Cover
Half Title
Series Page
Title Page
Copyright Page
Dedication
Table of Contents
Preface
Acknowledgments
Editors
Contributors
Section I: The Modern Management of Obesity
Chapter 1 Preventing and Managing Obesity: The Scope of the Problem
1.1 Introduction
1.2 The Burden of Overweight and Obesity in the United States
1.3 Health Effects of Obesity
1.4 Searching for Solutions
1.5 Need for Healthcare Professional Involvement
1.6 Summary/Conclusions
1.6.1 Clinical Applications
References
Chapter 2 The Pathophysiology of Obesity
2.1 Introduction
2.2 Energy Balance
2.3 Metabolic Predictors of Weight Gain
2.4 Fat Cells and Adipokines
2.5 Causes of Obesity
2.6 Summary/Conclusions
Practical Applications
References
Chapter 3 The Epidemiology of Adult Obesity
3.1 Introduction
3.2 Prevalence of Obesity
3.3 Health Consequences of Obesity
3.4 Economic Cost of Obesity in the United States
3.5 Summary/Conclusions
Clinical Applications
References
Chapter 4 Identification, Evaluation, and Treatment of Overweight and Obesity
4.1 Introduction
4.2 Identification of Obesity
4.3 Evaluation of the Obese/Overweight Patient
4.4 Guidelines for Treatment
4.5 Guidelines for Treatment by Age Group
4.6 Summary/Conclusions
Clinical Applications
References
Chapter 5 Exercise Management for the Patient with Obesity
5.1 Introduction
5.2 The Effect of Physical Activity on Prevention of Weight Gain
5.3 Effects of Physical Activity on Weight Loss
5.4 Weight Loss Variability in Response to Physical Activity
5.5 Physical Activity, Fitness, and Health Outcomes
5.6 Summary/Conclusions
Practical Applications
References
Chapter 6 Behavioral Management for the Patient with Obesity
6.1 Introduction
6.2 Getting Started
6.2.1 Assessment
6.2.2 Behavioral Management Strategies
6.2.3 Incorporating Behavioral Management into Intervention
6.2.4 Streamlining Behavioral Management
6.2.5 Behavioral Research Results
6.2.6 Long-Term Behavioral Management Results: The Gold Standards
6.2.6.1 Diabetes Prevention Program
6.2.6.2 Look AHEAD
6.3 Conclusion
Practical Applications
References
Chapter 7 Dietary Management of Overweight and Obesity
7.1 Introduction
7.2 Medical Assessment
7.3 Nutrition Assessment
7.4 Dietary Assessment
7.4.1 Determining Energy Expenditure
7.4.2 Determining Energy Intake
7.4.3 Determining Eating Environment and Readiness for Intervention
7.5 Dietary Intervention
7.6 Intensity of Intervention
7.7 Conclusions
Practical Applications
References
Chapter 8 A Clinical Approach to Pharmacological Management of the Patient with Obesity
8.1 Introduction
8.2 Drugs Approved for Pharmacological Management of Obesity
8.2.1 Drug Approved for Short-Term Pharmacological Management of Obesity
8.2.1.1 Phentermine (Trade Name Adipex, Ionamin, Lomaira)
8.2.2 Drugs Approved for Long-Term Pharmacological Management of Obesity
8.2.2.1 Phentermine-Topiramate ER (Trade Name Qsymia)
8.2.2.2 Naltrexone-Bupropion ER (Trade Name Contrave)
8.2.2.3 Liraglutide (Trade Name Saxenda)
8.2.2.4 Lorcaserin (Trade Name Belviq(sup[TM]), Belviq XR(sup[TM]))
8.2.2.5 Orlistat (Trade Name XenicalTM, AlliTM)
8.3 A Practical Approach to Pharmacological Management of Obesity: A Treatment Algorithm
8.3.1 Step 1. Pre-treatment Discussion
8.3.2 Step 2. Drug Optimizations
8.3.3 Step 3. Rule-Out Pharmacotherapy Choices
8.3.4 Step 4. Rule-in Pharmacotherapy Choices
8.3.5 Step 5. Prescribe Medicine Using the Recommended Titration Schedule, Watch Out for Side Effects and Monitor Efficacy
