| Patients with comorbid conditions | 83 | ||
| Surgical Approaches to Obesity Management—Evidence | 83 | ||
| Are the Effects Durable? | 84 | ||
| Surgical Approaches to Obesity Management—Recommendations | 84 | ||
| CONCLUSION | 85 | ||
| USEFUL SOURCES OF INFORMATION | 85 | ||
| REFERENCES | 85 | ||
| 9 - Obesity and Nonalcoholic Fatty Liver Disease | 89 | ||
| INTRODUCTION | 89 | ||
| THE HISTORICAL PERSPECTIVE OF FATTY LIVER DISEASE | 89 | ||
| THE SPECTRUM OF NONALCOHOLIC FATTY LIVER DISEASE | 89 | ||
| EPIDEMIOLOGY | 89 | ||
| THE IMPORTANCE OF DIAGNOSING NONALCOHOLIC FATTY LIVER DISEASE | 90 | ||
| THE CLINICAL EVALUATION OF NONALCOHOLIC FATTY LIVER DISEASE | 90 | ||
| DIAGNOSIS OF NONALCOHOLIC FATTY LIVER DISEASE | 90 | ||
| History and Examination | 90 | ||
| Biochemical Analysis | 90 | ||
| BIOMARKERS AND IMAGING IN NONALCOHOLIC FATTY LIVER DISEASE | 91 | ||
| Liver Steatosis | 91 | ||
| Imaging techniques for steatosis | 91 | ||
| Liver Fibrosis | 91 | ||
| Imaging techniques for fibrosis | 92 | ||
| LIVER BIOPSY IN NONALCOHOLIC FATTY LIVER DISEASE | 92 | ||
| SCREENING FOR HEPATOCELLULAR CARCINOMA | 93 | ||
| THE DIAGNOSIS AND STAGING OF NONALCOHOLIC FATTY LIVER DISEASE IN THE FUTURE | 93 | ||
| PATHOPHYSIOLOGY OF NONALCOHOLIC FATTY LIVER DISEASE | 93 | ||
| FATTY LIVER AND TYPE 2 DIABETES MELLITUS | 94 | ||
| NONALCOHOLIC FATTY LIVER DISEASE AND THE METABOLIC SYNDROME | 94 | ||
| NONALCOHOLIC STEATOHEPATITIS AND FIBROSIS WITH TYPE 2 DIABETES MELLITUS | 94 | ||
| NONALCOHOLIC FATTY LIVER DISEASE AND HEPATOCELLULAR CARCINOMA | 94 | ||
| MANAGEMENT OF NONALCOHOLIC FATTY LIVER DISEASE | 94 | ||
| Patient Education and Lifestyle Modification Including Diet and Exercise | 94 | ||
| Pharmacologic Treatment of Nonalcoholic Fatty Liver Disease | 95 | ||
| CONCLUSION | 95 | ||
| REFERENCES | 95 | ||
| 10 - Lipid Disorders in Obesity | 99 | ||
| INTRODUCTION | 99 | ||
| NORMAL LIPID METABOLISM | 99 | ||
| Exogenous Pathway | 99 | ||
| Endogenous Pathway | 99 | ||
| Reverse Cholesterol Transport | 99 | ||
| THE ROLE OF FREE FATTY ACIDS | 99 | ||
| THE ROLE OF INSULIN RESISTANCE | 100 | ||
| THE ROLE OF FAT DISTRIBUTION | 100 | ||
| THE ROLE OF BROWN FAT | 101 | ||
| MONITORING LIPID LEVELS IN OBESITY | 101 | ||
| Non–High-Density Lipoprotein Cholesterol | 102 | ||
| High-Density Lipoprotein Cholesterol | 103 | ||
| Triglycerides | 103 | ||
| EFFECT OF WEIGHT LOSS ON LIPID PROFILE | 103 | ||
| DIETARY INTERVENTIONS | 104 | ||
| ROLE OF EXERCISE IN LIPID PROFILE | 104 | ||
| PHARMACEUTIC INTERVENTIONS | 105 | ||
