Practical Manual of Clinical Obesity

205 Pages·2013·3.863 MB·English

by  Robert Kushner, Victor Lawrence, Sudhesh Kumar

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Robert Kushner, Professor of Medicine, Northwestern University Feinberg a
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Victor Lawrence, Consultant Physician, Endocrinology and Diabetes, a
St Mary’s Hospital, Newport, Isle of Wight, UK l
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Sudhesh Kumar, Professor of Medicine, Warwick Medical School, f
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Practical Manual of Clinical Obesity provides practical, accessible and i
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will be your perfect go-to tool in the management of your patients.
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chapter containing plenty of engaging text features such as key points, s
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understanding of obesity diagnosis and management. Key clinical trials
and major international society guidelines are referred to throughout. Obesity
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• Patterns, risks and benefits of weight loss r
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• Evaluation of management options: diet, exercise, drugs, a
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• Management of obesity related co-morbidities n
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Practical Manual of Clinical Obesity is ideal reading for endocrinologists a
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of all levels, as well as all other health professionals who manage obese d
patients such as specialist nurses, dieticians, and GP’s with an interest in K Robert Kushner,
obesity management. u
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a Victor Lawrence
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Titles of Related Interest
and Sudhesh Kumar
Obesity and Diabetes, 2nd Edition; Barnett; ISBN 9780470519813
Clinical Obesity in Adults and Children, 3rd Edition; Kopelman; ISBN 9781405182263
ISBN 978-0-470-65476-7
9 780470 654767
www.wiley.com/go/endocrinology

Practical Manual of Clinical Obesity

Practical Manual of
Clinical Obesity
Robert Kushner MD
Professor of Medicine
Northwestern University Feinberg School of Medicine
Chicago, IL, USA
Victor Lawrence MRCP PhD
Consultant Physician in Endocrinology and Diabetes Mellitus
The Arun Baksi Centre for Diabetes and Endocrinology
St Mary’s Hospital
Newport, Isle of Wight, UK
Sudhesh Kumar MD FRCP FRCPath
Professor of Medicine
Warwick Medical School
University of Warwick
And Consultant Endocrinologist
University Hospitals Coventry and Warwickshire
Coventry, UK
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Set in 9.5/13pt Meridien by SPi Publisher Services, Pondicherry, India
1 2013
Contents
Preface, vii
Part 1 The Biology of Obesity—Why It Occurs, 1
Victor Lawrence, Section Editor
1 Energy Balance and Body Weight Homeostasis, 3
2 The Genetic Basis of Obesity, 13
3 Adipocyte Biology, 25
4 Fetal and Infant Origins of Obesity, 33
5 Metabolic Fuels and Obesity, 41
Part 2 Clinical Management of the Obese Individual, 51
Robert Kushner, Section Editor
6 Practical Guide to Clinical Assessment and Treatment Planning, 53
7 Stages of Obesity and Weight Maintenance, 63
8 Dietary Management, 71
9 Physical Activity and Exercise, 81
10 Behavior Therapy, 91
11 Pharmacotherapy, 99
12 Surgery, 109
Part 3 Clinical Management of Obesity-Related
Co-morbidities, 121
Sudhesh Kumar and Milan K. Piya, Section Editors
13 Diabetes and Metabolic Diseases, 123
14 Obesity and Reproductive Health, 133
15 Gastro-intestinal and Hepatobiliary Disease, 141
16 Respiratory Disease, 149
17 Obesity and Cardiovascular Disease, 157
18 Obesity: Mental Health and Social Consequences, 167
19 Obesity and Musculo-skeletal Disease, 175
20 The Obese Patient in Hospital, 181
Conversion Table, 187
Index, 189
v

Preface
According to the World Health Organization (WHO), obesity is one of the
greatest public health challenges of the 21st century. In 2008, more than
1.4 billion adults, 20 years and older, were found to be overweight. Of
these, over 200 million men and nearly 300 million women were obese. In
the 27 member states of the European Union, approximately 60% of adults
and over 20% of school-age children are overweight or obese. The preva-
lence of overweight and obesity in the USA is even more distressing,
affecting over 68% of adults and 33% of children and adolescents.
Overweight and obesity are now linked to more deaths worldwide than
underweight. The cause for the rapid increase in the prevalence of obesity
is multifaceted, brought about by an interaction between predisposing ge-
netic and metabolic factors and a rapidly changing “modern” environment.
The health risks of excess weight have been demonstrated in multiple
population studies. Obesity significantly increases a person’s risk of devel-
oping numerous non-communicable diseases (NCDs), including cardio-
vascular disease, cancer, diabetes, sleep disturbance, and other disabilities.
The risk of developing more than one of these diseases (co-morbidity) also
increases with increasing body weight. Accordingly, obesity-related health-
care costs are soaring and contribute to an increasing percentage of total
health-care expenditures. These data suggest that halting and reversing
the obesity epidemic will require involvement of multiple stakeholders,
including the medical profession.
Regardless of which health-care area a provider is working, clinicians
are being called upon to provide care for persons affected by obesity. It is
no longer sufficient to simply advise our patients to “eat less and move
more.” Obesity is now considered a complex disease determined by g enetic,
physiological, behavioral, psychosocial, cultural, economic, and societal
factors. The etiological mechanisms underlying obesity-related co-m orbidities,
for example, hemodynamic alterations, insulin resistance, hormonal
abnormalities, ectopic fat, and secretion of adipokines, continue to be clar-
ified. Research over the past decade has also elucidated the metabolic and
genetic control systems that govern regulation of body weight and energy
expenditure, leading to the development of novel pharmacological and
vii
viii Preface
surgical interventions. Each year new intervention trials demonstrate the
beneficial effect of weight loss on a myriad of obesity-related co- morbidities.
In an effort to translate the emerging science and practice of obesity care
for clinicians, the Practical Manual of Clinical Obesity has been written as a
practical, evidence-based companion guide to the textbook Clinical Obesity
in Adults and Children, edited by P.G. Kopelman, I.D. Caterson, and W.H.
Dietz. The manual is intended for physicians, nurses, allied health profes-
sionals, and students who care for overweight and obese individuals. The
20 concise chapters of the manual are divided into three major sections:
The Biology of Obesity—Why It Occurs, Clinical Management of the Obese
Individual, and Clinical Management of Obesity-Related Co-morbidities.
Each chapter includes features that are directly intended to improve its
readability and usefulness for the busy clinician—key points, case studies,
boxed figures, pitfalls, key web links, and references. A collective effort has
been made by the three editors to write all chapters with “one voice.” We
hope that we have succeeded in publishing a manual that will be a valuable
resource for the care of patients affected by obesity.
R.F. Kushner
V. Lawrence
S. Kumar