||Screening For Obesity
Guideline For Health Professionals
Clinical Recommendation: Periodic height and weight measurements are recommended
for all patients (see Clinical
Burden of Suffering
Obesity is an excess of body fat.
studies rely on indices of relative weight, such as body mass index (BMI),
an index of body weight that is normalized for height, to estimate the prevalence
For example, the National Center for Health Statistics currently
uses the 85th percentile sex-specific values of BMI for persons aged 20-29
for men and >=27.3 kg/m2
for women) from
the second U.S. National Health and Nutrition Examination Survey (NHANES II)
as a cutoff to define overweight in adults.
Approximately one third of adult Americans aged 20 and older are estimated
to be overweight, based on data from NHANES III.
Using 1990 census figures, this corresponds to 58 million people. The prevalence
of overweight in the United States has increased dramatically during the past
15 years in men and women of all age and ethnic groups, and remains disproportionately
high among black and Hispanic women.
that have a high prevalence of obesity include Asian and Pacific Islanders,
Native Americans and Alaska Natives, and Native Hawaiians.
The prevalence of overweight among adolescents has also increased.
Based on NHANES III data, about one fifth of adolescents
aged 12-19 are overweight.
of obesity among younger children is uncertain, but is estimated to be between
5% and 25%,
and may also be increasing.
Increased mortality in adults has been clearly documented as a result
of morbid obesity, weight that is at least twice the desirable weight.
Less severe obesity (e.g., as
low as 26.4-28.5 kg/m
) has also been associated
with increased mortality in large prospective cohort studies.
some studies have reported greater mortality among the thinnest individuals,
a 1993 prospective cohort study that carefully controlled
for smoking and illness-related weight loss found a linear relationship between
BMI and mortality.
Two cohort studies suggest that
overweight children and adolescents may have increased mortality as adults.
Childhood obesity may be a significant
risk factor for adult obesity, with adolescent obesity being a better predictor
than obesity at younger ages.
Persons who are overweight are more likely to
have adult-onset diabetes, hypertension, and risk factors for other diseases.
The prevalence of diabetes and
hypertension is 3 times higher in overweight adults than in those of normal
Observational studies have established a
clear association between overweight and hypercholesterolemia and suggest
an independent relationship between overweight and coronary artery disease.
Being overweight has also been associated with several cardiovascular
risk factors in children and adolescents, including hypercholesterolemia and
An elevated waist/hip circumference ratio (WHR), which may indicate central
adiposity, has been shown to correlate with the presence of these conditions
independent of BMI,
and may predict the complications of obesity in adults better
than BMI does.
has also been associated with an increased risk of certain cancers (including
those of the colon, rectum, prostate, gallbladder, biliary tract, breast,
cervix, endometrium, and ovary), and with other disorders such as cholelithiasis,
obstructive sleep apnea, venous thromboembolism, and osteoarthritis.
obesity can affect the quality of life by limiting mobility, physical endurance,
and other functional measures,
as well as through
social, academic, and job discrimination.
Accuracy of Screening Tests
Extremely overweight individuals
can be identified easily in the clinical setting by their physical appearance.
More precise methods may be necessary, however, to evaluate persons who are
mildly or moderately overweight. The complications of obesity occur among
those with elevated body fat composition, which is most accurately measured
by underwater (hydrostatic) weighing, isotopic dilution measures, and other
sophisticated techniques that are not suited to clinical practice.
Bioelectric impedance, which provides an estimate of total
body water from which the percentage of body fat can be calculated, is not
widely available in clinical practice. This method has been reviewed elsewhere.
The most common clinical method for detecting
obesity is the evaluation of body weight and height based on a table of suggested
or "desirable" weights. e.g.,
These tables generally reflect the weight at which mortality
is minimized, and they only approximate the extent of fatness. The criteria
for healthy body weight are a matter of controversy among experts and vary
considerably as presented in different weight-for-height tables.
Weights for children and adolescents are typically evaluated
in relation to average weight for age, height, and gender. This information
can be obtained from growth charts that are based on percentile distributions
of body size attained at specific ages.
measure to using weight-for-height tables or growth charts is the BMI, a weight-height
index that is calculated by dividing the body weight in kilograms by the square
of the height in meters (kg/m2
). The BMI is easily performed,
is highly reliable,
and has a correlation of 0.7-0.8
with body fat content in adults.