| SURGICAL INTERVENTIONS | 105 | ||
| CONCLUSION | 105 | ||
| REFERENCES | 106 | ||
| 11 - Obesity and the Effects on the Respiratory System | 109 | ||
| RESPIRATORY PHYSIOLOGY | 109 | ||
| Normal Quiet Breathing | 109 | ||
| Effects of Obesity on Respiratory Physiology | 109 | ||
| CARDIOPULMONARY EXERCISE TESTING | 111 | ||
| SLEEP-DISORDERED BREATHING | 112 | ||
| OBSTRUCTIVE SLEEP APNEA SYNDROME | 112 | ||
| Epidemiology and Risk Factors | 113 | ||
| Associated Comorbidities | 114 | ||
| Treatment | 114 | ||
| OBESITY HYPOVENTILATION SYNDROME | 115 | ||
| Pathophysiology | 115 | ||
| Diagnosis | 116 | ||
| Management and Prognosis | 116 | ||
| THE EFFECT OF OBESITY ON RESPIRATORY DISEASE | 117 | ||
| Asthma | 117 | ||
| Pathophysiology | 117 | ||
| Treatment | 117 | ||
| CHRONIC OBSTRUCTIVE PULMONARY DISEASE | 118 | ||
| PULMONARY VASCULAR DISEASE | 119 | ||
| CONCLUSION | 119 | ||
| REFERENCES | 119 | ||
| 12 - The Effect of Obesity on Reproductive Health | 123 | ||
| INTRODUCTION | 123 | ||
| EFFECT OF OBESITY ON MALE REPRODUCTIVE FUNCTION | 123 | ||
| Male Obesity and the Hypothalamic-Pituitary-Gonadal Axis | 123 | ||
| Production of Adipokines | 124 | ||
| Impairment of Spermatogenesis | 124 | ||
| Spermatogenesis and Oxidative Stress | 124 | ||
| Physical Factors | 125 | ||
| EFFECT OF OBESITY ON FEMALE REPRODUCTIVE FUNCTION | 125 | ||
| Obesity and Sex Steroid Metabolism | 126 | ||
| Gonadotropins | 127 | ||
| Insulin | 127 | ||
| Adipokines | 127 | ||
| Leptin | 128 | ||
| Adiponectin | 128 | ||
| Cytokines and Chemokines | 128 | ||
| Effect of Obesity on Expression of Polycystic Ovarian Syndrome | 129 | ||
| OBESITY AND ASSISTED REPRODUCTIVE TREATMENTS | 129 | ||
| Ovulation Induction | 130 | ||
| Intrauterine Insemination | 130 | ||
| In Vitro Fertilization and Intracytoplasmic Sperm Injection | 130 | ||
| TREATMENT OPTIONS AND EFFECT ON REPRODUCTIVE FUNCTION | 135 | ||
| Lifestyle Modification | 135 | ||
| Pharmacologic Intervention | 135 | ||
| Bariatric Surgery and Management of Infertility | 136 | ||
| Bariatric Surgery and Assisted Reproduction Treatment | 137 | ||
| SUMMARY | 137 | ||
| REFERENCES | 137 | ||
| 13 - Obesity and Pregnancy | 143 | ||
| PART 1: THE EVIDENCE BASE | 143 | ||
| Defining Maternal Obesity | 143 | ||
| Population Trends in Maternal Obesity | 143 | ||
| Maternal Obesity Risks to Mother and Child | 144 | ||
| Gestational Weight Gain | 144 | ||
| Defining gestational weight gain | 144 | ||
| Excessive gestational weight gain | 145 | ||
| Gestational weight gain guidelines | 146 | ||
