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TABLE 26-5. Treatment approaches to obesity

Table 26-5. Treatment approaches to obesity.
1. Assess and treat medical complications of obesity. Patients must be monitored for hypertension, diabetes mellitus, heart disease, and fluid and electrolyte changes during weight loss.
2. Assess diet and exercise habits. Patients with binge-eating behaviors should be identified. A diet and exercise program should be prescribed in conjunction with an internist.
3. Diagnose and treat psychiatric comorbidity. Patients with affective disorders and binge-eating behaviors may be considered for treatment with antidepressant medications, particularly selective serotonin reuptake blockers.
4. Identify psychological and cognitive underpinnings of obesity. Cognitive-behavioral and dynamically oriented psychotherapies may be particularly helpful for obese individuals with affective disorders or with binge-eating patterns of behavior and for those who manifest extreme disparagement of self and body image. Support groups may also be helpful to these individuals.
5. Consider antiobesity medications. Appetite suppressants may be useful for some obese individuals who fail to respond to diet, exercise programs, and supportive psychotherapy. These medications must be reserved for significantly overweight patients (BMI >30), should be used for a short period of time, and should not be combined with serotonin reuptake blockers. Their use must be carefully monitored and they should be given only in conjunction with therapeutic modalities. Lipase inhibitors may also be helpful, but their safety and efficacy are still under investigation.
6. Consider surgical procedures as last resort. Surgical procedures such as gastric stapling, intestinal bypass, and intragastric balloons should be considered only for morbidly obese individuals who have failed all other treatment interventions.