Treatment of Obesity Pennington Biomedical Research Center Division of Education.
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Transcript of Treatment of Obesity Pennington Biomedical Research Center Division of Education.
Treatment of Treatment of ObesityObesity
Pennington Biomedical Research Pennington Biomedical Research Center Center
Division of EducationDivision of Education
20092009 22
Treatment optionsTreatment options
When does obesity threaten the health When does obesity threaten the health and life of a patient?and life of a patient?
Which patients have co-morbidities Which patients have co-morbidities that make an aggressive treatment that make an aggressive treatment necessary? necessary?
20092009 33
Steps in determining Steps in determining treatmenttreatment
Determine BMI.Determine BMI.
Assess complications and risk factorsAssess complications and risk factors
20092009 44
Steps in determining Steps in determining treatmenttreatment
Determine BMI-related health riskDetermine BMI-related health risk Determine weight reduction Determine weight reduction
exclusionsexclusions Mental illnessMental illness Unstable medical conditionUnstable medical condition Some medicationsSome medications TemporaryTemporary
Pregnancy or lactationPregnancy or lactation
20092009 55
Steps in determining Steps in determining treatmenttreatment
Possible exclusionsPossible exclusions OsteoporosisOsteoporosis BMI in minimal or no-risk categoryBMI in minimal or no-risk category History of mental illnessHistory of mental illness MedicationsMedications
Permanent exclusionsPermanent exclusions Anorexia nervosaAnorexia nervosa Terminal illnessTerminal illness
Assess patient readinessAssess patient readiness
20092009 66
Steps in determining Steps in determining treatmenttreatment
Treatment OptionsTreatment Options 1. 1. Mild energy-deficit regimenMild energy-deficit regimen
Diet, diet and exercise, behavioral therapyDiet, diet and exercise, behavioral therapy
2. 2. Aggressive energy-deficit regimenAggressive energy-deficit regimenVLCDVLCD
Extensive exercise programExtensive exercise program
3. 3. Obesity drugsObesity drugs
4.4. Surgery Surgery More extreme options
20092009 77
Dietary treatmentDietary treatment
When someone is a few pounds overweight When someone is a few pounds overweight and is motivated to lose weight, dietary and is motivated to lose weight, dietary approach is a safe and effective method for approach is a safe and effective method for weight loss. It is also the best method for weight loss. It is also the best method for helping to acquire new skills for maintaining helping to acquire new skills for maintaining a weight loss. a weight loss.
20092009 88
Dieting with the Exchange Dieting with the Exchange ListList
The The Exchange dietExchange diet.. Monitor intake of carbohydrates, fat Monitor intake of carbohydrates, fat
and protein as well as portion sizes.and protein as well as portion sizes. Includes foods from each group and Includes foods from each group and
can be used indefinitely.can be used indefinitely. It also works well in weight It also works well in weight
maintenance.maintenance.
20092009 99
Dieting with the Exchange ListDieting with the Exchange List
Food is broken down into 6 categories:Food is broken down into 6 categories:
Starch/BreadStarch/Bread
MeatMeat
VegetablesVegetables
FruitFruit
MilkMilk
FatFat
20092009 1010
The Exchange ListThe Exchange List
The number of exchanges is The number of exchanges is determined by the total number of determined by the total number of calories required.calories required.
Different for each person and Different for each person and depends on:depends on: height, weight, and energy expenditure.height, weight, and energy expenditure.