BMI also correlates with body
fat content in children and adolescents.
In adults, overweight has been
defined by the National Center for Health Statistics as a BMI >=27.8 for men
and >=27.3 for women (the 85th percentile values for persons aged 20-29
in NHANES II);
a BMI at this level has been associated
with increased risk of morbidity and mortality.
adolescents, a BMI exceeding the 85th percentile for age and gender has been
suggested as one definition for overweight
those at risk of overweight.
methods that may be useful in the clinical setting include the measurement
of skinfold thickness and the indirect assessment of body fat distribution.
Skinfold thickness is a more direct measure of adiposity than BMI and correlates
well with body fat content in both adults and children, but this technique
requires training and has lower intra- and interobserver reliability than
height and weight measurements used to calculate BMI.
The WHR, the circumference of the waist divided by the
circumference of the hips, which may be a better predictor of the sequelae
associated with adult obesity than BMI, can also be measured in the clinical
setting. The reliability of the WHR is comparable to that of BMI.
A WHR greater than 1.0 in men and 0.8 in women has been
shown to predict complications from obesity, independent of BMI,
although the WHR has not been evaluated in all ethnic groups.
Effectiveness of Early Detection
The purpose of screening for obesity is to assist the obese individual
lose or at least maintain weight and thereby prevent the complications of
obesity. Such screening may also assist with counseling other patients regarding
maintaining a healthy weight. Most studies of interventions for obesity
involve subjects who are overweight; we found no studies evaluating interventions
for persons identified solely on the basis of an elevated WHR. Although there
is little evidence from prospective studies that weight loss by obese individuals
improves their longevity, there is evidence that obesity is associated with
and that weight loss in obese persons reduces important
risk factors for disease and mortality.
Prospective cohort studies
and randomized clinical trials
demonstrated that caloric restriction or weight loss reduces systolic and
diastolic blood pressures as well as the requirements for antihypertensive
medication in obese adults with hypertension. These effects were independent
of sodium restriction. In controlled
of low-calorie diets
in obese diabetic patients, weight reduction was associated with improved
glycemic control and reduced need for oral hypoglycemic agents and insulin.
Weight loss generally improves the blood lipid profile
and can reduce symptoms related
to obstructive sleep apnea.
To benefit from the detection of obesity, however, patients must be motivated
to lose weight, must have access to an efficacious method of reducing body
weight, and must maintain the resulting weight loss.
regimens are available, but many have only short-term efficacy and fail to
achieve long-term weight loss.
Research to explain the difficulty
in achieving long-term weight loss is ongoing. One theory is that obesity
is related to an internal "set-point" that maintains excess body fat in certain
Some evidence suggests that energy expenditure
decreases to compensate for reduced body weight,
which would tend to return body weight to the usual weight. Such a decrease
in energy expenditure could contribute to the failure of most weight-reducing
regimens to achieve long-term benefits.
Dietary modification is
the most commonly used weight-loss strategy, and can achieve weight reduction
over the short-term in both adults and children.
Very-low-calorie diets (<800
kcal/day), which have been used for moderately to severely obese adults who
have failed more conservative approaches,
greater short-term weight loss than standard low-calorie diets of 1,000-1,500
Long-term results, however, are similar with both types of programs: the majority
of participants eventually return to their pre-treatment weight within 5 years,
although sustained weight loss
may be achieved by some patients.
studies and randomized controlled trials of behavioral modification, often
combined with dietary therapy, have shown modest long-term benefits in adults
The results of
the intensive dietary and behavioral interventions evaluated in these studies
may not necessarily be applicable to the type of counseling likely to be given
in a busy clinical primary care practice, and referral to other qualified
providers or to qualified weight-management programs
may be necessary to achieve similar results. The amount of weight loss that
can be achieved with exercise, either alone or in combination with other methods,
is relatively limited in adults
but physical activity may be beneficial
in maintaining weight loss
and reducing the WHR
in adults. Numerous randomized clinical trials have shown
that various appetite-suppressant drugs can be effective in producing short-term
weight loss in adults.
