C Development of the Evidence Model

The panel determined the evidence model used to develop the guidelines for the evaluation and treatment of obesity (Figure 7, and Figures 7a and 7b). The model contains two broad categories, the association of weight to cardiovascular and noncardiovascular mortality and morbidity in the population and the clinical issues related to the treatment of the overweight individual. The population portion of the model addresses such questions as, Is there an association between weight and...

BPharmacotherapy Trials

Evidence Statement Weight loss produced by weight loss medications and adjuvant lifestyle modifications produces no consistent change in blood lipids. Evidence Category B. Rationale The effects of pharmacological therapy on weight loss and subsequent changes in total serum cholesterol levels were evaluated by examining eight RCTs 386 390-393 395 407408 (Table III-3). The four trials of dexfenfluramine showed no consistent effects on total cholesterol three trials showed decreases in...

Identification of patients at very high absolute risk

The following disease conditions or target organ damage in hypertensive patients denote the presence of very high absolute risk that triggers the need for intense risk factor modification as well as disease management. For example, the presence of very high absolute risk indicates the need for aggressive cholesterol-lowering therapy. 142 2.a. Established coronary heart disease (CHD) 2.a.1. History of myocardial infarction 2.a.2. History of angina pectoris (stable or unstable) 2.a.3. History of...

Identification of cardiovascular risk factors that impart a high absolute risk

Patients can be classified as being at high absolute risk for obesity-related disorders if they have three or more of the multiple risk factors listed below. The presence of high absolute risk increases the intensity of cholesterol-lowering therapy 142 and blood pressure management. 545 4.b. Hypertension A patient is classified as having hypertension if systolic blood pressure is > 140 mm Hg or diastolic blood pressure is > 90 mm Hg, or if the patient is taking antihypertensive agents. 4.c....

Box 10 Assess Reasons for Failure to Lose Weight

If a patient fails to achieve the recommended 10 percent reduction in body weight in 6 months or 1 year, a reevaluation is required. A critical question is whether the level of motivation is high enough to continue clinical therapy. If motivation is high, revise the goals and strategies (see Box 8). If motivation is not high, clinical therapy should be discontinued, but the patient should be encouraged to embark on efforts to lose weight or to at least avoid further weight gain. Even if weight...

Hypercholesterolemia high blood cholesterol

Cholesterol is the most abundant steroid in animal tissues, especially in bile and gallstones. The relationship between the intake of cholesterol and its manufacture by the body to its utiliza tion, sequestration, or excretion from the body is called the cholesterol balance. When cholesterol accumulates, the balance is positive when it declines, the balance is negative. In 1993, the NHLBI National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High...

Box 8 Clinician and Patient Devise Goals

The decision to lose weight must be made jointly between the clinician and patient. Patient involvement and investment is crucial to success. The patient may choose not to lose weight but rather to prevent further weight gain as a goal. The panel recommends as an initial goal the loss of 10 percent of baseline weight, to be lost at a rate of 1 to 2 lb week, establishing an energy deficit of 500 to 1,000 kcal day. (See pages 71-72.) For individuals who are overweight, a deficit or 300 to 500...

A4 Annotated Bibliography of Studies Specifically Designed To Achieve Weight Reduction in Special Populations

The following annotations describe weight reduction studies in special populations or situations. From the total number of studies identified in which minorities or other special populations were included, the studies listed below are those for which the treatment or intervention program included design features specifically geared to the needs of a minority population or other special population of interest. Thus, these studies provide examples of ways in which researchers or service...

Percentage of Medicare Beneficiaries who are Overweight by Race Gender and Education 1991

* Overweight is defined as a BMI > 27.8 kg m2 for males and > 27.3 kg m2 for females. ** Based on samples of fewer than 30 persons. Source Medicare Current Beneficiary Survey 1991, Non-Institutionalized Persons only (N 9,721). 630 * Overweight is defined as a BMI > 27.8 kg m2 for males and > 27.3 kg m2 for females. ** Based on samples of fewer than 30 persons. Source Medicare Current Beneficiary Survey 1991, Non-Institutionalized Persons only (N 9,721). 630 Percentage of Medicare...

Very lowdensity lipoprotein VLDL

Lipoprotein particles that initially leave the liver, carrying cholesterol and lipid. VLDLs contain 10 to 15 percent of the total serum cholesterol along with most of the triglycerides in the fasting serum VLDLs are precursors of LDL, and some forms of VLDL, particularly VLDL remnants, appear to be atherogenic. Visceral fat One of the three compartments of abdominal fat. Retroperitoneal and subcutaneous are the other two compartments. VO2 max Maximal oxygen uptake is known as VO2 max and is the...

Strategies for Weight Loss and Weight Maintenance

Dietary Therapy A diet that is individually planned and takes into account the patient's overweight status in order to help create a deficit of 500 to 1,000 kcal day should be an integral part of any weight loss program. A patient may choose a diet of 1,000 to 1,200 kcal day for women and 1,200 to 1,500 kcal day for men. Depending on the patient's risk status, the low-calorie diet (LCD) recommended should be consistent with the NCEP's Step I or Step II Diet (see page 74 of the guidelines)....

Introduction

An estimated 97 million adults in the United States are overweight or obese, a condition that substantially raises their risk of morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. Obese individuals may also suffer from social stigmati-zation and...

Examples of Moderate Amounts of Activity

Washing and waxing a car for 45-60 minutes Washing windows or floors for 45-60 minutes Playing touch football for 30-45 minutes Wheeling self in wheelchair for 30-40 minutes Walking 1 miles in 35 minutes (20 min mile) Basketball (shooting baskets) for 30 minutes Dancing fast (social) for 30 minutes Pushing a stroller 1M miles in 30 minutes Walking 2 miles in 30 minutes (15 min mile) Wheelchair basketball for 20 minutes Basketball (playing a game) for 15-20 minutes Running 1M miles in 15 minutes...

Instructions for Measuring Waist Circumference According to Nhanes Iii Protocol

To define the level at which waist circumference is measured, a bony landmark is first located and marked. The subject stands and the examiner, positioned at the right of the subject, palpates the upper hip bone to locate the right iliac crest. Just above the uppermost lateral border of the right iliac crest, a horizontal mark is drawn, then crossed with a vertical mark on the midaxillary line. The measuring tape is placed in a horizontal plane around the abdomen at the level of this marked...

Obesity and Physical Activity

Strategy Development Workshop for Public Education on Weight and Obesity--Summary Report. Summary of a 1992 workshop held to identify issues in educating the public, identifying priority audiences, approaches, and communications channels for weight and physical activity. Available at http www.nhlbi.nih.gov nhlbi cardio obes prof obeshc.htm Methods for Voluntary Weight Loss and Control (National Institutes of Health Technology Assessment Conference). An edited summary of a 1992 NIH Technology...

Assessing Abdominal

For the most effective technique for assessing abdominal fat content, the panel considered measures of waist circumference, waist-to-hip ratio (WHR), magnetic resonance imaging (MRI), and computed tomography. Evidence from epidemiological studies shows waist circumference to be a better marker of abdominal fat content than WHR, and that it is the most practical anthropometric measurement for assessing a patient's abdominal fat content before and during weight loss treatment. Computed tomography...

Pharmacotherapy

Drug therapy has undergone radical changes in the last 2 years. With the publication of the trials with phentermine and fenfluramine by Weintraub in 1992 (210 weeks), drug therapy began to change from short-term to long-term use. Both dexfenfluramine and fenfluramine alone, as well as the combination of phenter-mine fenfluramine, were used long term. However, concerns about recently reported unacceptable side effects, such as valvular lesions of the heart causing significant insufficiency of...