Manual of Clinical Nutrition

Obesity and Weight Management

Manual of Clinical Nutrition Management III- 87 Copyright © 2013 Compass Group, Inc.

treated with orlistat plus diet (36). Because long-term safety has been demonstrated, orlistat has been
approved by the Food and Drug Administration for over-the-counter sales at a reduced dosage (6).

Medical nutrition therapy, exercise, and behavior modification should be provided in adjunct to
pharmacotherapy (Grade I) (4,6,7,29). With pharmacotherapy, weight loss plateaus by 6 months, and weight
regain occurs after medication therapy stops (31). A limited number of studies have evaluated the safety and
efficacy of anorexiant medications for more than 2 to 3 years. The physician must continually assess drug
therapy for efficacy and safety (4).

Surgery: Weight loss surgery is one option for weight reduction in adult patients with severe obesity, defined
as a BMI of at least 40 kg/m^2 or a BMI of at least 35 kg/m^2 with comorbid conditions (Grade I) (4,6,37). Roux-en-Y
gastric bypass and laparoscopic adjustable gastric band are the most common and widely accepted surgical
procedures for weight loss (6). More recent guidelines suggest weight loss sugery may be an option for
children and adolescents over the 95th percentile for weight based on age who present with a severe
comorbidity (36). Children and adolescents should be managed in specialized centers and currently only the
laparoscopic adjustable gastric band (LAGB) and Roux-en-Y gastric bypass (RYGB) should be offered as
surgical options in this population group (37). The primary benefit of surgical therapy is durable weight loss
and maintenance of weight loss (4,6). More than 90% of patients experience significant (>20% to 25%) weight
loss, and between 50% and 80% of patients maintain the weight loss for more than 5 years (38). Most weight
loss occurs in the first 6 months and continues for up to 18 to 24 months. The initial 6-month period is
marked by the most rapid weight reduction and improvements in comorbid conditions (1). Prospective
studies show that the average weight 10 years after surgery is approximately 55% of excess body weight,
with a weight regain of 10% to 15% of the initial weight lost (39). A preoperative behavior change program is
highly recommended. Complications of weight loss surgery include gallstones, nutritional deficiencies
requiring supplementation, dumping syndrome, protein-calorie malnutrition, and the complications that are
associated with any surgery. (Refer to “Nutrition Management of Bariatric Surgery” in Section B.)

*The Academy of Nutrition and Dietetics has assigned grades, ranging from Grade I (good/strong) to Grade V (insufficient evidence), to
evidence and conclusion statements. The grading system is described in Section III: Clinical Nutrition Management A Reference Guide,
page III-1.

References

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3. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the
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4. National Heart, Lung, and Blood Institute Obesity Education Initiative Expert Panel. Clinical Guidelines on the Identification,
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7. Adult Weight Management Evidence-Based Nutrition Practice Guideline. Academy of Nutrition and Dietetics Evidence Analysis
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