1111
Exchanges for Various Calorie Exchanges for Various Calorie LevelsLevels
Total Total Kcal/Kcal/dd
12001200 14001400 15001500 16001600 17001700 18001800 20002000 21002100 22002200
MeatMeat 44 44 55 66 66 66 66 66 66Bread/Bread/
starchstarch55 77 77 77 88 99 1010 1111 1111
VegsVegs 22 33 44 22 22 22 22 22 33FatsFats 33 33 33 33 33 44 44 44 44FruitFruit 33 33 33 33 33 33 33 33 44Skim Skim milk milk (cups)(cups)
22 22 22 -- -- -- -- -- --
2% 2% milkmilk 22 22 22 22 22 33
20092009 1212
Example of daily exchange Example of daily exchange diet: 1800 Kcals dailydiet: 1800 Kcals daily
1 c orange juice1 c orange juice
2 slices of toast2 slices of toast
1 hard-cooked egg1 hard-cooked egg
2 tsp margarine2 tsp margarine
1 c 2% milk1 c 2% milk
Coffee or teaCoffee or tea
2 Fruits2 Fruits
2 Breads2 Breads
1 Meat1 Meat
2 Fat2 Fat
1 Milk1 Milk
Free FoodFree Food
Yields
BREAKFASTBREAKFAST
20092009 1313
Example of daily exchange Example of daily exchange diet: 1800 Kcals dailydiet: 1800 Kcals daily
½ c tuna½ c tuna
2 slices whole wheat bread2 slices whole wheat bread
½ c tomato slices½ c tomato slices
Lettuce/cucumber salad Lettuce/cucumber salad
1 c sliced peaches1 c sliced peaches
1 tsp margarine1 tsp margarine
Tea with lemonTea with lemon
2 Meat2 Meat
2 Bread2 Bread
1 Vegetable1 Vegetable
Raw VegetableRaw Vegetable
2 Fruit2 Fruit
2 Fat2 Fat
Free FoodsFree Foods
Yields
LUNCHLUNCH
20092009 1414
Example of daily exchange Example of daily exchange diet: 1800 Kcals dailydiet: 1800 Kcals daily
3 oz baked chicken3 oz baked chicken
½ c mashed potato ½ c mashed potato
1 small whole grain roll1 small whole grain roll
½ c broccoli, ½ c carrots½ c broccoli, ½ c carrots
Tossed saladTossed salad
1 Tbsp salad dressing 1 Tbsp salad dressing
1 tsp margarine1 tsp margarine
CoffeeCoffee
3 meat3 meat
1 Bread1 Bread
1 Bread1 Bread
1 Vegetable1 Vegetable
Raw VegetableRaw Vegetable
1 Fat1 Fat
1 Fat 1 Fat
Free FoodFree Food
Yields
DINNERDINNER
20092009 1515
Example of daily exchange Example of daily exchange diet: 1800 Kcals dailydiet: 1800 Kcals daily
2 graham crackers2 graham crackers
1 c 2% milk 1 c 2% milk
1 Bread1 Bread
1 Milk1 Milk
EVENING EVENING SNACKSNACK
20092009 1616
The Exchange DietThe Exchange Diet
For more information please visit:For more information please visit:
http://www.diabetes.org/home.jsp
20092009 1717
Dieting Using Calorie Dieting Using Calorie Controlled PortionsControlled Portions
MEAL REPLACEMENT PLANMEAL REPLACEMENT PLAN
Liquid formula or a packaged item Liquid formula or a packaged item Fixed number of calories to replace a meal.Fixed number of calories to replace a meal.
Control portion sizes Control portion sizes Fat, carbohydrate, caloriesFat, carbohydrate, calories
Balanced mealsBalanced meals
20092009 1818
Meal Replacement PlanMeal Replacement Plan
4 types of meal replacers:4 types of meal replacers:Powder mixesPowder mixes
ShakesShakes
BarsBars
Prepackaged MealsPrepackaged Meals
20092009 1919
Meal Replacement PlanMeal Replacement Plan
An intake of An intake of fivefive fruits and vegetables is fruits and vegetables is recommended.recommended.
