Treatment of the Seriously Obese Patient

An ideal resource for practioners working with individuals who are serously overweight, this unique and timely volume takes a multidisciplinary approach to assessment and treatment. With 21 chapters written by experts for fields including clinical psychology, medicine, excercise physiology, nuitrition and metabolism, the book examines the many health risks of obesity, the goals and results of treatment, and findings concerning possible ill effects of stringent dieting. The volume opens with guidelines to help practitioners assess the health and mortality risks of overweight patients. Addressing the problem of integrating information about important risk-modifying factors, it presents a classification of obesity, an overview of current therapies, and discussion on the use of very low calorie diets. The biologic response to caloric restriction is explored in five chapters that cover methods of measuring body composition and the changes that occur during therapeutic weith loss; the animal literature on caloric restriction, body composition, and organ function; the fatal arrhymias that occurred in obese consumers of liquid protein diets; and the effects of dieting and weight loss on energy expenditure. Chapters on the consequences of therapeutic weight loss reveal that a reduction in initial weight of as little as 10 per cent is frequently sufficient to improve or control the adverse health effects of obesity. They also outline the potentially unique advantages of using very low calorie diets with obese Type II diabetics, describe the psychological changes that can be anticipated when an obese patient loses weight, and discuss the timely issue of binge eating in the obese. Providing a multidisciplinary "how to" of treatment, six chapters than review the clinical use of very low calorie diets. A physician discusses the initial medical evaluation, guidelines for monitoring patients throughout treatment and managing side effects. Psychologists describe the initial psychosocial evaluation and review behavioral interventions. A nutritionist/dietitian outlines the criteria for selecting the appropriate diet, methods of managing the refeeding period, and strategies for helping patients maintain a long-term nutritious low-fat diet. An excercise physiologist discusses the health benefits of physical activity and the special excercise needs of the seriously obese. Finally, in a chapter that will help sensitize clinicans to the daily challenges clients face, a former patient describes her experiences in losing weight in a combined program of very low calorie diet and lifestyle change. The book's closing section examines the critical issue of maintenance of weight loss and alternative therapies. A theoretical model for relapse prevention is presented, as is a summary of six studies investigating methods for facilitating weight loss. Other topics include the problems of interpreting long-term follow-up data on treatment, findings on serotonergic agents, and surgical interventions on the massively obese individual. Providing practioners with new approaches for treatment and a better understanding of the nature of their patients' ongoing struggle with weight, Treatment of the Seriously Obese Patient is an invaluable resource for all professionals who work with overweight individuals.