The effects, however, are limited
to periods when the drug is taken, and some studies have shown a plateauing
or gradual regain of weight with prolonged use.
Surgical techniques such as vertical band gastroplasty
and gastric bypass may benefit selected adults who are morbidly obese,
other procedures such as intragastric balloon insertion have not been shown
to be effective.
Certain weight reduction
methods may cause important adverse effects. Very-low-calorie diets can cause
fatigue, hair loss, dizziness, and symptomatic cholelithiasis.
Pharmacologic agents may cause palpitations, dizziness,
insomnia, headache, and gastrointestinal discomfort.
Surgical therapies such as gastroplasty and balloon insertion can lead to
gastric ulceration, perforation, and bowel obstruction.
Some cohort studies have reported that weight change or fluctuation in weight
(weight cycling) among adults is associated with increased cardiovascular
morbidity and mortality, but a review by the National Task Force on the Prevention
and Treatment of Obesity concluded there is insufficient evidence that weight
cycling is associated with adverse effects.
is conflicting evidence regarding the potential adverse effects of caloric
restriction and weight loss on growth velocity and development in obese children
Recommendations of Other Groups
The American Academy of Family Physicians,
the American Heart Association,
the Institute of
the American Academy of Pediatrics,
the Bright Futures guidelines,
and the American Medical Association guidelines for adolescent preventive
all recommend measurement of height
and weight as part of a periodic health examination for patients. Bright
Futures and GAPS also recommend the determination of BMI for all adolescents.
The Canadian Task Force on the
Periodic Health Examination concluded that there is insufficient evidence
to recommend the inclusion or exclusion of height, weight, BMI, or skinfold
measurement to screen for obesity in a routine health examination of either
children or adults.
The Canadian Task Force does,
however, recommend measuring and plotting the height and weight of infants
and children in order to identify those who are failing to thrive.
limited that screening for obesity and implementing weight-reducing or weight
maintenance strategies are effective in decreasing long-term morbidity and
mortality. This is unlikely to improve in the near future due to the difficulty
and cost of conducting controlled trials of weight loss with these outcome
measures and of separating the effect of obesity from that of other risk factors.
An additional obstacle is the low rate of long-term success in maintaining
weight loss. Obesity is a chronic disorder that requires continuing treatment,
which could explain the failure of short-term interventions in achieving long-term
success. Although losing weight has not been proven to reduce morbidity and
mortality, it is clear that weight loss reduces an individual's risk for major
chronic diseases such as hypertension and coronary artery disease, and it
also improves the management of both hypertension and diabetes. Periodic
height and weight measurements are inexpensive, rapid, reliable, and require
minimal training to perform. They may also be useful for the detection of
medical conditions causing unintended weight loss or weight gain, such as
cancer or thyroid disorders, and the detection of growth abnormalities in
childhood. Once height and weight have been determined, the BMI or standard
height and weight tables may be used as a means of evaluating adolescents
and adults for obesity. In addition, determination of the WHR may be useful
for assessing some adults, particularly those whose weight or BMI is borderline
for classification as overweight and who have personal or family medical histories
placing them at increased health risk. There are inadequate data to determine
the optimal frequency of obesity screening, and this is best left to clinical
Periodic height and weight measurements are recommended
for all patients ("B" recommendation). In adults, BMI (body weight in kilograms
divided by the square of height in meters) or a table of suggested weights
may be used, along with the assessment of other factors such as medical conditions
or WHR, as a basis for further evaluation, intervention, or referral to specialists.
In adolescents, a BMI exceeding the 85th percentile for age and gender may
be used as a basis for further assessment, treatment, or referral.
The height (or length if appropriate) and weight of infants
and children may be plotted on a growth chart e.g.,
or compared to tables of average weight for height, age, and gender to determine
the need for further evaluation, treatment, or referral. The optimal frequency
for measuring height and weight in the clinical setting has not been evaluated
and is a matter of clinical discretion. There is insufficient evidence to
recommend for or against determination of the WHR as a routine screening test
for obesity ("C" recommendation).
All patients should receive appropriate counseling
to promote physical activity
and a healthy diet.
