肥胖患者的诊疗建议

OfficeManagementoftheObesePatientPatient

BMIObesityManagementinan

OutpatientOfficePractice3729332140312720AppropriateOfficeEnvironmentforObesePatientsWaitingroomchairswithoutarmsStepstoolsnexttoexaminationtablesLargegownsandbloodpressurecuffsScalethatcanweighextremelyobesepatients,locatedinaprivateareaAppropriateobesityeducationalmaterials,handouts,andtreatmentprotocolsEmpathetic,respectful,andsupportiveofficestaffInitialOfficeVisitIncludeevaluationofpotentialobesityrelateddiseaseswithinhistory,physicalexamination,andlaboratorytestsObtainweighthistory,eating,andactivitybehaviorsSearchfortriggeringfactors,includingmedicationsMeasureweight,height,andcalculatebodymassindexCategorizeobesityclassificationandhealthriskDeterminereadinesstoloseweightInitiatetreatmentplan(involveotherprofessionals

ifneeded)DiscussgoalsandexpectationsArrangefollow-upandsupportKushnerandWeinsier.MedClinNorthAm2000;84:387.SelectedMedicationsThatCanCauseWeightGainPsychotropicmedicationsTricyclicantidepressantsMonoamineoxidaseinhibitorsSpecificSSRIsAtypicalantipsychoticsLithiumSpecificanticonvulsants-adrenergicreceptorblockersSSRI=selectiveserotoninreuptakeinhibitorDiabetesmedicationsInsulinSulfonylureasThiazolidinedionesHighlyactiveantiretroviraltherapyTamoxifenSteroidhormonesGlucocorticoidsProgestationalsteroids AssessingWeightLossReadinessMotivation:Stresslevel:Psychiatricissues:

Timeavailability:PatientseeksweightreductionFreeofmajorlifecrisesFreeofseveredepression,substanceabuse,bulimianervosaPatientcandevote15-30min/dtoweightcontrolfornext26weeksPatientReady?PreventweightgainandexplorebarrierstoweightreductionInitiateweightlosstherapyYESNOObesePatientsHaveUnrealisticWeightLossGoalsOutcomeWeight(lbs)%ReductionInitial2180Dream13538Happy15031Acceptable16325Disappointed18017Fosteretal.JConsultClinPsychol1997;65:79.ConclusionsObesityisachronicdiseaseModestweightloss(5%-10%ofbodyweight)canhaveconsiderablemedicalbenefitsLifestylechange(dietandphysicalactivity)isthecornerstoneoftherapyPharmacotherapycanbeusefulinproperlyselectedpatientsBariatricsurgeryisthemosteffectivetherapyforobesityObesity-RelatedResources

ProfessionalAssociationsNorthAmericanAssociationfortheStudyofObesity(NAASO)AmericanAcademyofFamilyPhysicians(AAFP)AmericanCollegeofSportsMedicine(ACSM)AmericanDiabetesAssociation(ADA)AmericanDieteticAssociation(ADA)AmericanGastroenterologicalAssociation(AGA)AmericanHeartAssociation(AOA)AmericanObesityAssociation(AOA)AmericanSocietyforBariatricSurgery(ASBS)

CentersforDiseaseControl(CDC):

ObesityandOverweightCentersforDiseaseControl(CDC):

PrevalencedataandgrowthchartsNationalInstitutesofHealth(NIH)NationalInstitutesofDiabetes&

Digestive&KidneyDiseases(NIDDK)

Weight-ControlInformationNetwork(WIN)NationalInstitutesofDiabetes&

Digestive&KidneyDiseases(NIDDK)

WeightLossandControlNationalLibraryofMedicine,

MEDLINEPlusObesity-RelatedResources

GovernmentOrganizations/nccdphp/dnpa/obesity/index.htm/nchs/nhanes.htm

/health/nutrit/win.htm

/health/nutrit/nutrit.htm

/medlineplus/obesity.

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