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Basics of Obesity Medicine

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Basics of Obesity Medicine

Overview of Assessing Patients with Overweight or Obesity and Related Comorbidities

1 hr(s) CE

Goal: To improve medical student clinical skills in understanding the extent of the obesity epidemic and assessment of overweight and obesity, medical evaluation of overweight and obesity and associated medical conditions.

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This activity is designed to change: Competence, Performance, Patient Outcome. 1 hr(s)

Overview

Professional Practice Gaps

Educational Objectives:

After completing this activity participants will be able to:

  • Describe the extent of the obesity epidemic
  • Assess patients for overweight and obesity using body mass measurements, in order to determine appropriate treatment.
  • Interpret patient body mass assessments in terms of diagnosis, severity, and corresponding level of treatment.
  • Focus a comprehensive medical evaluation and treatment of patients with high body mass based on an understanding of weight-related comorbidities.
  • Counsel patients on health improvements that they can obtain through weight loss
  • Determine which psychological disorders to consider when evaluating a patient for obesity
  • Facilitate patient setting of a weight-loss goal to help treat their weight-related comorbidities

Modules in this Training Activity

Activity Content

Pre-Assessments Basics 1 Test
Expand
Page Content
Basics of Obesity Medicine – Med Students Pre-Test
Intro to Obesity Medicine and Evaluating Patient Body Mass
Obesity-Related Comorbidities and Medical Evaluation of Obesity
Test Your Knowledge 1 Test
Expand
Page Content
Basics of Obesity Medicine – Med Students: Post-Test
Demographics
Post-Survey
Satisfaction Survey

Training Activity References

Audience and Accreditation

Audience: Healthcare providers, healthcare students

A letter of completion for 1 hours is available for non-physicians.

A score of 70% on the post-test is required to complete the activity.

Participation Requirements

Funding

Initial development of this activity was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (#2R44DK091144-01A1) and NIDDK (#4R44DK108608-02).

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc. requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest to the provider. The ACCME defines ‘relevant’ financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Any conflicts of interest are resolved prior to the delivery of the educational activity to the learner. CTI does not permit individuals with financial conflicts of interest to participate in any stage of activity development.

T Bradley Tanner, MD (President, Clinical Tools, Inc.)
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose. Dr. Tanner is the owner of Clinical Tools.

Read Bio
T. Bradley Tanner, MD is president of Clinical Tools and responsible for the vision of the company. He has received funding via grants and contracts from NIDA, NIAAA, NIMH, NCI, AHRQ, CDC, the Dept of Defense, and NASA to develop medical and health education projects. Dr. Tanner served as principal investigator on 2 NIDA grants to develop the DATA-2000 qualifying buprenorphine training program and clinical practice tools on BupPractice.com. He also has a strong background in technology and oversees the development and delivery of all Clinical Tools websites. Dr. Tanner is also a board-certified psychiatrist with experience in inpatient, outpatient, and emergency health settings. He currently treats patients and educates medical students and residents via his role as a Clinical Associate Professor of Psychiatry at the University of North Carolina at Chapel Hill.

Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Read Bio
Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and the University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.

Reviewers

Steve Applegate, MEd, MEd (President, Applegate Consulting, )
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Read Bio
Mr. Applegate has experience in substance use counseling, state initiatives impacting substance use, and professional training. His prior positions include director of higher education and instructional design at the North Carolina Governor’s Institute on Alcohol and Substance Abuse, project director of the North Carolina Initiative of the Mid-Atlantic Addiction Technology Transfer Center, and program director of the Addiction Sciences Center (an outpatient substance abuse treatment center at the University of Virginia Health Sciences Center). Mr. Applegate works as an on-site consultant and travels to the Clinical Tools (CTI) office on a monthly basis from his office in Richmond, VA. Mr. Applegate helped design the CTI Instructional Manual and works to continue to revise it as we expand our Instructional Design methodology. Mr. Applegate has extensive experience with online education and training, especially in the area of substance abuse. He often pushes the envelope of technology and brainstorms with Clinical Tools how we can utilize new technology in our products. He helped guide development of the curriculum plan and assessments in Phase I of the current project.

Most Recent Reviews

CTI Content Review: June 5, 2020
CTI Editorial Review: June 25, 2020

View Reviews


Reviews for this activity

Excellent primer

Excellent primer on how to begin assessing overweight/obese patients and incorporate weight loss medicine into a practice.