8.3.6 Step 6. Concomitant Management of Chronic Comorbidities
8.4 Practice Considerations before Prescribing Drugs for Weight Loss
8.4.1 Prepare Your HCPs for Prescribing Drugs for Weight Loss
8.4.2 Preparing for Introducing Pharmacological Management of Obesity
8.5 Summary and Conclusions
Practical Applications
References
Chapter 9 Bariatric Surgery
9.1 Introduction
9.2 Bariatric Surgical Procedures
9.2.1 Restrictive Surgeries
9.2.2 Restrictive Malabsorptive Bypass Procedure
9.3 Why Consider Bariatric Surgery? Long-Term Outcomes and Resolution of Comorbid Conditions
9.3.1 Weight Loss Outcomes
9.3.2 Medical Outcomes
9.4 Selecting the Appropriate Patient
9.5 Evaluating and Preparing the Patient for Surgery
9.5.1 Medical Evaluation
9.5.2 Psychological Evaluation
9.5.3 Nutritional Evaluation
9.5.4 Preparing the Patient for Surgery
9.6 Postoperative Care
9.6.1 Immediate Management (<3 Months)
9.6.2 Surgical and Medical Emergencies
9.7 Long-Term Management
9.7.1 Medical Management
9.7.2 Nutritional Management
9.7.2.1 Iron
9.7.2.2 Vitamin B(sup[12])
9.7.2.3 Calcium and Vitamin D
9.7.3 Recommendations for Physical Activity after Bariatric Surgery
9.7.4 Psychological Care
9.8 Weight Regain Following Bariatric Surgery
9.9 Conclusion
Practical Applications
References
Chapter 10 Pediatric Obesity
10.1 Introduction
10.2 Key Resources
10.3 Definition
10.4 Etiologies
10.5 Comorbid Conditions
10.6 Prevention of Childhood Obesity
10.7 Treatment of Childhood Obesity
10.8 Summary/Conclusions
Clinical Applications
References
Chapter 11 Adiposity-Based Chronic Disease: A New Diagnostic Term
11.1 Introduction
11.2 Consequences of ABCD
11.3 Intensive Lifestyle Intervention
11.4 Sleep Hygeine
11.5 Stress Reduction
11.6 Antibiotic Use and the Microbiome
11.6.1 Antibiotic Use by Humans
11.6.2 Antibiotic Use in Farming
11.7 Endocrine Disruptors
11.8 Alcohol Moderation
11.9 Mood
11.10 Community Engagement
11.11 Transculturalzation
11.12 Summary/Conclusion
Clinical Applications
References
Section II: Obesity and Specific Medical Conditions
Chapter 12 Obesity and Cardiovascular Disease
12.1 Introduction
12.2 Hemodynamics of Adipose Tissue
12.3 Hemodynamic Effects of Obesity
12.4 Effects on Left Ventricular Function
12.5 Obesity and Coronary Heart Disease
12.6 Obesity and Risk Factors for Coronary Heart Disease
12.7 The Effects of Obesity Treatment on Risk Factors for Coronary Heart Disease
12.8 Does Treatment of Obesity Decrease the Risk of Coronary Heart Disease?
12.9 The Role of Weight Gain as a Risk Factor for CHD
12.10 Clinical Assessment of Individuals with Obesity
12.11 Treatment of Obesity in Clinical Practice
12.12 Summary/Conclusions
Clinical Applications
References
Chapter 13 Obesity and Diabetes
13.1 Introduction
13.2 Prevalence of Obesity Pandemic
13.2.1 Obesity-Associated Morbidity and Mortality
13.3 Insulin Resistance and Diabetes: Pathophysiology, Symptoms, Assessment, and Associated Complications
13.3.1 Obesity and Insulin Resistance
13.3.2 Mechanisms of Progressive B-Cell Dysfunction in Obese Individuals
13.4 Mechanisms Linking Obesity and Insulin Resistance
13.4.1 Adipose Tissue Macrophages: A Link Between Obesity-Associated Inflammation and Insulin Resistance
13.4.2 Toll-like Receptor: Linking Obesity and Inflammation
13.4.3 Molecular Dysregulation Associated with Lipid Oversupply
13.4.4 Genetic Links between Obesity and Type 2 Diabetes
13.4.5 Endocrine Links between Obesity and Diabetes
13.4.6 Impaired Free Fatty Acid Utilization in Skeletal Muscle
13.4.7 Adipokines
13.4.8 Glucocorticoids