Effective Effective ConvenientConvenient Nutritionally balanced Nutritionally balanced
20092009 2020
Example:Example:A MEAL REPLACEMENT PLANA MEAL REPLACEMENT PLAN
BreakfastBreakfast Meal ReplacementMeal Replacement
LunchLunch Sensible Meal or Meal Sensible Meal or Meal ReplacementReplacement
DinnerDinner Sensible MealSensible Meal
SnacksSnacks Fruit, vegetable, fat-Fruit, vegetable, fat-free yogurt or cheese, free yogurt or cheese, nuts, pretzels, or air-nuts, pretzels, or air-
popped popcorn popped popcorn
20092009 2121
ExerciseExercise
Adults: Adults: 30-45 minutes30-45 minutes of exercise of exercise three to five daysthree to five days each weekeach week
Include 5-10 minute warm up and cool downInclude 5-10 minute warm up and cool down
Weight loss: at least Weight loss: at least 30 minutes of aerobic activity a 30 minutes of aerobic activity a dayday for five days for five days
20092009 2222
ExerciseExercise
Children: at least 60 minutes, and up to several Children: at least 60 minutes, and up to several hours of physical activity per day for children and hours of physical activity per day for children and adolescentsadolescents
Several bouts of physical activity lasting 15 Several bouts of physical activity lasting 15 minutes or more each dayminutes or more each day
20092009 2323
ExerciseExercise
Energy Balance = maintaining Energy Balance = maintaining weightweight. .
Positive energy balance leads to Positive energy balance leads to weight gain.weight gain.
Negative energy balance leads to Negative energy balance leads to weight loss.weight loss.
20092009 2424
Exercise: Exercise: BenefitsBenefits
Exercise builds lean body mass.
Walking, running and doing physical activity can burn two to three times more calories
than similar amount of time sitting.
With exercise there is an improvement in overall physical fitness.
Exercise improves maintenance of weight after weight loss.
20092009 2525
ExerciseExercise
For Weight LossFor Weight Loss 150 to 200 minutes of moderate physical activity
each week diet for weight loss
For For Improved HealthImproved Health
An exercise program with less than 150 minutes a week and lower intensity can result in improvement
in cardio-respiratory fitness.
20092009 2626
Aerobic ActivityAerobic Activity
Aerobic exercise is any extended activity that makes the lungs and heart work harder while using the large muscle
groups in the arms and legs at a regular, even pace.
EXAMPLES EXAMPLES
Brisk walking Jogging Bicycling Swimming Aerobic dancing
Racket sports Lawn mowing
Ice or roller skating Using aerobic equipment
(treadmill, stationary bike)
20092009 2727
Anaerobic ActivityAnaerobic Activity
Anaerobic activity is short bursts of very strenuous activity using large muscle groups
(Ex: weight lifting, curls, power lifting).
Helps build and tone muscles, but it does not benefit the heart or the lungs.
20092009 2828
Very Low Calorie Diets Very Low Calorie Diets (VLCD)(VLCD)
Formula diet of 800 calories or less.Formula diet of 800 calories or less. Must be under proper medical Must be under proper medical
supervision.supervision. Produce significant weight loss in Produce significant weight loss in
moderately to severely obese patients. moderately to severely obese patients.
20092009 2929
VLCD: VLCD: FactsFacts
Not recommended for pregnant or breastfeeding Not recommended for pregnant or breastfeeding womenwomen
Not appropriate for children or adolescentsNot appropriate for children or adolescents Not recommended for older individualsNot recommended for older individuals
20092009 3030
Behavioral TreatmentBehavioral Treatment
Widely used strategyWidely used strategy
Based on adjusting energy balance Based on adjusting energy balance
Individual treatment, orIndividual treatment, or
Group FormatGroup Format (Around 18-24 weeks)(Around 18-24 weeks)
One of the most successful One of the most successful treatment programstreatment programs
20092009 3131
Group ApproachesGroup Approaches
Social supportSocial support integration into social network and positive integration into social network and positive
interactions with others.interactions with others. Individual feels support, acceptance, and Individual feels support, acceptance, and
encouragement by others.encouragement by others.