— Preventive Medicine/Occupational

Basics of Obesity Medicine
5
2021-12-08T15:38:51-05:00

— Preventive Medicine/Occupational

Excellent primer on how to begin assessing overweight/obese patients and incorporate weight loss medicine into a practice.
https://obesity.clinicalencounters.com/blog/testimonials/excellent-primer/

Excellent educational program

Excellent educational program. Great resource; well done.

— Cardiology

Basics of Obesity Medicine
5
2021-12-08T15:38:51-05:00

— Cardiology

Excellent educational program. Great resource; well done.
https://obesity.clinicalencounters.com/blog/testimonials/excellent-educational-program/
5
2
Basics of Obesity Medicine


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Overview of Assessing Patients with Overweight or Obesity and Related Comorbidities

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Primary Sidebar

Activity Home Expand All
Pre-Assessments Basics
1 Test
Basics of Obesity Medicine – Med Students Pre-Test
Intro to Obesity Medicine and Evaluating Patient Body Mass
Obesity-Related Comorbidities and Medical Evaluation of Obesity
Test Your Knowledge
1 Test
Basics of Obesity Medicine – Med Students: Post-Test
Demographics
Post-Survey
Satisfaction Survey
Funding Information Development of this website was funded entirely by grant #2R44DK091144-01A1 and #5R44DK108608-04 from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA. Ongoing development and maintenance is funded by the training fee and Clinical Tools, Inc. No commercial support is received.
Clinical Tools is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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Professional Practice Gaps

Evidence-based guidelines recommend screening all patients for weight problems and classifying or diagnosing them as overweight or obese (M. D. Jensen et al., 2013). Recording of height and weight and waist circumference and calculating BMI are important steps in this classification. Making a separate, official diagnosis of obesity is associated with greater likelihood of a weight-management plan being developed (Mattar et al., 2017).

Despite the evidence to support these recommendations, weight and height data needed to assess for obesity using BMI is lacking in roughly 50% of medical records (STOP Obesity Alliance, 2010). Primary care physicians and other primary care clinicians do not consistently assess, diagnose, counsel, or advise patients who are overweight or obese (Mattar et al., 2017; Muo, Sacajiu, Kunins, & Deluca, 2013; Smith et al., 2011).

Additionally, physicians frequently report a lack of training and competence in weight management (Dietz et al., 2015; Sabin, Marini, & Nosek, 2012; STOP Obesity Alliance, 2010). In our survey of primary care providers, (N= 25) 84% felt they needed training in interpreting waist circumference, while 64% said they “rarely or never” assessed patients for overweight or obesity using waist circumference. Another 72% of providers felt they needed training in identifying risk factors for comorbid conditions (Tanner, 2011).

Practice Gap References

  • Dietz, W., Baur, L., Hall, K., Puhl, R., Taveras, E., Uauy, R., & Kopelman, P. (2015). Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet. http://dx.doi.org/10.1016/S0140-6736(14)61748-7

  • Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 01.cir.0000437739.71477.ee. https://doi.org/10.1161/01.cir.0000437739.71477.ee

  • Mattar, A., Carlston, D., Sariol, G., Yu, T., Almustafa, A., Melton, G. B., & Ahmed, A. (2017). The prevalence of obesity documentation in Primary Care Electronic Medical Records. Applied Clinical Informatics, 8(1), 67–79. https://doi.org/10.4338/ACI-2016-07-RA-0115

  • Muo, I. M., Sacajiu, G., Kunins, H., & Deluca, J. (2013). Effect of the availability of weight and height data on the frequency of primary care physicians documented BMI, diagnoses and management of overweight and obesity. Quality in Primary Care, 21(4). Retrieved from http://primarycare.imedpub.com/abstract/effect-of-the-availability-of-weight-andrnheight-data-on-the-frequency-of-primaryrncare-physicians-documented-bmirndiagnoses-and-management-of-overweightrnand-obesity-111.html

  • Sabin, J. A., Marini, M., & Nosek, B. A. (2012). Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender. PLOS ONE, 7(11), e48448. https://doi.org/10.1371/journal.pone.0048448

  • Smith, A. W., Borowski, L. A., Liu, B., Galuska, D. A., Signore, C., Klabunde, C., … Ballard-Barbash, R. (2011). U.S. primary care physicians’ diet-, physical activity-, and weight-related care of adult patients. American Journal of Preventive Medicine, 41(1), 33–42. https://doi.org/10.1016/j.amepre.2011.03.017

  • STOP Obesity Alliance. (2010). Provider/Patient Survey on Obesity in the Primary Care Setting. STOP Obesity Alliance. Retrieved from http://www.stopobesityalliance.org/research-and-policy/research-center/survey-results/

