Obesity Management
in Family Practice
Obesity Management in Family Practice
Thomas L. McKnight, MD, MDIV, MPH
With 30 Illustrations
Thomas L. McKnight, MD, MDIV, MPH Freeport Family and Preventive Medicine Freeport, FL 32539
USA
Library of Congress Control Number: 2005927518 ISBN-10: 0-387-26421-3 e-ISBN 978-0387-26426-4 ISBN-13: 0-387-26421-9
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To my incredible wife, Sue
Foreword
The acknowledgment that obesity is a disease—a disease with enormous impact on both the public health and the economy and an incredible burden to its victims—has finally come. This final recognition will hopefully free research dollars and will encourage third party payers to understand the need to cover services for treatment.
Dr McKnight is an honored family medicine educator who combines his sense of academic rigor with the understanding of a compassionate family phy- sician. Thus he approaches this clinical syndrome in the manner of a family physician: he aims to have an effect on the entire person and that person’s life, not just some disease entity. His broad-based approach draws on behavioral strategies, diet and exercise modification, and limited use of pharmaceuticals in selected cases. The practical tools presented here will prove to be valuable addi- tions to the armamentarium of care teams that look to develop treatment plans for their patients with this disease.
I myself have been obese as long as I can remember. I am the son of obese parents and my sister has shared this chronic problem. Over my lifetime I have dealt with almost all of the problems of obesity, and I have used all of the excuses. I have dealt with many obese patients during my years in practice, some who have said openly that they chose me as their physician because I really couldn’t tell them to lose weight, since I could not myself.
Just a few months before I was to be inaugurated as President of the American Academy of Family Physicians, I received a call from the American Academy’s Commission on Public Health asking me if I would be willing to become a “poster boy” for the Academy’s AIM Initiative (Americans in Motion).
I answered their request, and I made a commitment to be around to see my grandchildren grow up. I decided to approach this differently than I ever had before. I decided on a set of behavior changes that are revealed in this book. My quest has been successful. Today, just over a year after I made the commitment, I have lost over 55 pounds. But, more important, I have discovered a whole new concept of health and wellness that I can now recommend and show to my patients. It has to do with how I think about food and eating, and how I feel about fitness. It has become an almost spiritual quest for me, and I have never felt better, nor have I ever felt better about me.
Dr Tom McKnight has done an extensive, scholarly review of the literature, and his findings support the proposition that the management of obesity is indeed a strategy of behavioral changes that must be supported and maintained. This book outlines these strategies, and confirms the primary care physician’s mission for creating a new paradigm of health and wellness.
Michael Fleming, MD, FAAFP Board Chair, American Academy of Family Physicians
Obesity Management in Family Practice applies the best evidence-based obesity science and national recommendations to patients in the primary care setting.
The approach is based on the viewpoint that obesity is a chronic disease that can be controlled by the patient. My clinical perspective is from family practice, with a focus on the health of both the individual and the community. I am dual boarded in both Family Medicine and Preventive Medicine.
Obesity Management reviews the best research on obesity, along with com- monsense dietary and behavioral tools, and presents the information in a time- efficient process that any physician can use in a primary care setting. The book addresses practical obesity management questions and covers the entire process, from the first visit to the final weight maintenance appointment. Obesity Man- agement in Family Practice is written for any physician who delivers primary care medicine, especially family medicine physicians. Pediatricians will find the recommendations on childhood obesity particularly useful.
The first half of the book describes how to identify which patients are ready to begin a weight management program, how to use inexpensive dietary tools in a 6-month program, and how to encourage physical activity. The appropriate approach and goals for children and adolescents are covered, as is pharmaco- therapy as an adjunct to a dietary and exercise program. Chapter 7 discusses bariatric surgery options for obese patients with comorbidities.
The last four chapters present an appointment-by-appointment plan that the physician can implement to help the patient apply the weight management science. This program comes from experience in treating obesity in the primary care setting. The clinical process is designed to be used in the context of 15- minute appointments, using tools presented in the figures. The last chapter addresses counseling patients on how to use the plan for lifelong maintenance of appropriate weight.
As a family physician in a rural setting, the economic and educational char- acteristics of my patients vary greatly. I developed the treatment plan outlined in this book so that all my patients with obesity, not just the highly educated or financially well off, can be offered the best evidence-based science in a practical format that will enable them to have long-term success in controlling their obesity.
Thomas L. McKnight, MD, MDIV, MPH Freeport, FL
Preface
Contents
Foreword . . . vii
Preface . . . . ix
Chapter 1 Obesity as a Chronic Disease . . . . 1
Chapter 2 The Obesity Bias . . . . 15
Chapter 3 Dietary Tools . . . . 23
Chapter 4 Physical Activity . . . . 37
Chapter 5 Childhood and Adolescent Obesity . . . . 48
Chapter 6 Pharmacotherapy . . . . 68
Chapter 7 Bariatric Surgery . . . . 77
Chapter 8 The First Appointment: Explaining the Process . . . . 87
Chapter 9 The Second Appointment: Dietary Intervention . . . . 101
Chapter 10 The Third Appointment: Behavior Modification and Physical Activity . . . . 113
Chapter 11 Monthly Monitoring and Long-Term Maintenance . . . . 123
Index . . . . 134
