Obesity and weight loss.(Women's Health Adviser)

An estimated 127 million adults in the United States are overweight, 60 million are obese, and 9 million are severely obese, according to national statistics.

And yet, studies show that obesity remains an undertreated condition. Many physicians are uncomfortable discussing it with overweight patients, and some view it as a disease of morality--patients are at fault because they have no self-control. And became these patients require a consistent, long-term program of lifestyle modification, perhaps with pharmacotherapy as well, many primary care providers don't have the time or skills to manage them.

* Assessment. Ob.gyns. should record body mass index (BMI) at each patient visit. The BMI shows relative weight for height and correlates significantly with body fat content. It may not be completely accurate for some women who exercise heavily and have an unusually high percentage of muscle.

In nonpregnant women, a BMI of 25-29 is considered overweight; 30 and above is considered obese. Abdominal waist circumference is another key indicator: A circumference of more than 35 inches in nonpregnant women significantly increases the relative risk of disease.

* Management. One BMI unit is about 6 pounds, which most women can lose in less than a month. On the other hand, it will usually rake at least 6 months to lose 10% of initial body weight. After 6 months, the rate of weight loss usually declines and additional weight reduction is even more difficult.

For these women, the initial goal of treatment is to reduce Body weight by 10% from baseline. This can be accomplished by achieving a deficit of 500-1,000 calories per day while following a low-fat diet rich in fruits and vegetables and low-fat dairy products. The National Cholesterol Education Program's Therapeutic Lifestyle Change diet plan limits fat intake to 25%-30% of daily calories; this plan is available at the National Heart, Lung, and Blood Institute Web site, www.nhlbi.nih.gov.

Many studies have shown that women achieve greater weight loss with group support than if they attempt to lose weight on their own. The Weight Watchers program is an example of a nutritionally sound plan that not only reduces caloric intake but includes behavior ...