  • Tanner, B. (2011). Improving Obesity Outcomes Through Interactive Web-Based Clinical Skills Training | SBIR.gov. Retrieved April 3, 2019, from https://www.sbir.gov/sbirsearch/detail/389149

Training Activity References

Introduction to Obesity Medicine and Evaluating Patient Body Mass

  • American Council on Exercise. (2015). Percent Body Fat Calculator: Skinfold Method [Informative]. Retrieved January 23, 2015, from American Council on Exercise (ACE) website: http://www.acefitness.org/acefit/healthy_living_tools_content.aspx?id=2
  • American Medical Association. (2013). AMA Adopts New Policies on the Second Day of Voting at Annual Meeting. AMA. Retrieved from http://news.cision.com/american-medical-association/r/ama-adopts-new-policies-on-second-day-of-voting-at-annual-meeting,c9430649
  • Apovian, C. M., Aronne, L. J., Bessesen, D. H., McDonnell, M. E., Murad, M. H., Pagotto, U., … Still, C. D. (2015). Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 100(2), 342–362. https://doi.org/10.1210/jc.2014-3415
  • Basulto, D. (2013, June 20). A changing battlefield in the fight against fat. The Washington Post. Retrieved from https://www.webcitation.org/6HWwftXgI?url=http://www.washingtonpost.com/blogs/innovations/wp/2013/06/20/a-changing-battlefield-in-the-fight-against-fat/?wpisrc=nl_tech_b
  • Bays, H., Seger, J., Primack, C., & et al. (2017). Obesity Algorithm, presented by the Obesity Medicine Association [Informative]. Retrieved July 18, 2017, from Obesity Medicine Association website: https://obesitymedicine.org/obesity-algorithm/
  • Belavy, D., Mohlig, M., Pfeiffer, A., & et al. (2014). Preferential deposition of visceral adipose tissue occurs due to physical inactivity. International Journal of Obesity, 38, 1478–1480. Retrieved from http://www.nature.com/ijo/journal/v38/n11/abs/ijo201426a.html?WT.ec_id=IJO-201411
  • Collison, K. S., Zaidi, M. Z., Saleh, S. M., Inglis, A., Mondreal, R., Makhoul, N. J., … Al-Mohanna, F. A. (2011). Effect of trans-fat, fructose and monosodium glutamate feeding on feline weight gain, adiposity, insulin sensitivity, adipokine and lipid profile. British Journal of Nutrition, 106(2), 218–226. https://doi.org/10.1017/S000711451000588X
  • Davis, L., Coleman, C., Kiel, J., Rampolla, J., Hutchisen, T., Ford, L., … Hanlon-Mitola, A. (2010). Efficacy of a meal replacement diet plan compared to a food-based diet plan after a period of weight loss and weight maintenance. Nutrition Journal, 9(11). https://doi.org/10.1186/1475-2891-9-11
  • Dietary Guidelines Advisory Committee. (2014, December 15). 2015 DGAC: Meeting 7. Retrieved from https://health.gov/dietaryguidelines/2015-binder/meeting7/docs/dgac-meeting-7-sc-1.Pdf
  • Dietz, W., Baur, L., Hall, K., Puhl, R., Taveras, E., Uauy, R., & Kopelman, P. (2015). Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet. http://dx.doi.org/10.1016/S0140-6736(14)61748-7
  • Engin, A. (2017). The Definition and Prevalence of Obesity and Metabolic Syndrome. Advances in Experimental Medicine and Biology, 960, 1–17. https://doi.org/10.1007/978-3-319-48382-5_1
  • Flegal, K. M., Kruszon-Moran, D., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2016). Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA, 315(21), 2284–2291. https://doi.org/10.1001/jama.2016.6458
  • Forman-Hoffman, V., Little, A., & Wahls, T. (2006). Barriers to obesity management: a pilot study of primary care clinicians. BMC Family Practice, 7, 35. https://doi.org/10.1186/1471-2296-7-35
  • Fryar, C., Carroll, M., & Ogden, C. (2014). Prevalence of overweight, obesity, and extreme obesity among adults: United States, 1960-1962 through 2011-2012. Retrieved from CDC National Center for Health Statistics Health E-Stats website: https://www.cdc.gov/nchs/data/hestat/obesity_adult_11_12/obesity_adult_11_12.htm
  • Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., … Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Executive Summary. Complete Guidelines available at https://www.aace.com/publications/guidelines. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 22(7), 842–884. https://doi.org/10.4158/EP161356.ESGL