13.5 Cell-Intrinsic Mechanisms Linking Obesity to Diabetes
13.5.1 Ectopic Fat Storage
13.5.2 Oxidative Stress
13.5.3 Mitochondrial Dysfunction
13.5.4 Neural Mechanisms
13.6 Common Approaches to Treat Insulin Resistance and Obesity
13.6.1 Physical Activity
13.6.2 Nutrition
13.6.3 Improving Insulin Sensitivity in Obesity with Pharmacological Agents
13.6.4 Available Medications for Weight Loss
13.6.5 Other Non-Behavioral Treatments
13.6.5.1 Bariatric Surgery
13.7 Conclusions
Clinical Applications
References
Chapter 14 Obesity and the Metabolic Syndrome
14.1 Introduction
14.2 Elusive Definition of Metabolic Syndrome
14.3 Describing the Metabolic Syndrome in the United States
14.4 Controversies in MetS in Science and Medicine
14.5 Predicting Cardiometabolic Risk from MetS
14.6 Obesity and the Etiology of Insulin Resistance and Metabolic Syndrome
14.7 Screening and Evaluation for MetS
14.8 Treatment and Management of MetS
14.9 Summary/Conclusions
Clinical Applications
References
Chapter 15 Lifestyle Approaches Targeting Obesity to Lower Cancer Risk, Progression, and Recurrence
15.1 Introduction
15.2 Mechanisms of Obesity Impact on Cancer
15.3 Strategies to Disrupt the Obesity/Cancer Linkage
15.4 Lifestyle Recommendations to Disrupt the Obesity/Cancer Linkage
15.5 Type 2 Diabetes Mellitus and Cancer Risk
15.6 Conclusions
Clinical Applications
References
Chapter 16 Obesity and Arthritis
16.1 Introduction
16.2 Osteoarthritis
16.3 Rheumatoid Arthritis
16.4 Considerations for Weight Loss Interventions in Arthritic Populations
16.5 Considerations for Exercise Prescriptions in Arthritic Populations
16.6 Summary/Conclusions
Clinical Applications
References
Section III: Future Directions and Public Health Issues
Chapter 17 Beyond Subcutaneous Fat
17.1 Introduction
17.2 Central Abdominal Obesity
17.3 Visceral Adiposity
17.4 Peripheral Fat Does No Harm
17.5 Non-Alcoholic Fatty Liver Disease
17.6 Are Weight Gain, Abdominal Obesity, and Development of Fatty Liver a One-Way Street?
17.7 Other Ectopic Depots
17.8 Summary/Conclusions
Practical Applications
References
Chapter 18 Public Health and Obesity
18.1 Introduction
18.2 Agriculture and Food Supply Policies That Support Healthy Eating
18.3 Supports for a Physically Active Lifestyle
18.3.1 School Settings
18.3.2 School-Based Food Policy
18.3.3 School-Based Physical Activity Policies
18.4 Health Care Service Policies
18.5 Urban Design, Land Use, and Transportation Policies for Active Living/Healthy Eating
18.6 Conclusions
Clinical Applications
References
Chapter 19 Future Directions in Obesity and Weight Management
19.1 Introduction
19.2 Lifestyle Medicine and the Obesity Epidemic
19.2.1 Physical Activity
19.2.2 Nutrition
19.2.3 Behavioral Approaches to Weight Management
19.2.4 Motivational Interviewing
19.2.5 Positive Psychology
19.2.6 Coaching
19.2.7 Stress Reduction
19.2.8 Sleep
19.3 New Paradigms for Practicing Medicine
19.4 Removing Barriers to Better Outcomes
19.4.1 Entrenched Bias and Stigma
19.4.2 Inadequate Resources for Obesity Care
19.4.3 Payment Systems Favor Treating Obesity Complications Rather than Obesity
19.5 More Effective Public Health Strategies in the Future
19.5.1 A Narrow Focus on Food Policy
19.5.2 Accounting for Complex Systems Driving Obesity
19.6 New Technologies
19.7 New Visions for Health
19.8 Research Priorities
19.8.1 Advances in Pharmacotherapy
19.8.2 Precision Medicine
19.8.3 Attention to Long-Term Outcomes
19.8.4 Translational Science
19.9 Summary/Conclusions
Clinical Applications
References
Index