Obesity and sedentary lifestyle are...

Obesity and sedentary lifestyle are escalating national and global epidemics that warrant increased attention on physicians. Manson and colleagues issue a call to action for physicians and provide guidelines directed at the pivotal part of physicians in the prevention and management of obesity. "The Escalating Pandemics of Obesity and Sedentary Lifestyle: A Call to Action for Clinicians" appears in the February 9 2004 issue of Annals of Internal Medicine and is available online at http:// archinte.ama-assn.org/cgi/reprint/ 164/3/249

Physicians can play a clew role in combating the epidemics of exces weight and physical inactivity. They clearly have access; the average American makes three office visits by year, and 60 percent of office visits are made to primary care physicians. Their advice is usually sought abroad and respected, and there is evidence that physician advice can motivate patients to change unhealthy behaviors. even now physicians generally do not capitalize in succession these opportunities. In fact, many physicians do not routinely assess weight and physical activity or furnish advice on these factors.

Research has shown that those patients who received advice to let slip through the fingers weight were significantly more likely to essay losing weight than those who did not receive similar advice. Rates of counseling about physical activity may be on the same level lower. Only 34 percent of adults who had seen a physician in the prior year reported being interchange of opinioned about physical activity at their last physician visit.

The reasonable rates of physician counseling generally are attributed to lack of training, lack of time for counseling in practice settings, a dearth of appropriate patient education materials, and little or no reimbursement. Although full-scale counseling about weight los and physical activity would be ideal for patients who ne it, a simple, direct acknowledgment of the question at issue and straightforward suggestions for remedies are eminent starting points that require little training.

A strategy based forward the National Heart, Lung, and house Institute's guidelines on obesity and the surgeon general's reports in succession physical activity and obesity proffers physicians an easily adapted blueprint for incorporating information about weight and physical activity into their discussions with patients, and includes the following:

* At each visit, measure the patient's weight and height, and calculate his or her visible form [i]or[/i] frame mass index (BMI). If the BMI is 25 or more, measure the waist circumference; assessing the waist-hip ratio provides little additional advantage and is appreciably more difficult and time consuming. If the BMI and waist circumference are within the healthy range (BMI les than 25 and waist circumference les than 40 in [102 cm] for men and les than 35 in [89 cm] for women) congratulate the patient and propose encouragement about the importance of maintaining a healthy weight. If the patient's BMI is not in the healthy range, describing the health risks of exces weight may help motivate him or her to begin losing weight. A BMI of 30 or higher doubles the risks of coronary heart disease and premature mortality, and more than triples the risk of developing exemplar 2 diabetes.

* If the patient is receptive to losing weight, establish a target of 5 to 10 percent below baseline weight at a rate of 022 to 09 kg (05 to 2 lb) thrown away per week. This amount of weight los generally can be accomplished with an spiritedness deficit of 500 to 1000 kcal by means of day that is best achieved by dint of restricting intake through smaller portion sizes, minimizing snacks and dessert replacing high-fat and high-calorie nutriments with low-fat and low-calorie choices, and increasing physical activity. power training should be recommended as an integral part of increased physical activity because the associated increase in resting metabolic rate may contribute to weight loss

* A patient with a starting BMI of 30 or higher (or BMI of 27 or higher with comorbidities) whose weight does not be agreeable to to a lower calorie diet and increased physical activity after six month may be a candidate for pharmacotherapy.

* Bariatric surgery may be an option for psychologically stable, fiercely obese patients (BMI of 40 or higher) or those with a BMI of 35 or higher with comorbidities when musical entertainmented efforts of lifestyle modification and pharmacotherapy have failed. Bariatric surgery has been shown to have salutary tenors on obesity-related diabetes, hypertension, lipid profiles, and quality of life. Comorbidities so as hypertension and hyperlipidemia should be managed intensively.

* For sedentary patients, a make comments [i]or[/i] remarks such as, "It must be hard to stay physically active with all the time you ne to devote at a desk job,"may render free of access the door to a discussion about exercise. A description of the existing guidelines promoting 30 minutes of moderateintensity activities upon most days of the week could dispel the notion that exercise must be a hard, sweaty chore that must be crammed into already busy days. Something as simple as writing a prescription for exercise (walk briskly at least five days a week, covering a mile in 15 to 20 minutes) demonstrates to the patient the importance of physical activity.