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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.

Effective Strategies for Treating Obesity

To provide physicians with current information on new advances in the management and treatment of obesity.

This activity is designed for gastroenterologists, endocrinologists, primary care physicians, and other physicians who treat overweight or obese patients.

After reading this issue, the participant should be able to:

  • Identify factors necessary for long-term weight loss and management.
  • Recognize the importance of diet and exercise, as well as the role of support and encouragement in obesity management.
  • Describe the medical and behavioral aspects of obesity.

This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

The Johns Hopkins University School of Medicine designates this continuing medical education activity for a maximum of 1 hour in Category 1 credit toward the American Medical Association PhysiciansÕ Recognition Award. Each physician should claim only those hours of credit that are actually spent on the educational activity. Credits are available until the expiration date of January 31, 2004.

This continuing education activity was produced under the supervision of Lawrence J. Cheskin, MD, Associate Professor of Gastroenterology, Johns Hopkins University School of Medicine; Director, Division of Digestive Diseases, Johns Hopkins Bayview Medical Center; Associate Professor-International Health, Bloomberg School of Public Health; and Director, Johns Hopkins Weight Management Center, Baltimore, Maryland.

This program is supported by an unrestricted educational grant from Roche Laboratories.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: Copyright ©2001 by Galen Publishing, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.


    Lawrence J. Cheskin, MD
    Associate Professor of Gastroenterology
    Johns Hopkins University School of Medicine
    Director, Division of Digestive Diseases
    Johns Hopkins Bayview Medical Center
    Johns Hopkins Health System
    Associate Professor - International Health
    Bloomberg School of Public Health
    Director, Johns Hopkins Weight Management Center
    Baltimore, Maryland
    • Dr Cheskin reports receiving grant support from and serving on the speakers' bureau for Roche.


    George L. Blackburn, MD, PhD
    Associate Professor of Surgery and Nutrition
    S. Daniel Abraham Chair in Nutrition Medicine
    Associate Director of Nutrition, Division of Nutrition
    Harvard Medical School
    Director, Nutrition Support Service
    Director, Center for the Study of Nutrition and Medicine
    Program Director, Surgical Therapy for Severe Obesity
    Chief, Nutrition Metabolism Laboratory
    Beth Israel Deaconess Medical Center
    Boston, Massachusetts
    • Dr Blackburn reports receiving grant support from Atkins Foundation, Sanofi-Synthelabo; serving as a consultant to Bristol-Myers Squibb, Functional Foods LCC, Roche Laboratories, Sanofi-Synthelabo, Amgen, and Slim-Fast Foods; serving as a speaker for Abbott, Monsanto, and Roche; and receiving royalties from Novartis Nutrition.

    Thomas Pickering, MD
    Director, Integrative and Behavioral Medicine
    Professor of Medicine
    Wiener Cardiovascular Institute
    Mount Sinai School of Medicine
    New York, New York
    • Dr Pickering reports serving on the scientific advisory board for

    Anne Wolf, MS, RD
    Director of Nutrition
    University of Virginia Medical School
    President, Ann Wolf and Associates
    Charlottesville, Virginia
    • Ms Wolf reports serving on the advisory boards for Roche and Abbott.

Advanced Studies in Medicine provides disclosure information from contributing authors, participating faculty, and presenters only. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies

Effective Strategies for Treating Obesity
Lawrence J. Cheskin, MD

As statistics from the Centers for Disease Control and Prevention indicate, approximately 60% of the US population is now overweight. For the years 1989 to 1994, 55% of adults 20 years of age and older were overweight, as were 11% of adolescents between the ages of 12 and 17 and 14% of children between the ages of 6 and 11. For both children and teenagers, the prevalence reflects an increase of 6% from the years 1976 to 1980.1

The prevalence of obesity continues to rise, as does the prevalence of obesity-associated conditions such as cardiovascular disease, type 2 diabetes, osteoarthritis of weight-bearing joints, breast and colon cancer, and sleep apnea. Other problems associated with obesity include hypercholesterolemia, complications of pregnancy, menstrual irregularities, stress incontinence, certain psychiatric conditions such as depression, and increased surgical risk.

