Current methods used for defining, measuring, and treating obesity.

Abstract

Obesity, despite becoming a recognized epidemic in the United States and many countries around the world cannot be necessarily defined, measured, and treated in a simplified fashion. Numerous organizations have classified overweight and obesity using different anthropometric parameters. Older methods to determine the extent of obesity, such as crude weight and skin calipers, contain serious limitations. For example, measuring abdominal obesity cannot be determined using calipers. Other methods such as lean body mass, body mass index (BMI), and waist-to-hip ratio (WHR) are more commonly used in epidemiologic studies but also contain inherent errors. More expensive and technologically advanced methods, such as densitometry, dual-energy x-ray absorptiometry (DEXA), and bioelectrical impedance analysis are also helpful, but the time and cost of using these methods in large-scale studies are a concern. Numerous options for treating obesity exist, and the clinician should be made aware of their strengths and limitations. Lifestyle changes are not only cost effective, but may be the best approach for individuals who desire to lose weight or to maintain their weight while becoming more fit. The addition of drug therapy is also a possibility. A variety of pharmacotherapy interventions are available to the patient on a short-term basis. In addition, two drugs have Food and Drug Administration approval for the long-term treatment of obesity. Drug therapy should be viewed as adjunctive treatment to lifestyle changes for the individuals who qualify based on their BMI and other comorbidities. Drug therapy carries several adverse effects, and the potential for indefinite treatment continues to be an area of controversy. Therefore, a multidisciplinary approach to treating obesity must be considered in any patient who is obese. These treatments in combination with drug therapy in some cases have provided some of the best results in randomized trials. Obesity needs to be considered a chronic disease that requires long-term commitment and multidisciplinary treatment to achieve the desired results. Unless therapy is individualized, it may be difficult to reverse the dramatic trends in obesity rates that have been observed over the past several decades.