The Challenge Of Treating Obesity And Overweight

The Roundtable on Obesity Solutions of the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, on April 6, 2017, titled The Challenge of Treating Obesity and Overweight: A Workshop. The discussions covered treatments for obesity, overweight, and severe obesity in adults and children; emerging treatment opportunities; the development of a workforce for obesity treatments; payment and policy considerations; and promising paths to move forward. This publication summarizes the presentations and discussions from the workshop.

Promotes the recognition, treatment, and prevention of conditions of overweight and obesity in the United States.

Obesity and overweight pose significant challenges to the armed forces in the United States, affecting service members (including active duty, guard, and reserve components), veterans, retirees, and their families and communities. The consequences of obesity and overweight in the armed forces influence various aspects of its operations that are critical to national security. On May 7, 2018, the National Academies of Sciences, Engineering, and Medicine, held a workshop titled "Understanding and Overcoming the Challenge of Obesity and Overweight in the Armed Forces." Speakers examined how obesity and overweight are measured in the armed forces and how they affect recruitment, retention, resilience, and readiness; discussed service-specific issues related to these problems and highlighted innovative strategies to address them through improved nutrition, physical activity, and stress management; and offered perspectives from outside of the armed forces on approaches to prevent and treat obesity. They also discussed the challenges and opportunities related to overcoming the concerns posed by obesity and overweight in the armed forces, military families, and their communities, including potential cross-sector opportunities. This publication summarizes the presentations and discussions from the workshop.

Obesity now represents a serious problem in industrialized nations. An increasingly large number of people, especially children, are overweight - leading to subsequent illness and a reduced life expectancy. At long last, with this first evidence-based review of the current intervention strategies for treating and preventing obesity clinicians and health insurers have a guide that allows them to select the most efficient and cost-effective method of treatment for any given state of the illness. The whole is backed by extensive tables, a checklist for quality assurance and an extensive glossary. With a foreword by George A. Bray, Boyd Professor at Louisiana State University and Chief of the Clinical Obesity section: ""Treating and Preventing Obesity - An Evidence Based Review" provides a careful and thoughtful assessment of this disease and the options for its control and treatment. It started with the medical model where cure is the outcome. This valuable report provides a timely new analysis of a growing problem."

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 stigmatization and discrimination. As a major contributor to preventive death in the United States today, overweight and obesity pose a major public health challenge. Overweight is here defined as a body mass index (BMI) of 25 to 29.9 kg/m2 and obesity as a BMI of 3 30 kg/m2. However, overweight and obesity are not mutually exclusive, since obese persons are also overweight. A BMI of 30 is about 30 lb overweight and equivalent to 221 lb in a 6'0" person and to 186 lb in one 5'6." The number of overweight and obese men and women has risen since 1960; in the last decade the percentage of people in these categories has increased to 54.9 percent of adults age 20 years or older. Overweight and obesity are especially evident in some minority groups, as well as in those with lower incomes and less education. Obesity is a complex multifactorial chronic disease that develops from an interaction of genotype and the environment. Our understanding of how and why obesity develops is incomplete, but involves the integration of social, behavioral, cultural, physiological, metabolic and genetic factors. While there is agreement about the health risks of overweight and obesity, there is less agreement about their management. Some have argued against treating obesity because of the difficulty in maintaining long-term weight loss and of potentially negative consequences of the frequently seen pattern of weight cycling in obese subjects. Others argue that the potential hazards of treatment do not outweigh the known hazards of being obese. The intent of these guidelines is to provide evidence for the effects of treatment on overweight and obesity. The guidelines focus on the role of the primary care practitioner in treating overweight and obesity.

The acknowledgment that obesity is a disease—a disease with enormous impact on both the public health and the economy and an incredible burden to its victims—has ?nally come. This ?nal recognition will hopefully free research dollars and will encourage third party payers to understand the need to cover services for treatment. Dr McKnight is an honored family medicine educator who combines his sense of academic rigor with the understanding of a compassionate family p- sician. Thus he approaches this clinical syndrome in the manner of a family physician: he aims to have an effect on the entire person and that person’s life, not just some disease entity. His broad-based approach draws on behavioral strategies, diet and exercise modi?cation, and limited use of pharmaceuticals in selected cases. The practical tools presented here will prove to be valuable ad- tions to the armamentarium of care teams that look to develop treatment plans for their patients with this disease. I myself have been obese as long as I can remember. I am the son of obese parents and my sister has shared this chronic problem. Over my lifetime I have dealt with almost all of the problems of obesity, and I have used all of the excuses. I have dealt with many obese patients during my years in practice, some who have said openly that they chose me as their physician because I really couldn’t tell them to lose weight, since I could not myself.