| PART 2: A CLINICIAN’S PERSPECTIVE | 147 | ||
| SUMMARY | 149 | ||
| REFERENCES | 149 | ||
| IV - GENETICS AND ONSET OF OBESITY | 153 | ||
| 14 - Genetics of Obesity | 153 | ||
| POLYGENIC OBESITY | 153 | ||
| SYNDROMIC OBESITIES | 154 | ||
| Genetic Diagnosis | 157 | ||
| Treatment in Genetic Obesity | 158 | ||
| CONCLUSION AND PERSPECTIVES | 159 | ||
| REFERENCES | 159 | ||
| 15 - Childhood Obesity | 163 | ||
| INTRODUCTION | 163 | ||
| DEFINING OVERWEIGHT AND OBESITY IN CHILDREN | 163 | ||
| ETIOLOGY OF OBESITY | 163 | ||
| Hypothalamus | 163 | ||
| Intrauterine Environment | 164 | ||
| Endocrine Causes | 166 | ||
| Simple Exogenous Obesity | 167 | ||
| HOW EARLY COULD OBESITY BE PREVENTED? | 167 | ||
| FIRST CONSULTATION WITH AN OBESE CHILD | 169 | ||
| TREATMENT | 170 | ||
| Lifestyle Modifications | 170 | ||
| Pharmacologic Management of Obesity in Children and Adolescents | 170 | ||
| Orlistat | 170 | ||
| Gastric Bypass | 173 | ||
| THE FUTURE | 173 | ||
| REFERENCES | 173 | ||
| V - BEVIOURAL ASPECTS AND PSYCHOSOCIAL APPROACH TO OBESITY MANAGEMENT | 177 | ||
| 16 - Obesity and Depression | 177 | ||
| INTRODUCTION | 177 | ||
| DEPRESSION | 177 | ||
| Epidemiology | 177 | ||
| Depressive Symptomatology Versus Diagnosis Depressive Disorder | 177 | ||
| Treatment of Depression | 179 | ||
| Etiologic Factors | 179 | ||
| OBESITY AND DEPRESSION | 179 | ||
| Obesity and Depression: A Confirmed Association | 179 | ||
| Mechanisms of Interaction | 180 | ||
| PRELIMINARY CONCLUSIONS, CLINICAL IMPLICATIONS, AND FUTURE CONSIDERATIONS | 180 | ||
| REFERENCES | 181 | ||
| 17 - Visual Biases in Estimating Body Size | 183 | ||
| THE PROBLEM OF ESTIMATING BODY SIZE | 183 | ||
| Contraction Bias | 183 | ||
| Adaptation | 183 | ||
| Weber’s Law | 185 | ||
| DISCUSSION | 185 | ||
| REFERENCES | 185 | ||
| 18 - Eating Disorders and Obesity | 189 | ||
| INTRODUCTION | 189 | ||
| PSYCHOLOGICAL AND PSYCHO-SOCIAL FACTORS IN DEVELOPING EATING DISORDERS AND OBESITY | 189 | ||
| BINGE EATING DISORDER | 190 | ||
| BULIMIA NERVOSA | 190 | ||
| ANOREXIA NERVOSA AND OBESITY | 190 | ||
| PARTIAL SYNDROMES | 190 | ||
| OTHER MENTAL HEALTH PROBLEMS AND OBESITY | 190 | ||
| TREATMENT FOR OBESITY WHERE IT IS PART OF AN EATING DISORDER | 190 | ||
| CLINICAL VIGNETTE | 191 | ||
| REFERENCES | 191 | ||
| 19 - Motivational Interviewing and Mindfulness in Weight Management | 193 | ||
| INTRODUCTION | 193 | ||
| DECONSTRUCTING OBESITY BEHAVIORS | 193 | ||
| WHAT IS MOTIVATIONAL INTERVIEWING? | 194 | ||
| Spirit of Motivational Interviewing | 195 | ||
| Ambivalence | 196 | ||
