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Overview of the Treatment of Obesity

  • Neil S. Freedman
Part of the Current Clinical Practice book series (CCP)

Abstract

Obesity is a chronic disease that has become more common in America during the last 20 years (1). The prevalence of overweight adults in the United States is 65%, with obesity affecting at least 31% of American adult population (1). These increases in overweight and obesity are observed in all ethnic groups and both sexes in this country (1). Increases in the prevalence of obesity are also being seen among the children and adolescents (2,3). Obesity is a known risk factor for several medical comorbidities and is the most common risk factor associated with obstructive sleep apnea syndrome (OSAS) (4). Although the exact mechanisms linking excess body weight to the pathophysiology of OSAS are not totally clear, most population-based and cross-sectional studies have found a strong association between OSAS and excess body weight (5–10). Whereas excess weight has been clearly linked to OSAS, there is presently no consensus that any particular body habitus phenotype is the most important in the pathophysiology of OSAS.

Keywords

Obstructive Sleep Apnea Bariatric Surgery Sleep Apnea Continuous Positive Airway Pressure Obstructive Sleep Apnea Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Flegal KM, Carroll MD, Ogden CL, et al. (2002) Prevalence and trends in obesity among US adults, 1999-2000. JAMA 288:1723–1727.PubMedCrossRefGoogle Scholar
  2. 2.
    Hedley AA, Ogden CL, Johnson CL, et al. (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291:2847–2850.PubMedCrossRefGoogle Scholar
  3. 3.
    Ogden CL, Flegal KM, Carroll MD, et al. (2002) Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 288:1728–1732.PubMedCrossRefGoogle Scholar
  4. 4.
    Young T, Peppard PE, Gottlieb D (2002) Epidemiology of obstructive sleep apnea. Am J Respir Crit Care Med 165:1217–1239.PubMedCrossRefGoogle Scholar
  5. 5.
    Levinson P, McGarvey S, Carlisle C, et al. (1993) Adiposity and cardiovascular risk factors in men with obstructive sleep apnea. Chest 103:1336–1342.PubMedGoogle Scholar
  6. 6.
    Millman R, Carlisle C, McGarvey S, et al. (1995) Body fat distribution and sleep apnea severity in women. Chest 107:362–366.PubMedGoogle Scholar
  7. 7.
    Newman AB, Nieto FJ, Guidry U, et al. (2001) Relation of sleep-disordered breathing to cardiovascular disease risk factors: The Sleep Heart Health Study. Am J Epidemiol 154:50–59.PubMedCrossRefGoogle Scholar
  8. 8.
    Mortimore IL, Marshall I, Wraith PK, et al. (1998) Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 157:280–283.PubMedGoogle Scholar
  9. 9.
    Kiselak J, Clark M, Pera V, et al. (1993) The association between hypertension and sleep apnea in obese patients. Chest 104:775–780.PubMedGoogle Scholar
  10. 10.
    Peppard PE, Young T, Palta M, et al. (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021.PubMedCrossRefGoogle Scholar
  11. 11.
    Smith P, Gold A, Meyers D, et al. (1985) Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 103:850–855.PubMedGoogle Scholar
  12. 12.
    Noseda A, Kempenaers C, Kerkhofs M, et al. (1996) Sleep apnea after 1 year domiciliary nasalcontinuous positive airway pressure and attempted weight reduction: potential for weaning from continuous positive airway pressure. Chest 109:138–143.PubMedGoogle Scholar
  13. 13.
    Suratt P, McTier R, Findley L, et al. (1987) Changes in breathing and the pharynx after weight loss in obstructive sleep apnea. Chest 92:631–637.PubMedGoogle Scholar
  14. 14.