This chapter was prepared for the U.S. Preventive
Services Task Force by Barbara Albert, MD, MS, and Carolyn DiGuiseppi, MD,
MPH, based in part on background papers written for the Canadian Task Force
on the Periodic Health Examination by James Douketis, MD, William Feldman,
MD, FRCPC, and Brenda Beagen, MA.
Weighing the options: criteria for evaluating weight-management
programs. Washington, DC: National Academy Press, 1995.
Najjar MF, Rowland M.
data and prevalence of overweight, United States, 1976-80. Vital and
health statistics; series 11, no 238. Washington, DC: Government Printing
Office, 1987. (DHHS Publication no. (PHS) 87-1688.)
Kuczmarski RJ, Flegal KM, Campbell SM, et al.
prevalence of overweight among US adults. JAMA
Special issues regarding obesity in minority populations. Ann Intern Med 1993;119:650-654.
Centers for Disease Control and Prevention.
of overweight among adolescents -- United States, 1988-91. MMWR 1994;43:818-821.
Childhood obesity: susceptibility, cause, and management. J Pediatr 1983;103:676-686.
Gortmaker SL, Dietz WH, Sobol AM, et al.
pediatric obesity in the United States. Am J Dis Child 1987;141:535-540.
Foster WR, Burton BT, eds.
National Institutes of Health consensus conference:
health implications of obesity. Ann Intern Med
TB, Kral JG.
The dilemma of morbid obesity. JAMA 1981;246:999-1003.
Hubert HB, Feinleib M, McNamara PM, et al.
Obesity as an independent risk
factor for cardiovascular disease: a 26-year follow-up of participants in
the Framingham Heart Study. Circulation 1983;67:968-977.
Rhoads GG, Kagan A.
of coronary disease, stroke, and mortality to weight in youth and middle age. Lancet 1983;1:492-495.
Wilcosky T, Hyde J, Anderson JJ, et al.
Obesity and mortality
in the Lipid Research Clinics Program Follow-up Study. J Clin Epidemiol 1990;43:743-752.
Harris T, Cook EF, Garrison R, et al.
Body mass index and
mortality among nonsmoking older persons: the Framingham Heart Study. JAMA 1988;259:1520-1524.
Manson JE, Stampfer MJ, Hennekens CH, et al.
and longevity: a reassessment. JAMA 1987;257:353-358.
Lee IM, Manson JE, Hennekens CH,
Body weight and mortality: a 27-year follow-up of middle-aged men. JAMA 1993;270:2823-2828.
Javier Nieto F, Szklo M, Comstock GW.
Childhood weight and
growth rate as predictors of adult mortality. Am J Epidemiol 1992;136:201-213.
Must A, Jacques PF, Dallal GE, et al.
Long-term morbidity and mortality
of overweight adolescents: a follow-up of the Harvard Growth Study of 1922
to 1935. N Engl J Med 1992;327:1350-1355.
Epstein LH, Wing RR, Valoski A,
Childhood obesity. Pediatr Clin North Am
Roche AF, Chumlea WC, et al.
The predictive value of childhood body mass
index values for overweight at age 35 years. Am J Clin
Medical hazards of obesity. Ann Intern
Van Itallie TB.
Health implications of overweight and obesity in the United
States. Ann Intern Med 1985;103:983-988.
Manson JE, Colditz GA, Stampfer
MJ, et al.
A prospective study of obesity and risk of coronary heart disease
in women. N Engl J Med 1990;322:882-889.
Willett WC, Manson JE, Stampfer
MJ, et al.
Weight, weight change, and coronary heart disease in women:
risk within the "normal" weight range. JAMA
Burke GL, Webber LS, et al.
Relation of obesity to clustering of cardiovascular
disease risk factors in children and young adults. Am
J Epidemiol 1987;125:364-372.
Aristimuno GG, Foster TA, Voors AW, et al.
Influence of persistent
obesity in children on cardiovascular risk factors: the Bogalusa Heart Study. Circulation 1984;69:895-904.
Burns TL, Moll PP, Lauer RM.
The relation between
ponderosity and coronary risk factors in children and their relatives: the
Muscatine Ponderosity Family Study. Am J Epidemiol
LO, Larsson B, Svardsudd K, et al.
The influence of body fat distribution
on the incidence of diabetes mellitus: 13.5 years of follow-up of the participants
in the study of men born in 1913. Diabetes
Folsum AR, Sprafka JM, et al.
