Overweight and Obesity

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Key Points Î More than 78 million adults in the United States were obese in 2009-2010. Obesity raises the risk of morbidity from hypertension, dyslipidemia, type 2 diabetes mellitus (diabetes), coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and some cancers. Obesity is also associated with increased risk in all-cause and cardiovascular disease (CVD) mortality. Î Overweight is defined as a body mass index (BMI) of 25-29.9 kg/m 2 and obesity as a BMI of ≥30 kg/m 2 . Current estimates are that 69% of adults are either overweight or obese with approximately 35% obese. Î It has been reported that, compared with normal weight individuals, obese patients incur 46% increased inpatient costs, 27% more physician visits and outpatient costs, and 80% increased spending on prescription drugs. The medical care costs of obesity in the United States in 2008 totaled about $147 billion. Comprehensive Lifestyle Intervention (for every patient who needs to lose weight) Elements of High Intensity Comprehensive Lifestyle Intervention Î Lower calorie diet Î Increased physical activity Î Behavioral strategies to achieve diet and activity goals • Delivered on site by a trained interventionist a • 14 or more sessions in the first 6 months • Continued follow-up for 1 year a Trained interventionist: In the studies reviewed, trained interventionists included mostly health professionals (e.g., registered dietitians, psychologists, exercise specialists, health counselors, or professionals in training ) who adhered to formal protocols in weight management. In a few cases, lay persons were used as trained interventionists; they received instruction in weight management protocols (designed by health professionals) in programs that have been validated in high-quality trials published in peer-reviewed journals.

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