Volume 1 Guidelines Management of Overweight

MANAGEMENT OF OVERWEIGHT

Treatment of obesity

Treatment of obesity is difficult; patience and persistence are needed, but the outcome may be very rewarding.

Acceptable weight ranges for height.

The goal should be one agreed between doctor and patient:

a lesser degree of weight loss may be more realistic, to avoid the patient becoming disillusioned and abandoning the effort

the preferred rate of weight loss is 0.5 - 1 kg per week

‘Central’ obesity

The distribution of obesity is significant, as well as its extent. Specifically, excess of truncal and intra-abdominal fat is a risk factor for coronary disease and is an important adverse influence on lipid levels, HDL cholesterol, blood pressure and glucose tolerance. Thus, ‘central’ obesity should be sought and treated with particular care; abdominal skinfold thickness should be checked and recorded.

Weight-reducing programme

To enhance compliance the doctor plays a supportive, encouraging role, seeing the patient as often as is practicable. The benefits of weight loss are emphasised:

subjectively: better effort tolerance, better appearance

objectively: improved life expectancy. fall in blood pressure, improved glucose an lipid metabolism

Prescription of a calorie-restricted lipid-lowering diet

for most patients this will provide 1000 kcal/day

it is often helpful for the patient to commence the meal with a helping of a bulky, very-low-calorie item such as a mixed or green salad without oil, or clear soup

high-energy density foods (those with high fat and/or sugar content) are minimised, and little or no alcohol should be consumed during weight reduction

Prescription of an exercise programme. The type of exercise prescribed depends on the patient’s preference and/or fitness and health status:

progressively brisk walking for 30 - 45 minutes, five to seven days per week, is a useful option; this should be continued after target weight is attained, to assist in weight maintenance

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