    Suratt P, McTier R, Findley L, et al. (1992) Effect of very-low-calorie diets with weight loss on obstructive sleep apnea. Am J Clin Nutr 56:182S–184S.PubMedGoogle Scholar
  15. 15.
    Harman E, Wynne J, Block A (1982) The effect of weight loss on sleep-disordered breathing and oxygen desaturation in morbidly obese men. Chest 82:291–294.PubMedGoogle Scholar
  16. 16.
    Pillar G, Peled R, Lavie P (1994) Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery. Chest 106:1702–1704.PubMedGoogle Scholar
  17. 17.
    Aubert-Tulkens G, Culee C, Rodenstein D (1989) Cure of sleep apnea syndrome after long-term nasal continuous positive airway pressure therapy and weight loss. Sleep 12:216–222.PubMedGoogle Scholar
  18. 18.
    Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report; National Institutes of Health. (1998) Obes Res 6(Suppl 2): 51S–209S.Google Scholar
  19. 19.
    Obesity: Preventing and Managing the Global Epidemic. World Health Organization, Geneva, Switzerland, 1997.Google Scholar
  20. 20.
    McTigue KM, Harris R, Hemphill B, et al. (2003) Screening and interventions for obesity in adults: summary of the evidence for the U.S. preventive services task force. Ann Intern Med 139:933–949.PubMedGoogle Scholar
  21. 21.
    Calle EE, Thun MJ, Petrelli JM, et al. (1999) Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341:1097–1105.PubMedCrossRefGoogle Scholar
  22. 22.
    Stuart R (1967) Behavioral control of overeating. Behav Res Ther 5:357.CrossRefGoogle Scholar
  23. 23.
    Foreyt JP, Goodrick GK (1993) Evidence for success of behavior modification in weight loss and control. Ann Intern Med 119:698–701.PubMedGoogle Scholar
  24. 24.
    Kajaste S, Brander P, Telakivi T, et al. (2004) A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med 5:125–131.PubMedCrossRefGoogle Scholar
  25. 25.
    Stradling J, Roberts D, Wilson A, et al. (1998) Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea. Int J Obes 28:278–281.CrossRefGoogle Scholar
  26. 26.
    Bray G (2004) Behavior modification in the treatment of obesity. Up To Date 12:1–7.Google Scholar
  27. 27.
    Heshka S, Greenway F, Anderson J, et al. (2000) Self-help weight loss versus a structured commercial program after 26 weeks: a randomized controlled study. Am J Med 109:282–287.PubMedCrossRefGoogle Scholar
  28. 28.
    Ravussin E, Lillioja S, Knowler W, et al. (1988) Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med 318:467–472.PubMedCrossRefGoogle Scholar
  29. 29.
    Robinson TN (1999) Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA 282:1561–1567.PubMedCrossRefGoogle Scholar
  30. 30.
    Slentz CA, Duscha BD, Johnson JL, et al. (2004) Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE; a randomized controlled study. Arch Intern Med164:31–39.PubMedCrossRefGoogle Scholar
  31. 31.
    Ross R, Dagnone D, Jones PJH, et al. (2000) Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men: a randomized, controlled trial. Ann Intern Med 133:92–103.PubMedGoogle Scholar
  32. 32.
    Jakicic JM, Winters C, Lang W, et al. (1999) Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. JAMA 282:1554–1560.PubMedCrossRefGoogle Scholar
  33. 33.
    Jakicic JM, Marcus BH, Gallagher KI, et al. (2003) Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. JAMA 290:1323–1330.PubMedCrossRefGoogle Scholar
  34. 34.
    Miller W, Koceja D, Hamilton E (1997) A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes 21:941–947.CrossRefGoogle Scholar
  35. 35.
    Acheson KJ (2004) Carbohydrate and weight control: where do we stand? Curr Opin Clin Nutr Metab Care 7:485–492.PubMedCrossRefGoogle Scholar
  36. 36.