20092009 3232
Behavior TreatmentBehavior Treatment
Need to change one’s Need to change one’s approach approach thinkingthinking feelings feelings actions actions
to eating and physical activity.to eating and physical activity.
20092009 3333
Behavioral targetsBehavioral targets
WeightWeight =Total energyintake
Total energy expenditure
_
EatingEating ActivityActivity
Targets of behavioral therapy
20092009 3434
Behavior Therapy: Behavior Therapy: Important ComponentsImportant Components
1.1. Making Lifestyle Change a PriorityMaking Lifestyle Change a Priority
2.2. Establishing a Plan for SuccessEstablishing a Plan for Success
20092009 3535
Behavior Therapy: Behavior Therapy: Important ComponentsImportant Components
3.3. Setting GoalsSetting Goals Calories, fat, physical activity.Calories, fat, physical activity. Short-term goal of losing 1 to 2 pounds a week. Short-term goal of losing 1 to 2 pounds a week. ChooseChoose specific, attainable, and realisticspecific, attainable, and realistic goals. goals. Have a long-term goal. Have a long-term goal.
20092009 3636
Behavior Therapy: Behavior Therapy: Important ConceptsImportant Concepts
4. 4. Keeping Track of Eating and ExercisingKeeping Track of Eating and Exercising Tracking to raise awareness.Tracking to raise awareness. Self monitoringSelf monitoring.. Record time, activating event, place and quantity of Record time, activating event, place and quantity of
eating, and activity behaviors.eating, and activity behaviors.
20092009 3737
Behavior Therapy: Behavior Therapy: Important ConceptsImportant Concepts
5. 5. Avoiding a Food Chain ReactionAvoiding a Food Chain Reaction
Stimulus control.Stimulus control.
Learning to recognize cues. Learning to recognize cues.
20092009 3838
Behavior Therapy: Behavior Therapy: Important ConceptsImportant Concepts
Techniques to conquer eating triggers include:Techniques to conquer eating triggers include: eating regular mealseating regular meals eating at the same time and placeeating at the same time and place use smaller platesuse smaller plates keeping accessible food out of sightkeeping accessible food out of sight eating only when hungry eating only when hungry avoiding activities that encourage eatingavoiding activities that encourage eating
20092009 3939
Behavior Therapy: Behavior Therapy: Important ConceptsImportant Concepts
6. 6. Changing Eating and Activity PatternsChanging Eating and Activity Patterns
slowing pace of eatingslowing pace of eating reducing portion sizes reducing portion sizes measuring food intakemeasuring food intake leaving food on plateleaving food on plate improving food choicesimproving food choices eliminating second servings eliminating second servings
20092009 4040
Behavior Therapy: Behavior Therapy: Important ConceptsImportant Concepts
Changing Eating and Activity PatternsChanging Eating and Activity Patterns
Programmed exercise vs lifestyleProgrammed exercise vs lifestyle Lifestyle activity preferable for weight Lifestyle activity preferable for weight
loss.loss.
20092009 4141
Behavior Therapy: Behavior Therapy: Important ConceptsImportant Concepts
7. 7. Contingency ManagementContingency Management Positive reinforcement (reward) Positive reinforcement (reward)
An effective reward - immediate, desirable, and given An effective reward - immediate, desirable, and given based on meeting a specific goal. based on meeting a specific goal.
Tangible rewards - a new CDTangible rewards - a new CD Intangible reward – taking time off Intangible reward – taking time off
20092009 4242
Behavior Therapy: Behavior Therapy: Important ConceptsImportant Concepts
8. 8. Cognitive Behavioral StrategiesCognitive Behavioral Strategies Traditional behavioral treatment components Traditional behavioral treatment components
with emphasis on thinking patterns that may with emphasis on thinking patterns that may affect eating behaviors.affect eating behaviors.
20092009 4343
Behavior Therapy: Behavior Therapy: Important ConceptsImportant Concepts
9. 9. Stress ManagementStress Management
Stress is a primary predictor of Stress is a primary predictor of overeating and relapse.overeating and relapse.
