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1. Introduction

An estimated 97 million adults in the United States are overweight or obese. In European Union over 50% of both men and women were overweight, and roughly 23% of women and 20% of men were 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 and European Union 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% 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 our course – unique online - is to provide evidence for the effects of treatment on overweight and obesity. Our course focuses on the role of the primary care practitioner in treating overweight and obesity.

Areas of expertise contributed our course included primary care, epidemiology, clinical nutrition, exercise physiology, psychology, physiology, and pulmonary disease.

Question: Who is at Risk?

Answer: All overweight and obese adults (age 18 years of age or older) with a BMI of 25 are considered at risk for developing  associated morbidities or diseases such as hypertension, high blood cholesterol, type 2 diabetes, coronary heart disease, and other diseases. Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI 30 are considered obese.

Treatment of overweight is recommended only when patients have two or more risk factors or a high waist circumference. It should focus on altering dietary and physical activity patterns to prevent development of obesity and to produce moderate weight loss. Treatment of obesity should focus on producing substantial weight loss over a prolonged period. The presence of comorbidities in overweight and obese patients should be considered when deciding on treatment options.

Question:  Why Treat Overweight and Obesity?

Answer: Obesity is clearly associated with increased morbidity and mortality. There is strong evidence that weight loss in overweight and obese individuals reduces risk factors for diabetes and cardiovascular disease (CVD). Strong evidence exists that weight loss reduces blood pressure in both overweight hypertensive and nonhypertensive individuals; reduces serum triglycerides and increases high-density lipoprotein (HDL)-cholesterol; and generally produces some reduction in total serum cholesterol and low-density lipoprotein (LDL)-cholesterol.

Weight loss reduces blood glucose levels in overweight and obese persons without diabetes; and weight loss also reduces blood glucose levels and HbA1c in some patients with type 2 diabetes. Although there have been no prospective trials to show changes in mortality with weight loss in obese patients, reductions in risk factors would suggest that development of type 2 diabetes and CVD would be reduced with weight loss.

Question: What Treatments Are Effective?

Answer: A variety of effective options exist for the management of overweight and obese patients, including dietary therapy approaches such as low-calorie diets and lower-fat diets; altering physical activity patterns; behavior therapy techniques; pharmacotherapy; surgery; and combinations of these techniques.

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