Increased incidence of diabetes mellitus
in relation to abdominal adiposity in older women. J
Clin Epidemiol 1991;44:329-334.
Freedman DS, Jacobsen SJ, Barboriak JJ, et al.
Body fat distribution
and male/female differences in lipids and lipoproteins. Circulation 1990;81:1498-1506.
Larsson B, Svarsudd K, Welin L, et al.
tissue distribution, obesity, and risk of cardiovascular disease and death:
13 year follow-up of participants in the study of men born in 1913. BMJ 1984;288:1401-1404.
Lapidus L, Bengtsson C, Larsson B, et al.
adipose tissue and risk of cardiovascular disease and death: a 12 year follow-up
of participants in the population study of women in Gothenberg, Sweden. BMJ 1984;289:1257-1261.
Ducimetiere P, Richard J, Cambien F.
The pattern of subcutaneous
fat distribution on middle-aged men and the risk of coronary heart disease:
the Paris prospective study. Int J Obesity
Cupples LA, Ramaswami R, et al.
Regional obesity and risk of cardiovascular
disease: the Framingham study. J Clin Epidemiol
Prineas RJ, Kaye SA, et al.
Incidence of hypertension and stroke in relation
to body fat distribution and other risk factors in older women. Stroke 1990;21:701-706.
Folsum AR, Kaye SA, Sellers TA, et al.
Body fat distribution
and 5-year risk of death in older women. JAMA
Regional patterns of fat distribution. Ann Intern
Obesity: basic considerations and clinical approaches. Dis Month 1989;35:449-537.
Wadden TA, Stunkard AJ.
Social and psychological consequences
of obesity.Ann Intern Med 1985;103:1062-1067.
Klesges RC, Klem ML, Hanson CL,
The effects of applicant's health status and qualifications on
simulated hiring decisions.Int J Obesity 1990;14:527-535.
Gortmaker SL, Must A, Perrin JM,
Social and economic consequences of overweight in adolescence and
young adulthood.N Engl J Med 1993;329:1008-1012.
Methods for the
assessment of human body composition: traditional and new.Am J Clin Nutr 1987;46:537-556.
National Institute of Diabetes and Digestive and Kidney Disease
and the NIH Office of Medical Applications of Research.
impedance analysis in body composition measurement. Technology assessment
conference statement, 1994 Dec 12-14.Bethesda:
National Institutes of Health, 1994.
U.S. Department of Agriculture and U.S. Department of Health
and Human Services.
Dietary guidelines for Americans. 4th ed. Washington,
DC: Department of Agriculture and Department of Health and Human Services,
Metropolitan Life Insurance
New weight standards for men and women.Stat Bull Metropol Life Insur Co 1959;40:1-4.
Metropolitan Life Insurance Company.
height and weight tables.Stat Bull Metropol Life Insur
Obese, overweight, desirable, ideal: where to draw the line
in 1986?J Am Diet Assoc 1986;86:1702-1704.
Willett WC, Stampfer M, Manson
J, et al.
New guidelines for Americans: justified or injudicious?Am J Clin Nutr 1991;53:1102-1103.
Stewart AW, Jackson RT, Ford MA, et al.
of relative weight by the self-reported height and weight.Am J Epidemiol 1987;125:122-126.
Keys A, Fidanza F, Karvonen MJ, et al.
Indices of relative
weight and obesity.J Chronic Dis 1972;25:329-343.
Deurenberg P, Westrate JA, Seidel
Body mass index as a measure of body fatness: age- and sex-specific
prediction formulas.Br J Nutr 1991;65:105-114.
Roche AF, Siervogel RM, Chumlea
WM, et al.
Grading body fatness from limited anthropometric data.Am J Clin Nutr 1981;34:2831-2838.
Gray DS, Fujioka K.
Use of relative weight and
body mass index for the determination of adiposity.J
Clin Epidemiol 1991;44:545-550.
Schey HM, Michieluttie R, Corbett WT, et al.
indices as measures of adiposity in children.J Chronic
Himes JH, Dietz WH.
Guidelines for overweight in adolescent preventive
services: recommendations from an expert committee.Am
J Clin Nutr 1994;59:307-316.