Stress management skills Stress management skills
20092009 4444
Drug Treatment of Drug Treatment of Obesity:Obesity: Indicated whenIndicated when
BMI is greater than 30BMI is greater than 30 BMI is higher than 27 and there are BMI is higher than 27 and there are
other cardiovascular complications other cardiovascular complications After several attempts diet alone is After several attempts diet alone is
not enoughnot enough
Cardiovascular complications include: Hypertension, Dyslipidemia, Coronary Heart Disease, Type 2 Diabetes, and Sleep Apnea
20092009 4545
Drug TherapyDrug Therapy
Commonly prescribed drugs for the Commonly prescribed drugs for the treatment of obesity include:treatment of obesity include:
PhenterminePhentermine
SibutramineSibutramine
OrlistatOrlistat
20092009 4646
Drug Therapy: Drug Therapy: PhenterminePhentermine
Brand names are Brand names are Adipex-P, Obenix, Oby-TrimAdipex-P, Obenix, Oby-Trim Most commonly prescribed medication for weight Most commonly prescribed medication for weight
loss.loss.
Phentermine increases norepinephrine, a Phentermine increases norepinephrine, a neurotransmitter in the brain that decreases neurotransmitter in the brain that decreases
appetite. appetite.
Phentermine has stimulant properties, and it may cause high blood pressure or irregular heat beats.
20092009 4747
Drug Therapy: Drug Therapy: SibutramineSibutramine
The brand name is MeridiaThe brand name is Meridia
Sibutramine induces weight loss by reducing food intake. Sibutramine induces weight loss by reducing food intake. It stimulates the
satiety centers in the brain.
Sibutramine use may Sibutramine use may increaseincrease heart rate and blood heart rate and blood pressure.pressure.
Sibutramine is not recommended for someone with Sibutramine is not recommended for someone with uncontrolled hypertension, tachycardia, or serious uncontrolled hypertension, tachycardia, or serious
heart, liver, or kidney disease. heart, liver, or kidney disease.
20092009 4848
Drug Therapy:Drug Therapy: OrlistatOrlistat
The Brand name is The Brand name is XenicalXenical
Orlistat prevents the digestion of dietary fat.
Bowel habits will likely change.Bowel habits will likely change.
Leads to improvement in blood lipids.Leads to improvement in blood lipids.
Multivitamin supplement is encouraged.Multivitamin supplement is encouraged.
20092009 4949
Surgical Treatment of Surgical Treatment of ObesityObesity
Criteria used for surgical treatmentCriteria used for surgical treatment::
BMI is 40 or higher BMI is 40 or higher
BMI of 35-39.9 and a serious obesity-related BMI of 35-39.9 and a serious obesity-related health problemhealth problem
such assuch as: Type 2 diabetes, hypertension, heart : Type 2 diabetes, hypertension, heart disease, or sleep apneadisease, or sleep apnea
20092009 5050
Types of GI surgeries Types of GI surgeries availableavailable
RestrictiveRestrictive
MalabsorptiveMalabsorptive
Combined restrictive/malabsorptiveCombined restrictive/malabsorptive
20092009 5151
GI Surgeries: RestrictiveGI Surgeries: Restrictive
Purely restrictive operations only limit food intake and do not interfere with the normal digestive process.
Create a pouch. Create a pouch.
Delay in food emptying. Delay in food emptying.
20092009 5252
Restrictive Operations: Restrictive Operations: ExamplesExamples
1.1. Adjustable gastric bandingAdjustable gastric banding
A band is clamped to create a pouch. A band is clamped to create a pouch.
20092009 5353
Restrictive Operations: Restrictive Operations: ExamplesExamples
2. Vertical banded gastroplasty.2. Vertical banded gastroplasty.
Uses the band and staples to createUses the band and staples to create
a small pouch. Not commonly useda small pouch. Not commonly used
today. today.