    Stamler J, Beard R, Connor W, et al. (1972) Report of inter-society commission for heart disease resources: prevention of cardiovascular disease; primary prevention of the atherosclerotic diseases. Circulation 42:A55–A95.Google Scholar
  37. 37.
    Schwartz A, Gold A, Schubert N, et al. (1991) Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med 144:494–498.Google Scholar
  38. 38.
    Rubenstein I, Colapinto N, Rotstein L, et al. (1988) Improvement in upper airway function after weight loss in patients with obstructive sleep apnea. Am Rev Respir Crit Care Med 138:1192–1195.Google Scholar
  39. 39.
    Rajala R, Partinen M, Sane T, et al. (1991) Obstructive sleep apnea in morbidly obese patients. J Intern Med 230:125–129.PubMedCrossRefGoogle Scholar
  40. 40.
    Lojander J, Mustajoki P, Ronka S, et al. (1998) A nurse-managed weight reduction programme for obstructive sleep apnoea syndrome. J Intern Med 244:251–255.PubMedCrossRefGoogle Scholar
  41. 41.
    Kansanen M, Vanninen E, Tuunainen A, et al. (1998) The effect of very-low calorie diet-induced weight loss on the severity of obstructive sleep apnea and autonomic nervous function in obese patients with obstructive sleep apnoea syndrome. Clin Physiol 18:377–385.PubMedCrossRefGoogle Scholar
  42. 42.
    Pasquali R, Colella P, Cirignotta F, et al. (1990) Treatment of obese patients with obstructive sleep apnea syndrome (OSAS): effect of weight loss and interference of otorhinolaryngoiatric pathology. Int J Obes 14:207–217.PubMedGoogle Scholar
  43. 43.
    Wadden T, Foster G (2000) Behavioral treatment of Obesity. Med Clin North Am 84:441–461, vii.PubMedCrossRefGoogle Scholar
  44. 44.
    Champagne CM, Bray GA, Kurtz AA, et al. (2002) Energy intake and energy expenditure: a controlled study comparing dietitians and non-dietitians. J Am Diet Assoc 102:1428–1432.PubMedCrossRefGoogle Scholar
  45. 45.
    Lin P-H, Proschan MA, Bray GA, et al. (2003) Estimation of energy requirements in a controlled feeding trial. Am J Clin Nutr 77:639–645.PubMedGoogle Scholar
  46. 46.
    Leibel RL, Rosenbaum M, Hirsch J (1995) Changes in energy expenditure resulting from altered body weight. N Engl J Med 332:621–628.PubMedCrossRefGoogle Scholar
  47. 47.
    Seidell J (2000) Obesity, insulin resistance and diabetes: a worldwide epidemic. Br J Nutr 83:S5–S8.PubMedGoogle Scholar
  48. 48.
    Samaha FF, Iqbal N, Seshadri P, et al. (2003) A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 348:2074–2081.PubMedCrossRefGoogle Scholar
  49. 49.
    Foster GD, Wyatt HR, Hill JO, et al. (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348:2082–2090.PubMedCrossRefGoogle Scholar
  50. 50.
    Westman E, Yancy W, Edman J, et al. (2002) Effect of 6-month adherence to a very low carbohydrate diet program. Am J Med 113:30–36.PubMedCrossRefGoogle Scholar
  51. 51.
    Yanovski SZ, Yanovski JA (2002) Obesity: drug therapy. N Engl J Med 346:591–602.PubMedCrossRefGoogle Scholar
  52. 52.
    The Physicians’ Desk Reference. 55th ed. Medical Economics, Montvale, NJ, 2004.Google Scholar
  53. 53.
    Inoue S (1995) Clinical studies with mazindol. Obes Res 3(Suppl 4):549S–552S.PubMedGoogle Scholar
  54. 54.
    Enzi G, Baritussio A, Marchiori E, et al. (1976) Short-term and long-term evaluation of a nonamphetaminic anorexiant (mazindol) in the treatment of obesity. J Int Med Res 4:305–318.PubMedGoogle Scholar
  55. 55.
    Steel J, Munro J, Duncan L (1973) A comparative trial of different regimens of fenfluramine and phentermine in obesity. Practitioner 211:232–236.PubMedGoogle Scholar
  56. 56.
    Connolly HM, Crary JL, McGoon MD, et al. (1997) Valvular heart disease associated with fenfluraminephentermine. N Engl J Med 337:581–588.PubMedCrossRefGoogle Scholar