Bray GA, Greenway FL, Molitch ME, et al.
Use of anthropometric
measures to assess weight loss.Am J Clin Nutr
CP, Merrifield HH.
Interrater reliability of skinfold fat measurements.Phys Ther 1987;67:917-920.
Kushi LH, Kaye SA, Folsum AR, et al.
Accuracy and reliability
of self-measurement of body girth.Am J Epidemiol
Short-term medical benefits and adverse effects of weight loss.Ann Intern Med 1993;119:722-726.
Tuck ML, Sowers J, Dornfeld L, et al.
of weight reduction on blood pressure, plasma renin activity, and plasma aldosterone
levels in obese patients.N Engl J Med 1981;304:930-933.
Kannel WB, Brand N, Skinner JJ,
The relation of adiposity to blood pressure and the development
of hypertension.Ann Intern Med 1967;67:48-59.
Fagerberg B, Berglund A, Andersson
OK, et al.
Weight reduction versus antihypertensive drug therapy in obese
men with high blood pressure: effects upon plasma insulin levels and association
with changes in blood pressure and serum lipids.J Hypertens 1992;10:1053-1061.
Weinsier RL, James LD, Darnell BE, et al.
evaluation of the separate effects of energy restriction and weight reduction
on hemodynamic and neuroendocrine status.Am J Med
Prevention Trial Research Group.
The Hypertension Prevention Trial: three-year
effects of dietary changes on blood pressure.Arch Intern
Davis BR, Blaufox MD, Oberman A, et al.
Reduction in long-term antihypertensive
medication requirements: effects of weight reduction by dietary intervention
in overweight persons with mild hypertension.Arch Intern
Deleted in proof.
Stevens VJ, Corrigan SA, Obarzanek E, et al.
Weight loss intervention
in phase 1 of the Trials of Hypertension Prevention. The TOHP Collaborative
Research Group.Arch Intern Med 1993;153:849-858.
Wing RR, Marcus MD, Salata R,
Effects of a very-low-calorie diet on long-term glycemic control
in obese type 2 diabetic subjects.Arch Intern Med
MA, Schneider G, Ertel NH, et al.
An eight-year experience with a very-low-calorie
formula diet for control of major obesity.Int J Obesity 1988;12:69-80.
Fitz JD, Sperling EM, Fein HG.
A hypocaloric high-protein diet as primary
therapy for adults with obesity-related diabetes: effective long-term use
in a community hospital.Diabetes Care 1983;6:328-333.
The effect of
a weight reduction program on cardiovascular risk factors among overweight
hypertensives in primary health care.Scand J Soc Med 1991;19:66-71.
Dattilo AM, Kris-Etherton PM.
Effects of weight reduction on blood lipids
and lipoproteins: a meta-analysis.Am J Clin Nutr
Influence of weight reduction on plasma lipoproteins in obese
Smith PL, Gold AR, Meyers DA,
Weight loss in mildly to moderately obese patients with obstructive
sleep apnea.Ann Intern Med 1985;103:850-855.
Wittels EH, Thompson S.
sleep apnea and obesity.Otolaryngol Clin North Am
Conservative treatments for obesity.Am J Clin
NIH Technology Assessment Conference Panel.
Methods for voluntary weight
loss and control: Technology Assessment Conference Statement.Ann Intern Med 1993;119:764-770.
Beyond overeating.N Engl
J Med 1995;332:673-674.
Leibel RL, Rosenbaum M, Hirsch J.
Changes in energy expenditure resulting
from altered body weight.N Engl J Med 1995;332:621-628.
Treatment of obesity
by moderate and severe caloric restriction: results of clinical research trials.Ann Intern Med 1993;119:688-693.
National Task Force on the Prevention and Treatment
Very low-calorie diets.JAMA
TA, Syernberg JA, Letizia KA, et al.
Treatment of obesity by very low
calorie diet, behavior therapy, and their combination: a five-year perspective.Int J Obesity 1989;13(Suppl 2):39-46.
Karvetti RL, Hakala P.
A seven year
follow up of a weight reduction programme in Finnish primary health care.Eur J Clin Nutr 1992;46:743-752.