20092009 5454
Restrictive Operations: Restrictive Operations: AdvantagesAdvantages
1.1. Generally safer than malabsorptive Generally safer than malabsorptive procedures.procedures.
2.2. Done via laparoscopy allowing for Done via laparoscopy allowing for smaller incisions.smaller incisions.
3.3. Surgeries can be reversed if necessary.Surgeries can be reversed if necessary.
4.4. Result in few nutritional deficiencies. Result in few nutritional deficiencies.
20092009 5555
Restrictive Operations: Restrictive Operations: DisadvantagesDisadvantages
1.1. Smaller weight loss.Smaller weight loss.
2.2. Can lead to weight gain over time.Can lead to weight gain over time.
3.3. No change in eating habits.No change in eating habits.
4.4. Success depends on the patient’s Success depends on the patient’s willingness to adopt a healthy willingness to adopt a healthy lifestyle.lifestyle.
20092009 5656
Restrictive Operations: Restrictive Operations: RisksRisks
1.1. Overeating leading to vomiting.Overeating leading to vomiting.2.2. Break in tubing.Break in tubing.3.3. Problems leading to a second operation.Problems leading to a second operation.
These risks need to be taken into account by any individual considering the
surgery!
20092009 5757
Malabsorptive OperationsMalabsorptive Operations
The main malabsorptive operation is the The main malabsorptive operation is the jejunoileal bypass jejunoileal bypass which is not which is not performed today because of the high performed today because of the high incidence of health complications. incidence of health complications.
20092009 5858
Combined Restrictive and Combined Restrictive and Malabsorptive OperationsMalabsorptive Operations
Restricts both food intake and the amount of Restricts both food intake and the amount of calories and nutrients the body absorbs.calories and nutrients the body absorbs.
Roux-en-Y gastric bypass (RGB) (RGB)Creates a pouch. Creates a pouch. Connects the small intestineConnects the small intestineto the pouch, bypassing large to the pouch, bypassing large sections of the intestines.sections of the intestines.
20092009 5959
Combined Restrictive and Combined Restrictive and
Malabsorptive OperationsMalabsorptive Operations
Biliopancreatic diversion (BPD)
Remove portion of stomach. Remove portion of stomach.
Connect this directly to theConnect this directly to the
final segment of the small intestinefinal segment of the small intestine
completely bypassing sections of completely bypassing sections of
intestines. intestines.
20092009 6060
Combined Operations: Combined Operations: AdvantagesAdvantages
1.1. Rapid weight loss.Rapid weight loss.
2.2. Maintain good weight loss for 10 years or Maintain good weight loss for 10 years or more.more.
3.3. Can lose up to 75-80% of excess weight.Can lose up to 75-80% of excess weight.
4.4. May lead to greater improvement in May lead to greater improvement in health. health.
20092009 6161
Combined Operations: Combined Operations: DisadvantagesDisadvantages
1.1. Can be difficult. Can be difficult. 2.2. May result in long-term nutritional May result in long-term nutritional
deficiencies.deficiencies.3.3. Decreased absorption of iron and calcium.Decreased absorption of iron and calcium.4.4. Require fat soluble vitamin Require fat soluble vitamin
supplementation.supplementation.5.5. May have dumping syndrome.May have dumping syndrome.
20092009 6262
Combined Operations: Combined Operations: RisksRisks
1.1. May lead to complications.May lead to complications.
2.2. Greater risk for abdominal hernias.Greater risk for abdominal hernias.
3.3. The risk of death may be higher.The risk of death may be higher.
20092009 6363
Bariatric Surgery: Bariatric Surgery: FactsFacts
Procedures cost from $20,000 to $35,000. Procedures cost from $20,000 to $35,000.
Medical insurance coverage varies by state.Medical insurance coverage varies by state.