| Resistance and Discord | 197 | ||
| Sustain Talk and Change Talk | 198 | ||
| Using Elaboration, Affirmations, Reflections, Summaries to Respond to Change Talk | 202 | ||
| FOUR PROCESSES IN MOTIVATIONAL INTERVIEWING: APPLICATION TO WEIGHT MANAGEMENT | 203 | ||
| Engaging | 204 | ||
| Focusing | 204 | ||
| Evoking | 206 | ||
| Planning | 207 | ||
| RECOMMENDATIONS FOR TRAINING | 208 | ||
| SUMMARY | 210 | ||
| MINDFULNESS IN WEIGHT MANAGEMENT | 210 | ||
| CONCLUSIONS AND RECOMMENDATIONS | 211 | ||
| REFERENCES | 212 | ||
| VI ENERGY AND METABOLISM MANAGEMENT | 215 | ||
| 20 - The Role of Physical Activity and Exercise in Managing Obesity and Achieving Weight Loss | 215 | ||
| INTRODUCTION | 215 | ||
| EXERCISE, PHYSICAL ACTIVITY, PHYSICAL INACTIVITY, AND SEDENTARINESS | 215 | ||
| AEROBIC EXERCISE | 216 | ||
| HIGH-INTENSITY INTERMITTENT-BASED EXERCISE | 217 | ||
| RESISTANCE EXERCISE | 217 | ||
| COMBINED AEROBIC AND RESISTANCE EXERCISE | 217 | ||
| PHYSICAL INACTIVITY AND SEDENTARY TIME: WHY IS BEING ACTIVE IMPORTANT BEYOND WEIGHT LOSS? | 218 | ||
| Sedentary Behavior and Physical Inactivity | 218 | ||
| DIET VERSUS EXERCISE-INDUCED WEIGHT LOSS | 221 | ||
| EXERCISE TRAINING COUPLED WITH CALORIC RESTRICTION | 221 | ||
| DIFFERENCES IN EXERCISE-INDUCED WEIGHT LOSS RESPONSE BETWEEN SEXES | 221 | ||
| EXERCISE AND PHYSICAL ACTIVITY INTERVENTIONS TARGETED AT OBESE CHILDREN AND YOUTH | 222 | ||
| THE WIDER BENEFITS OF PHYSICAL ACTIVITY | 223 | ||
| COMMUNITY-BASED ADULT WEIGHT MANAGEMENT | 223 | ||
| SUMMARY | 224 | ||
| REFERENCES | 224 | ||
| 21 - Weight Management Programs | 231 | ||
| INTRODUCTION | 231 | ||
| COMPONENTS OF WEIGHT MANAGEMENT PROGRAMS | 231 | ||
| Commercial Programs | 231 | ||
| Programs Delivered by the Health Sector | 233 | ||
| EFFICACY OF WEIGHT MANAGEMENT PROGRAMS | 233 | ||
| Body Weight | 233 | ||
| Cardiovascular Risk Reduction | 236 | ||
| Diabetes Prevention | 237 | ||
| COST-EFFECTIVENESS OF WEIGHT MANAGEMENT PROGRAMS | 237 | ||
| LIMITATIONS OF WEIGHT MANAGEMENT PROGRAMS | 237 | ||
| Sustainability | 237 | ||
| Attrition | 237 | ||
| Applicability | 238 | ||
| SUMMARY AND RECOMMENDATIONS | 238 | ||
| REFERENCES | 238 | ||
| 22 - Breakfast for the Prevention and Treatment of Obesity | 241 | ||
| INTRODUCTION | 241 | ||
| EPIDEMIOLOGICAL LINKS BETWEEN BREAKFAST HABITS AND OBESITY | 241 | ||
| BREAKFAST FOR THE PREVENTION OF OBESITY | 241 | ||
| Chronic responses | 242 | ||
| Body Mass and Adiposity | 243 | ||
| Metabolic Health | 244 | ||
| Acute responses | 244 | ||
| Chronic responses | 244 | ||