Perri MG, McAllister DA, Gange JJ, et al.
of four maintenance programs on the long-term management of obesity.J Consult Clin Psychol 1988;56:529-534.
Ginsberg-Fellner F, Knittle JL.
in young obese children. I. Effects on adipose tissue cellularity and metabolism.Pediatr Res 1981;15:1381-1389.
Nuutinen O, Knip M.
Long-term weight control
in obese children: persistence of treatment outcome and metabolic changes.Int J Obesity 1992;16:279-287.
Holden J, Darga LL, Olson SM, et al.
follow-up of patients attending a combination very-low calorie diet and behavior
therapy weight loss programme.Int J Obesity
Karvetti RL, Ronnemaa T.
Group vs. individual weight reduction programmes
in the treatment of severe obesity--a five year follow-up study.Int J Obesity 1993;17:97-102.
Behavioral treatment of severe obesity.Am J Clin Nutr 1992;55(Suppl 2):545s-551s.
Epstein LH, McCurley J, Wing RR, et al.
year follow-up of family-based behavioral treatments for childhood obesity.J Clin Consult Psychol 1990;58:661-664.
Epstein LH, Valoski A, Wing RR, et al.
follow-up of behavioral, family-based, treatment for obese children.JAMA 1990;264:2519-2523.
King AC, Tribble DL.
The role of exercise in weight regulation
in nonathletes.Sports Med 1991;11:331-349.
Evidence for success
of exercise in weight loss and control.Ann Intern Med 1993;119:702-706.
Sweeney ME, Hill JO, Heller PA, et al.
Severe vs moderate energy restriction
with and without exercise in the treatment of obesity: efficiency of weight
loss.Am J Clin Nutr 1993;57:127-134.
Epstein LH, Wing RR, Koeske R,
The effects of diet plus exercise on weight change in parents and
children.J Consult Clin Psychol 1984;52:429-437.
Epstein LH, Wing RR, Penner BC,
Effect of diet and controlled exercise on weight loss in obese
children.J Pediatr 1985;107:358-361.
Reybrouck T, Vinckx J, Van den
Berghe G, et al.
Exercise therapy and hypocaloric diet in the treatment
of obese children and adolescents.Acta Paediatr Scand 1990;79:84-89.
Pavlou KN, Krey S, Steffee WP.
Exercise as an adjunct to weight loss and
maintenance in moderately obese subjects.Am J Clin Nutr 1989;49:1115-1123.
Sikand G, Kondo A, Foreyt JP, et al.
Two year follow-up of patients treated
with a very low calorie diet and exercise training.J
Am Diet Assoc 1988;88:487-488.
Wood PD, Stefanick ML, Williams PT, et al.
The effects on
plasma lipoproteins of a prudent weight-reducing diet, with or without exercise,
in overweight men and women.N Engl J Med 1991;325:461-469.
Use and abuse of
appetite-suppressant drugs in the treatment of obesity.Ann Intern Med 1993;119:707-713.
Goldstein DJ, Rampey AH, Enas GG, et al.
Fluoxetine: a randomized
clinical trial in the treatment of obesity.Int J Obesity 1994;18:129-135.
Toubro S, Astrup AV, Breum L, et al.
Safety and efficacy of long-term
treatment with ephedrine, caffeine and an ephedrine/caffeine mixture.Int J Obesity 1993;17(Suppl 1):S69-S72.
Weintraub M, Sundaresan PR, Schuster B,
Long-term weight control study: I-VII.Clin Pharmacol Ther 1992;51:581-646.
Gray DS, Fujioka K, Devine W, et al.
of the obese diabetic.Int J Obesity 1992;16:193-198.
Darga LL, Carroll-Michals L,
Botsford SJ, et al.
Fluoxetine's effect on weight loss in obese subjects.Am J Clin Nutr 1991;54:321-325.
Levine LR, Enas GG, Thompson WL, et al.
of fluoxetine, a selective serotonin-uptake inhibitor, in the treatment of
obesity: a dose-response study.Int J Obesity
B, Crepaldi G, Lefebre P, et al.
International trial of long-term dexfenfluramine
in obesity.Lancet 1989;2:1142-1145.
Enzi G, Crepaldi G, Inelman
EM, et al.
