Questions and Answers

Evidence from the National Weight Control Registry (NWCR), which tracks indices and predictors in individuals who have lost at least 30 pounds and have maintained that loss for at least 1 year, suggests that patterns associated with successful weight maintenance include the following: Self-monitoring of weight; Consumption of a low-fat diet; Daily physical activity of […] Read More

A reasonable goal for weight loss in the setting of a medical treatment program is approximately 1-2 lb/wk. However, it is becoming increasingly apparent that the weight-loss goal for each patient must be individualized and cannot be unilaterally based on standard weight-for-height norms. In addition to the patient’s weight, factors to consider when setting individualized […] Read More

Before enrolling any patient in a weight-loss program, the clinician must have a clear idea of that individual’s expectations. A patient with unrealistic expectations should not be enrolled until these are changed to realistic and attainable goals. The clinician should guide the patient who seeks weight reduction to create goals that fit the mnemonic SMART: […] Read More

In patients with morbid obesity associated with comorbidities, bariatric surgery is the only available therapeutic modality associated with clinically significant and relatively sustained weight loss. Well-performed bariatric surgery, in carefully selected patients and with a good multidisciplinary support team, substantially ameliorates the morbidities associated with severe obesity. Read More

Obesity is associated with insulin resistance and increased serum levels of fasting insulin and C-peptide serum levels. However, insulin levels are normal in many persons who are obese. All patients with obesity should be screened for diabetes. Additional information is gained by using glucose and HbA1c tests together if the patient is fasting. The American […] Read More

Thyroid function test results are also typically normal, but checking them to detect primary hypothyroidism (characterized by increased serum thyrotropin and normal or reduced thyroxine and/or triiodothyronine levels) is worthwhile. Screening with a serum thyrotropin level is usually sufficient. Of importance, hypothyroidism itself rarely causes more than mild obesity. Read More

Liver function tests yield normal results in most obese patients. However, elevated transaminase levels may indicate nonalcoholic steatohepatitis (NASH) or fatty infiltration of the liver. Read More

Mesomorphic body states, as seen in bodybuilders and people in related occupations (e.g., professional wrestling), may be associated with elevated BMIs, but as a result of increased muscle mass rather than excess adiposity. In addition, anasarca may be mistaken for obesity if not carefully evaluated clinically. Other conditions to consider while examining for obesity include […] Read More

In the clinical examination, anthropometric parameters are measured and the standard, detailed examination required in evaluating patients with any chronic, multisystem disorder, such as obesity, is performed. Waist and hip circumference are useful surrogates in estimating visceral fat; serial tracking of these measurements helps in estimating the clinical risk over time. Neck circumference is predictive […] Read More

A longitudinal study by Stessman et al of more than 1000 individuals indicated that a normal BMI, rather than obesity, is associated with a higher mortality rate in elderly people. The investigators determined that a unit increase in BMI in female members of the cohort could be linked to hazard ratios (HRs) of 0.94 at […] Read More