New Techniques in Office Management of Obesity

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Abstract
As a result of participating in a controlled, double-blind, weight reduction study, one of the authors has changed his approach to the treatment of the obese patient and now has much greater success with a smaller expenditure of time and effort. ‘Responders’ are selected early in treatment; the physician continues to work with these patients while ‘non-responders’ are identified and told that continuation is inadvisable until they demonstrate better motivation. Feinstein's Reduction Index is used as a measure of performance at set intervals in the programme; patients being seen every two weeks for a given period of time. At each visit patients are questioned about diet and eating habits and advised regarding changes. Patients are encouraged or chastised as necessary, bearing in mind that recent research demonstrates variations in hormonal patterns and efficiency of energy utilization in obesity so that uniform weight loss proportionate to caloric restriction cannot be expected. The Cumulative Reduction Index, developed for the study, was valuable for evaluating the treatment programme as a whole, but the ‘standard’ Feinstein's Reduction Index is more useful for the clinician managing the individual patient. Finally, it must be pointed out that frequently obesity is only one symptom of an underlying problem, often emotional, and until all aspects of the problem are treated, successful management of the obesity is impossible.

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