Medical management of obesity. Promoting healthy dieting.

Per capita caloric intake in the United States has not increased significantly in the past 75 years, but energy expenditure has decreased. As a result, average body weight and prevalence of obesity have increased. Paralleling this increase in body weight has been an increase in longevity. Minor obesity, therefore, is not related to increased mortality unless the patient has an underlying disease such as diabetes mellitus, hypertension, or hyperlipemia. Patients with these disorders or with a body weight in excess of 20% of the ideal will benefit most from aggressive therapy for obesity. The team approach to obesity--which may include a physician, nutritionist, psychologist, and physical therapist--has been the most successful. Team members need to understand the difficulties involved in weight loss and the numerous individual variables. A diet should be selected carefully to conform as nearly as possible to the patient's life-style. Regular exercise commensurate with the patient's physical abilities should be encouraged to promote caloric expenditure and to shape the body. Supportive and individualized care with continual motivation is necessary to achieve and maintain weight loss. Of course, the therapy chosen depends upon the risk of morbidity and mortality associated with the degree of obesity.