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Basic Principles of Obesity Therapy
Obesity Therapy
Adipose tissue
Energy Intake
Energy Expenditure
Relationship Between Rate of Weight Loss and Gallstone Formation
Incidence of Gallstone Formation (% subjects/wk)
Weinsier et al. Am J Med 1995;98:115.
Reprinted with permission from Excerpta Medica.
Rate of Weight Loss (kg/wk)
0
0.5
1
1.5
2
2.5
1
2
3
4
5
6
7
8
9
Prevention of Gallstone Formation by Ursodeoxycholic Acid During Rapid Weight Loss
New Gallstones (%)
*Shiffman et al. Ann Intern Med 1995;122:899. ?Sugerman et al. Am J Surg 1995;169:91.
Ursodeoxycholic Acid (mg/d)
0
300
600
1200
0
300
600
1200
VLCD = very-low-calorie diet.
16 wk of VLCD*
6 mo after gastric bypass procedure?
28%
8%
3%
2%
32%
13%
2%
6%
Short-term Obesity Therapy Does Not Result in Long-term Weight Loss
Change in Weight (kg)
Wadden et al. Int J Obes 1989;13 (Suppl 2):39.
5-year Follow-up
1-year Follow-up
End of Treatment
Baseline
Diet alone
Behavior therapy
Combined therapy
Long-term Weight Loss is Improved with Long-term Maintenance Therapy
Weight Loss (%)
Perri et al. J Consult Clin Psychol 1988;56:529.
P <0.05
No maintenance tx
Maintenance tx
Diet and behavior modification therapy
Obesity Treatment Pyramid
Obesity Treatment Guidelines
The Practical Guide can be found at:
NHLBI web site: www.nhlbi.nih.gov
NAASO web site: www.naaso.org
Guide for Selecting Obesity Treatment
The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. October 2000, NIH Pub. No.00-4084
BMI Category (kg/m2)