Vclinical Management Of Adults With Established Obesity

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Clinical treatment of obesity in childhood and adolescence is beyond the scope of this chapter. The Obesity Education Initiative (OEI) of the National Institutes of Health provides a reasonable approach to the management of adults with established obesity (1,2). Similar guidelines are available from other sources (2). The OEI report focuses primarily on weight reduction strategies; although it indicated the need to evaluate coexisting risk factors, it did not directly recommend their management before instituting weight reduction. The ATP III report, on the other hand, placed priority on initiating therapies for risk factors before dealing with the problem of obesity. ATP III contends that risk factors typically impart a more immediate risk to patients than does obesity itself; thus, risk factor control takes precedence in clinical management. The present chapter will attempt to integrate OEI and ATP III reports so as to facilitate both weight reduction and treatment of metabolic risk factors. Both OEI and ATP III base recommendations on available scientific evidence. They contain a large number of references and evidence tables. They are both available on the National Heart Lung and Blood Institute website (www.nhlbi.nih.gov). The current chapter summarizes key features of these guidelines but does not detail the literature available in the reports. They can be obtained from the website or corresponding publications of the reports.

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