Efficacy and safety of dexfenfluramine in obese patients: multi-centre
study.Clin Neuropharmacol 1988;11(Suppl 1):S173-S178.
Weintraub M, Hasday JD, Mushlin
AI, et al.
A double-blind clinical trial in weight control: use of fenfluramine
and phentermine alone and in combination.Arch Intern
Mathus-Vliegen EM, Van De Voore K, Kok AM, et al.
Dexfenfluramine in the
treatment of severe obesity: a placebo-controlled investigation of the effects
on weight loss, cardiovascular risk factors, food intake and eating behavior.J Intern Med 1992;232:119-127.
Andersen T, Astrup A, Quaade F.
as adjuvant to a low-calorie formula diet in the treatment of obesity: a randomized
clinical trial.Int J Obesity 1992;16:35-40.
MacLean LD, Rhode BM, Sampalis
J, et al.
Results of the surgical treatment of obesity.Am J Surg 1993;165:155-162.
MacGregor AM, Rand CS.
Gastric surgery in morbid obesity:
outcome in patients aged 55 years and older.Arch Surg 1993;128:1153-1157.
Mason EE, et al.
Impact of vertical banded gastroplasty on mortality from
obesity [abstract].Obes Surg 1991;1:115.
Kramer FM, Stunkard AJ, Spiegel TA, et
Limited weight losses with a gastric balloon.Arch Intern Med 1989;149:411-413.
Meshkinpour H, Hsu D, Farivar S.
Effects of gastric bubble
as a weight reduction device: a controlled, cross-over study.Gastroenterology 1988;95:589-592.
Benjamin SB, Maher KA, Cattau EL, et al.
trial of the Garren-Edwards gastric bubble: an adjunctive treatment for exogenous
Lindor KD, Hughes RW, Ilstrup
DM, et al.
Intragastric balloons in comparison with standard therapy for
obesity: a randomised, double-blind trial.Mayo Clin Proc 1987;62:992-996.
Contribution of obesity and weight loss to gallstone disease.Ann Intern Med 1993;119:1029-1035.
Physicians' desk reference.
48th ed. Montvale,
NJ: Medical Economics Data, 1994.
Overview of surgical techniques for treating obesity.Am J Clin Nutr 1992;55:552S-555S.
National Task Force on the Prevention and Treatment
Weight cycling.JAMA 1994;272:1196-1202.
of obesity and weight control in children: a review of the literature.Am J Public Health 1983;73:78-82.
Dietz WH, Hartung R.
Changes in height velocity
of obese preadolescents during weight reduction.Am J
Dis Child 1985;139:705-707.
Obesity in childhood and adolescence: special
problems in diagnosis and treatment.Postgrad Med
LH, McCurley J, Valoski A, et al.
Growth in obese children treated for
obesity.Am J Dis Child 1990;144:1360-1364.
Epstein LH, Valoski A, McCurley
Effect of weight loss by obese children on long-term growth.Am J Dis Child 1993;147:1076-1080.
American Academy of Family Physicians.
charts for periodic health examination. Kansas City, MO: American Academy
of Family Physicians, 1994. (Reprint no. 510.)
Grundy SM, Greenland P, Herd A, et al.
risk factor evaluation of healthy American adults. A statement for physicians
by an ad hoc committee appointed by the Steering Committee, American Heart
National Academy of Sciences,
Institute of Medicine.
Preventive services for the well population. Washington,
DC: National Academy of Sciences, 1978.
American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine.
for preventive pediatric health care.Pediatrics
Bright Futures: national guidelines for health supervision of infants,
children, and adolescents. Arlington, VA: National Center for Education in
Maternal and Child Health, 1994.
American Medical Association.
Guidelines for adolescent preventive services
(GAPS): recommendations and rationale.Chicago: American
Medical Association, 1994.
Canadian Task Force on the Periodic Health Examination.
to clinical preventive health care.Ottawa: Canada Communication
Group, 1994:334-344, 574-584.
[a] Overweight refers
to an excess of body weight relative to height that includes all tissues and
therefore may reflect varying degrees of adiposity. Despite the distinction
between obesity and overweight, the majority of overweight persons are also
obese, and these terms tend to be used interchangeably in the medical literature.
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