20092009 6464
NIDDKNIDDK (National Institute of Diabetes and Digestive (National Institute of Diabetes and Digestive and Kidney Diseases)and Kidney Diseases)
The patient should consider the following The patient should consider the following questions prior to weight loss surgery:questions prior to weight loss surgery:
1.1. Are you unlikely to lose weight or keep weight Are you unlikely to lose weight or keep weight off long-term with non-surgical measures?off long-term with non-surgical measures?
2.2. Are you well informed about the surgical Are you well informed about the surgical procedure and the effects of treatment?procedure and the effects of treatment?
3.3. Are you determined to lose weight and Are you determined to lose weight and improve your health?improve your health?
20092009 6565
NIDDKNIDDK
4. Are you aware of how your life may change 4. Are you aware of how your life may change after the operation?after the operation?
5. Are you aware of the potential for serious 5. Are you aware of the potential for serious complications, dietary restrictions, and complications, dietary restrictions, and occasional failures? occasional failures?
6. Are you committed to lifelong medical follow-6. Are you committed to lifelong medical follow-up and vitamin/mineral supplementation?up and vitamin/mineral supplementation?
20092009 6666
ConclusionsConclusions
When there are no complications or co-When there are no complications or co-morbidities associated with obesity, morbidities associated with obesity, dietary, exercise and behavioral dietary, exercise and behavioral approaches are the safest and best approaches are the safest and best approaches. approaches.
For successful weight loss to become For successful weight loss to become permanent, an individual has to adopt new permanent, an individual has to adopt new behaviors to maintain weight loss. behaviors to maintain weight loss.
20092009 6767
ConclusionConclusion
It is very important for individuals considering It is very important for individuals considering initiation of weight loss drug therapy or surgeries initiation of weight loss drug therapy or surgeries to be well aware of the risks associated with the to be well aware of the risks associated with the treatments.treatments.
Once all risks are understood, then ultimately it Once all risks are understood, then ultimately it is the individual’s decision to go along with the is the individual’s decision to go along with the treatment or not.treatment or not.
20092009 6868
References: References: Behavior Therapy Behavior Therapy and VLCD Informationand VLCD Information
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Foreyt, J.P., & Poston, W.S.C., Jr. (1998b). What is the role of Foreyt, J.P., & Poston, W.S.C., Jr. (1998b). What is the role of cognitive-behavior therapy in patient management? cognitive-behavior therapy in patient management? Obes Res, Obes Res, 66(Supplement 1), 18S-22S(Supplement 1), 18S-22S
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http://www.cdc.gov http://www.cdc.gov National Heart, Lung, and Blood Institute, Clinical Guidelines National Heart, Lung, and Blood Institute, Clinical Guidelines
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www.meridia.netwww.meridia.net Waitman, JA, Aronne LJ. Phrmacotherpay of obesity. Waitman, JA, Aronne LJ. Phrmacotherpay of obesity.
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Pennington Biomedical Pennington Biomedical Research CenterResearch Center
Division of EducationDivision of Education Heli J. Roy, PhD, RDHeli J. Roy, PhD, RD Beth KalickiBeth Kalicki Division of EducationDivision of Education
Phillip Brantley, PhD, DirectorPhillip Brantley, PhD, DirectorPennington Biomedical Research Pennington Biomedical Research CenterCenterClaude Bouchard, PhD, Executive Claude Bouchard, PhD, Executive DirectorDirector
Edited: October 2009
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About Our Company…About Our Company…The Pennington Biomedical Research Center is a world-renowned nutrition research center. Mission:To promote healthier lives through research and education in nutrition and preventive medicine. The Pennington Center has several research areas, including: Clinical Obesity ResearchExperimental ObesityFunctional FoodsHealth and Performance EnhancementNutrition and Chronic DiseasesNutrition and the BrainDementia, Alzheimer’s and healthy agingDiet, exercise, weight loss and weight loss maintenance The research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis. The Division of Education provides education and information to the scientific community and the public about research findings, training programs and research areas, and coordinates educational events for the public on various health issues. We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at www.pbrc.edu or call (225) 763-3000.