| BREAKFAST FOR THE TREATMENT OF OBESITY | 244 | ||
| Chronic responses | 245 | ||
| Body Mass and Adiposity | 246 | ||
| Chronic responses | 246 | ||
| INTERACTIONS BETWEEN BREAKFAST AND OTHER GUIDELINES FOR PREVENTION OF OBESITY | 247 | ||
| PERSPECTIVES ON THE FUTURE | 247 | ||
| REFERENCES | 247 | ||
| 23 - Overview of a Range of Diets in Obesity Management | 251 | ||
| INTRODUCTION | 251 | ||
| CONVENTIONAL DIETS | 251 | ||
| Low-Carbohydrate Diet | 251 | ||
| Low-Fat Diets | 251 | ||
| High-Protein Diets | 251 | ||
| Very-Low-Calorie Diets | 252 | ||
| PORTION CONTROL | 252 | ||
| CONCLUSION | 252 | ||
| REFERENCES | 253 | ||
| 24 - New Approach to Type 2 Diabetes Reversal in Obesity: Acute Calorie Restriction | 255 | ||
| OBESITY, EXCESS INTRAORGAN FAT AND RISK OF TYPE 2 DIABETES | 255 | ||
| OVERVIEW OF THE USE OF VERY LOW–CALORIE DIET IN TYPE 2 DIABETES | 257 | ||
| METABOLIC CHANGES DURING DIABETES REVERSAL USING VERY LOW–CALORIE DIET | 257 | ||
| LIMITATIONS TO REVERSAL OF TYPE 2 DIABETES | 258 | ||
| WEIGHT MAINTENANCE FOLLOWING A VERY LOW–CALORIE DIET | 259 | ||
| COMPARISON OF EFFECTS OF VERY LOW–CALORIE DIET AND BARIATRIC SURGERY | 260 | ||
| Practical Aspects of This Approach | 261 | ||
| CONCLUSIONS | 261 | ||
| REFERENCES | 262 | ||
| VII - PHARMACOTHERAPIES IN OBESITY | 265 | ||
| 25 - Historical Drug Therapies in Obesity | 265 | ||
| INTRODUCTION | 265 | ||
| LAXATIVES | 265 | ||
| THYROID HORMONE | 265 | ||
| DINITROPHENOL | 265 | ||
| AMPHETAMINES AND RAINBOW PILLS | 266 | ||
| AMPHETAMINE ANALOGUES | 266 | ||
| Phentermine | 267 | ||
| Phenylpropanolamine | 267 | ||
| DIETHYLPROPION | 267 | ||
| AMINOREX | 267 | ||
| FENFLURAMINE AND DEXFENFLURAMINE | 267 | ||
| BENFLUOREX | 267 | ||
| SIBUTRAMINE | 268 | ||
| RIMONABANT | 268 | ||
| CONCLUSION | 268 | ||
| REFERENCES | 268 | ||
| 26 - New Therapies in Obesity | 271 | ||
| INTRODUCTION | 271 | ||
| ANTIOBESITY DRUGS—SPECIAL CONSIDERATIONS | 271 | ||
| Newer Approaches | 271 | ||
| Orlistat | 271 | ||
| Safety | 272 | ||
| NEW AGENTS | 272 | ||
| Liraglutide 3mg | 272 | ||
| Naltrexone and Bupropion | 273 | ||
| Naltrexone SR 8mg+ Bupropion SR 90mg (NB) | 273 | ||
| NEW AGENTS NOT APPROVED IN EUROPE | 276 | ||
| Lorcaserin | 276 | ||
| Phentermine and Topiramate | 276 | ||
| Phentermine+topiramate SR (PT) | 276 | ||
| WEIGHT LOSS AS A SIDE EFFECT | 276 | ||
| Antiepileptics and Antidepressants | 276 | ||
| Zonisamide | 276 | ||
| Zonisamide+bupropion | 277 | ||
| Fluoxetine | 277 | ||
| Glucose-Lowering Agents | 277 | ||
| Metformin | 277 | ||
