A high priority for health care in our society is to prevent the development of mass population obesity. Prevention strategy is directed first to factors leading to obesity in childhood, adolescence, and young adulthood. Nonetheless, prevention must extend into middle age and the later years, where changes in body composition accentuate the adverse effects of excess body fat. Once obesity becomes established, attention must turn to reducing excess both weight as well as to preventing further weight gain. At this time too, medical intervention must aim to prevent the complications of obesity, particularly cardiovascular disease and type 2 diabetes. This chapter will briefly address prevention of obesity in the general population and will then focus on the clinical management of overweight/obese patients with particular attention to preventing medical complications.
In the approach to the problem of obesity a clear distinction cannot be drawn between ''prevention'' and ''treatment.'' Except when severe obesity is present, obesity per se does not cause physical limitation. Instead, associated medical problems usually develop insidiously over a period of many years. Once obesity is established, aims of management are twofold: (a) prevention of the medical complications, and (b) elimination of excess body fat. Unfortunately, clinical weight-reduction therapy has met with only limited success. Certainly with therapy some obese patients will effectively lose weight, others will lose small amounts, and some will be able to prevent further weight gain; but still others will continue to gain weight. Efforts to achieve weight reduction are warranted, but in view of the limited success of weight reduction programs, parallel intervention to prevent the complications of obesity must come into play.
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