Obesity: a move from traditional to more patient-oriented management.

Abstract

Family physicians have been encouraged to be aggressive in their treatment of obesity in their overweight patients. This article examines our traditional management of obesity and presents a management approach that is relatively safe, healthy, and patient-oriented. A review of the literature on obesity and its treatment was performed by searching MEDLINE, PsychINFO, ERIC, and SOCA data bases from 1980 to 1993. Additional references were accessed by cross-referencing the bibliographies of the articles obtained through this search. Both physicians and society in general tend to be biased against obese individuals, and this bias has negative consequences in that it reinforces patients' negative stereotypes about their fatness and could contribute to their avoidance of physicians. To circumvent this tendency, physicians should make a conscious effort to treat their obese patients with understanding and respect and to offer treatment that optimizes their risk-benefit profile. Regardless of weight, all patients should be asked about their diet and exercise history, and a brief mental status evaluation should be performed to screen for eating disorders and other psychosocial disorders. In addition, all patients should be encouraged to follow a healthy lifestyle, which includes regular, moderate exercise and a balanced, low-fat diet. Repeated dieting should be avoided, because it can produce more harm than benefit by contributing to binge eating, loss of self-esteem, and increased risk of sudden death and cardiovascular disease. Thus, only obese patients who have never attempted comprehensive weight reduction programs should be encouraged to try such a program. Patients who have severe obesity that interferes with their lives or who have moderate obesity and a comorbid condition can be offered a gastroplasty or gastric bypass procedure, coupled with an explanation and discussion of the success and failure rates involved. Regardless of whether patients are able to lose weight, the family physician can still provide long-term support and care and encourage a healthy lifestyle in these patients.