With this increasing understanding of the link between obesity and disease, obesity is emerging as a condition with medical consequences and not, as many overweight and obese people have heard, a character flaw or indicative of a lack of willpower. Within the framework of obesity as a condition associated with medical consequences, the need for effective weight-loss strategies, weight maintenance programs, and obesity prevention is clear.

Treatment Strategies

Several strategies are available to treat obesity. These include weight-loss groups such as Weight Watchers, Overeaters Anonymous, and Take Off Pounds Sensibly; prescribed food plans such as Jenny Craig and Nutri-System; meal-replacement plans such as Slim-Fast and Opti-Fast; a variety of fad diets such as the Atkins Diet and the Stillman Diet; numerous exercise programs; a number of pharmacologic agents with various mechanisms of action to facilitate weight loss; and even surgery.

No single approach is appropriate for everyone, and no single approach will take the weight off and keep it off over the long term. Diet-based programs work best when combined with increased physical activity, exercise programs work best when combined with a sensible diet containing fewer calories, and drugs that promote weight loss are most likely to produce successful results when combined with diet and regular exercise.

The most commonly used obesity treatment strategies each have pros and cons. These strategies are discussed in this issue of Advanced Studies in Medicine, as well as some of the problems encountered by physicians and other health care professionals in counseling overweight and obese patients. In addition, patient attitudes toward several commercial weight-loss programs and weight-loss drugs, along with their feelings toward the medical professionals who are treating them for obesity, are addressed.

Behavioral and Emotional Issues

Being overweight or obese is not simply the result of an imbalance between caloric intake and caloric expenditure. A complex set of behavioral and emotional issues plays a major supporting role, and it is these issues that often derail weight-loss attempts.

When discussing weight-related issues, eg, many patients say they eat more than they should as a response to stress or to satisfy or compensate for an emotional need-such as a need for comfort, attention, or love. Other typical responses reflect short-term reasons to lose weight-with short-term results-such as going on a crash diet to look one's best at a special event or losing weight primarily to please a mate or loved one. Still other responses catalogue a history of multiple attempts that failed, feelings of deprivation and isolation at family or social events where everyone else is eating "regular" food, and an overall lack of support and encouragement from family, friends, and the medical community.

For a weight-loss strategy to be effective in the long run, it must include components that address these behavioral and emotional issues and suggest potential solutions. Instructing a patient to lose weight and providing a general diet and menu plan is usually not enough. We need to know why the patient overeats, what the usual eating habits are, whether and why the patient wants to lose weight now, whether there were previous failed weight-loss attempts (and how many), and whether there is a support network in place. The answers to the questions will allow us to tailor our recommendations to the individual patient and enhance the potential for successful weight loss.

Other important components of an effective weight-loss program are education regarding adequate nutrition, therapeutic diets, menu planning, and the importance of regular exercise; periodic follow-up and assessment; and ongoing encouragement and support. Patients should be reminded that weight loss is a process that takes time, commitment, and hard work, and they should be complimented for their decision to lose weight and for the progress they have made so far.


This issue of Advanced Studies in Medicine includes an overview article by Dr George L. Blackburn of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston and interviews with Dr Anne Wolf, Director of Nutrition at the University of Virginia Health Science Center in Charlottesville, and Dr Thomas Pickering, Director of Integrative and Behavioral Research at the Mount Sinai School of Medicine in New York.

In his article, Dr Blackburn addresses the epidemic of obesity in the United States, its comorbidities and costs, the strategies available to promote and maintain weight loss, the characteristics of an ideal weight-loss drug, and the key factors that are necessary for long-term weight loss and maintenance. He also discusses the use of 2 relatively new pharmacologic agents, orlistat and sibutramine, in obesity management.

The interview with Dr Wolf focuses on the dietary and exercise aspects of weight-loss management and the need of patients to receive sensitivity, encouragement, and support from the health care community.

The interview with Dr Pickering focuses on certain medical and behavioral aspects of obesity. As with hypertension and diabetes, Dr Pickering notes, obesity is a lifelong condition that requires lifelong treatment and surveillance.

The information that follows should help physicians and other health care professionals understand the complex nature of obesity and obesity management. Armed with this knowledge, the health care community will be better able to help patients lose weight and provide the necessary ongoing support to sustain a more healthful body weight.


1. Centers for Disease Control Web site. Available at: April 2000. Accessed July 20, 2001.

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