肥胖患者的診療建議

OfficeManagementoftheObesePatientPatient

BMIObesityManagementinan

OutpatientOfficePractice3729332140312720AppropriateOfficeEnvironmentforObesePatientsWaitingroomchairswithoutarmsStepstoolsnexttoexaminationtablesLargegownsandbloodpressurecuffsScalethatcanweighextremelyobesepatients,locatedinaprivateareaAppropriateobesityeducationalmaterials,handouts,andtreatmentprotocolsEmpathetic,respectful,andsupportiveofficestaffInitialOfficeVisitIncludeevaluationofpotentialobesityrelateddiseaseswithinhistory,physicalexamination,andlaboratorytestsObtainweighthistory,eating,andactivitybehaviorsSearchfortriggeringfactors,includingmedicationsMeasureweight,height,andcalculatebodymassindexCategorizeobesityclassificationandhealthriskDeterminereadinesstoloseweightInitiatetreatmentplan(involveotherprofessionals

ifneeded)DiscussgoalsandexpectationsArrangefollow-upandsupportKushnerandWeinsier.MedClinNorthAm2000;84:387.SelectedMedicationsThatCanCauseWeightGainPsychotropicmedicationsTricyclicantidepressantsMonoamineoxidaseinhibitorsSpecificSSRIsAtypicalantipsychoticsLithiumSpecificanticonvulsants-adrenergicreceptorblockersSSRI=selectiveserotoninreuptakeinhibitorDiabetesmedicationsInsulinSulfonylureasThiazolidinedionesHighlyactiveantiretroviraltherapyTamoxifenSteroidhormonesGlucocorticoidsProgestationalsteroids AssessingWeightLossReadinessMotivation:Stresslevel:Psychiatricissues:

Timeavailability:PatientseeksweightreductionFreeofmajorlifecrisesFreeofseveredepression,substanceabuse,bulimianervosaPatientcandevote15-30min/dtoweightcontrolfornext26weeksPatientReady?PreventweightgainandexplorebarrierstoweightreductionInitiateweightlosstherapyYESNOObesePatientsHaveUnrealisticWeightLossGoalsOutcomeWeight(lbs)%ReductionInitial2180Dream13538Happy15031Acceptable16325Disappointed18017Fosteretal.JConsultClinPsychol1997;65:79.ConclusionsObesityisachronicdiseaseModestweightloss(5%-10%ofbodyweight)canhaveconsiderablemedicalbenefitsLifestylechange(dietandphysicalactivity)isthecornerstoneoftherapyPharmacotherapycanbeusefulinproperlyselectedpatientsBariatricsurgeryisthemosteffectivetherapyforobesityObesity-RelatedResources

ProfessionalAssociationsNorthAmericanAssociationfortheStudyofObesity(NAASO)AmericanAcademyofFamilyPhysicians(AAFP)AmericanCollegeofSportsMedicine(ACSM)AmericanDiabetesAssociation(ADA)AmericanDieteticAssociation(ADA)AmericanGastroenterologicalAssociation(AGA)AmericanHeartAssociation(AOA)AmericanObesityAssociation(AOA)AmericanSocietyforBariatricSurgery(ASBS)

CentersforDiseaseControl(CDC):

ObesityandOverweightCentersforDiseaseControl(CDC):

PrevalencedataandgrowthchartsNationalInstitutesofHealth(NIH)NationalInstitutesofDiabetes&

Digestive&KidneyDiseases(NIDDK)

Weight-ControlInformationNetwork(WIN)NationalInstitutesofDiabetes&

Digestive&KidneyDiseases(NIDDK)

WeightLossandControlNationalLibraryofMedicine,

MEDLINEPlusObesity-RelatedResources

GovernmentOrganizations/nccdphp/dnpa/obesity/index.htm/nchs/nhanes.htm

/health/nutrit/win.htm

/health/nutrit/nutrit.htm

/medlineplus/obesity.

html9、人的價值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20234:29:20PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一個人炫耀什么，說明他內(nèi)心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、業(yè)余生活要有意義，不要越軌。2023/2/32023/2/303February202317、一個人即使已登上頂峰，也仍要自強不息。2023/2/32023/2/32023/2/32023/2/39、人的價值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20234:29:20PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最