| α-Glucosidase inhibitors | 277 | ||
| Pramlintide | 277 | ||
| Glucagon-like peptide-1 receptor agonists | 277 | ||
| Sodium-glucose cotransporter 2 inhibitors | 277 | ||
| NOVEL APPROACHES | 277 | ||
| REFERENCES | 278 | ||
| VIII SURGICAL APPROACH | 281 | ||
| 27 - Medical Management of Patients Before and After Bariatric Surgery | 281 | ||
| INTRODUCTION | 281 | ||
| STRUCTURE OF NONSURGICAL WEIGHT MANAGEMENT SERVICE | 281 | ||
| INITIAL ASSESSMENT | 281 | ||
| BARIATRIC SURGERY AND MANAGEMENT OF DIABETES | 282 | ||
| ASSESSMENT FOR SLEEP APNEA | 283 | ||
| ASSESSMENT OF OTHER MEDICAL PROBLEMS PREOPERATIVELY | 283 | ||
| POST–BARIATRIC SURGERY MANAGEMENT OF MEDICAL PROBLEMS | 284 | ||
| POST–BARIATRIC SURGERY HYPOGLYCEMIA | 285 | ||
| CONCLUSION | 285 | ||
| REFERENCES | 285 | ||
| 28 - Surgical Management of Obesity | 287 | ||
| INTRODUCTION | 287 | ||
| ELIGIBILITY FOR BARIATRIC SURGERY | 287 | ||
| CHOICE OF BARIATRIC SURGERY | 287 | ||
| BARIATRIC SURGERY AND WEIGHT REDUCTION | 290 | ||
| BARIATRIC SURGERY AND DIABETES | 292 | ||
| BARIATRIC SURGERY AND DEPRESSION | 294 | ||
| BARIATRIC SURGERY AND OBSTRUCTIVE SLEEP APNEA | 295 | ||
| BARIATRIC SURGERY AND HYPERTENSION, DYSLIPIDEMIA, AND CARDIOVASCULAR RISK | 295 | ||
| CONCLUSION | 296 | ||
| REFERENCES | 296 | ||
| 29 - Psychological Management Before and After Weight Loss Surgery | 299 | ||
| DECONSTRUCTING OBESITY | 299 | ||
| LITERATURE REVIEW OF PSYCHOLOGICAL FACTORS AND WEIGHT LOSS SURGERY | 300 | ||
| Psychological Predictors of Outcomes Following Weight Loss Surgery | 300 | ||
| Psychological Status in Severely Obese Patients Seeking Weight Loss Surgery | 300 | ||
| What Psychological Factors Are Contraindications for Weight Loss Surgery? | 301 | ||
| THE ROLE OF PSYCHOLOGISTS IN MULTIDISCIPLINARY TEAMS | 303 | ||
| CASE STUDY: JANET | 303 | ||
| Presenting Difficulty | 303 | ||
| IX - BOTTOM LINE | 329 | ||
| 31 - The Future of Obesity Medicine | 329 | ||
| DISEASE STATES ASSOCIATED WITH OBESITY | 329 | ||
| HYPOTHYROIDISM | 329 | ||
| POLYCYSTIC OVARIAN SYNDROME | 329 | ||
| Cushing’s Disease Or Syndrome | 330 | ||
| HYPOTHALAMIC OBESITY | 330 | ||
| NEXT STEP | 330 | ||
| REFERENCES | 334 | ||
| Index | 335 | ||
| A | 335 | ||
| B | 335 | ||
| C | 336 | ||
| D | 337 | ||
| E | 338 | ||
| F | 339 | ||
| G | 339 | ||
| H | 340 | ||
| I | 341 | ||
| K | 341 | ||
| L | 341 | ||
| M | 342 | ||
| N | 342 | ||
| O | 343 | ||
| P | 343 | ||
| Q | 344 | ||
| R | 344 | ||
| S | 345 | ||
| T | 345 | ||
| U | 346 | ||
| V | 346 | ||
| W | 346 | ||
| X | 347 | ||
| Z | 347 |