  57. 57.
    Kernan WN, Viscoli CM, Brass LM, et al. (2000) Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 343:1826–1832.PubMedCrossRefGoogle Scholar
  58. 58.
    Fanghanel G, Cortinas L, Sanchez-Reyes L, et al. (2000) A clinical trial of sibutramine for the treatment of patients suffering essential obesity. Int J Obes Relat Metab Disord 24:144–150.PubMedCrossRefGoogle Scholar
  59. 59.
    Bray G, Blackburn G, Ferguson J, et al. (1999) Sibutramine produces dose-related weight loss. Obes Res 7:189–198.PubMedGoogle Scholar
  60. 60.
    McMahon FG, Fujioka K, Singh BN, et al. (2000) Efficacy and safety of sibutramine in obese white and African American patients with hypertension: a 1-year, double-blind, placebo-controlled, multicenter trial. Arch Intern Med 160:2185–2191.PubMedCrossRefGoogle Scholar
  61. 61.
    Ryan D (2000) Use of sibutramine and other noradrenergic drugs in the management of obesity. Endocrine 2:175–187.Google Scholar
  62. 62.
    James W, Astrup A, Finer N, et al. (2000) Effect of sibutramine on weight maintenance after weight loss: a randomized trial. Lancet 356:2119–2125.PubMedCrossRefGoogle Scholar
  63. 63.
    Apfelbaum M, Vague P, Ziegler O, et al. (1999) Long-term maintenance of weight loss after a verylow calorie diet: a randomized blinded trial of the efficacy and tolerability of sibutramine. Am J Med 106:179–184.PubMedCrossRefGoogle Scholar
  64. 64.
    Davidson MH, Hauptman J, DiGirolamo M, et al. (1999) Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA 281:235–242.PubMedCrossRefGoogle Scholar
  65. 65.
    Hauptman J, Lucas C, Boldrin MN, et al. (2000) Orlistat in the long-term treatment of obesity in primary care settings. Arch Fam Med 9:160–167.PubMedCrossRefGoogle Scholar
  66. 66.
    Rossner S, Sjostrom L, Noack R, et al. (2000) Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. Obes Res 8:49–61.PubMedCrossRefGoogle Scholar
  67. 67.
    Hill JO, Hauptman J, Anderson JW, et al. (1999) Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study. Am J Clin Nutr 69:1108–1116.PubMedGoogle Scholar
  68. 68.
    NIH conference: gastrointestinal surgery for severe obesity; Consensus Development Conference Panel. (1991) Ann Intern Med 115:956–961.Google Scholar
  69. 69.
    Steinbrook R (2004) Surgery for severe obesity. N Engl J Med 350:1075–1079.PubMedCrossRefGoogle Scholar
  70. 70.
    Sjostrom CD, Peltonen M, Wedel H, et al. (2000) Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 36:20–25.PubMedGoogle Scholar
  71. 71.
    Sjostrom C, Lissner L, Wedel H, et al. (1999) Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res 7:477–484.PubMedGoogle Scholar
  72. 72.
    Peiser J, Lavie P, Ovnat A, et al. (1984) Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery. Ann Surg 199:112–115.PubMedCrossRefGoogle Scholar
  73. 73.
    Sugerman H, Fairman R, Sood R, et al. (1992) Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 55:597S–601S.PubMedGoogle Scholar
  74. 74.
    Charuzi I, Ovnat A, Peiser J (1985) The effect of surgical weight reduction on sleep quality in obesity related sleep apnea syndrome. Surgery 97:535–538.PubMedGoogle Scholar
  75. 75.
    Ip MS, Lam KS, Ho C, et al. (2000) Serum leptin and vascular risk factors in obstructive sleep apnea. Chest 118:580–586.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2007

Authors and Affiliations

  • Neil S. Freedman
    • 1
  1. 1.The Sleep and Behavioral Medicine Institute, Bannockburn, IL and The Sleep CenterLake Forest HospitalLake Forest

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