  • Gonzalez-Casanova, I., Sarmiento, O. L., Gazmararian, J. A., Cunningham, S. A., Martorell, R., Pratt, M., & Stein, A. D. (2013). Comparing three body mass index classification systems to assess overweight and obesity in children and adolescents. Revista Panamericana De Salud Publica = Pan American Journal of Public Health, 33(5), 349–355. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23764666
  • Gregor, M., & Hotamisligil, G. (2011). Inflammatory mechanisms in obesity. Annual Review of Immunology, 29, 415–445. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21219177
  • Iacobini, C., Pugliese, G., Blasetti Fantauzzi, C., Federici, M., & Menini, S. (2019). Metabolically healthy versus metabolically unhealthy obesity. Metabolism, 92, 51–60. https://doi.org/10.1016/j.metabol.2018.11.009
  • International Diabetes Federation. (2006). The IDF consensus worldwide definition of the metabolic syndrome. IDF.Org. Retrieved from https://www.idf.org/e-library/consensus-statements/60-idfconsensus-worldwide-definitionof-the-metabolic-syndrome
  • Jay, M., Kalet, A., & Ark, T. (2009). Physicians’ attitudes about obesity and their associations with competency and specialty: a cross-sectional study. BMC Health Services Research, 9(106). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705355/
  • Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 01.cir.0000437739.71477.ee. https://doi.org/10.1161/01.cir.0000437739.71477.ee
  • Jensen, M., Ryan, D., Apovian, C., & et al. (2013). 2013 Report on the Management of Overweight and Obesity in Adults: Full Panel Report Supplement. Retrieved from The National Heart, Lung, and Blood Institute website: http://jaccjacc.cardiosource.com/acc_documents/2013_FPR_S5_Obesity.pdf
  • Johnston, B., Kanters, S., Bandayrel, K., & et al. (2014). Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults A Meta-analysis. The Journal of the American Medical Association, 312(9), 923–933. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=1900510&resultClick=3
  • Kassi, E., Pervanidou, P., Kaltsas, G., & et al. (2011). Metabolic syndrome: definitions and controversies. BMC Medicine, 9, 48. Retrieved from http://www.biomedcentral.com/1741-7015/9/48
  • Keating, S., Machan, E., O’Connor, H., & et al. (2014). Continuous exercise but not high intensity interval training improves fat distribution in overweight adults. Journal of Obesity. https://doi.org/10.1155/2014/834865
  • Koliaki, C., Liatis, S., & Kokkinos, A. (2019). Obesity and cardiovascular disease: revisiting an old relationship. Metabolism, 92, 98–107. https://doi.org/10.1016/j.metabol.2018.10.011
  • Kraschnewski, J. L., Boan, J., Esposito, J., Sherwood, N. E., Lehman, E. B., Kephart, D. K., & Sciamanna, C. N. (2010). Long-term weight loss maintenance in the United States. 34(11), 1644–1654. https://doi.org/10.1038/ijo.2010.94
  • Mattar, A., Carlston, D., Sariol, G., Yu, T., Almustafa, A., Melton, G. B., & Ahmed, A. (2017). The prevalence of obesity documentation in Primary Care Electronic Medical Records. Applied Clinical Informatics, 8(1), 67–79. https://doi.org/10.4338/ACI-2016-07-RA-0115
  • McKinney, L., & American Academy of Family Physicians (AAFP). (2013). Diagnosis and Management of Obesity. Retrieved from http://www.aafp.org/dam/AAFP/documents/patient_care/fitness/obesity-diagnosis-management.pdf
  • Muo, I. M., Sacajiu, G., Kunins, H., & Deluca, J. (2013). Effect of the availability of weight and height data on the frequency of primary care physicians documented BMI, diagnoses and management of overweight and obesity. Quality in Primary Care, 21(4). Retrieved from http://primarycare.imedpub.com/abstract/effect-of-the-availability-of-weight-andrnheight-data-on-the-frequency-of-primaryrncare-physicians-documented-bmirndiagnoses-and-management-of-overweightrnand-obesity-111.html
  • National Center for Health Statistics. (2018). International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Retrieved April 10, 2019, from Center for Disease Control and Prevention website: https://www.cdc.gov/nchs/icd/icd10cm.htm#FY%202019%20release%20of%20ICD-10-CM
  • Nimptsch, K., Konigorski, S., & Pischon, T. (2019). Diagnosis of obesity and use of obesity biomarkers in science and clinical medicine. Metabolism: Clinical and Experimental, 92, 61–70. https://doi.org/10.1016/j.metabol.2018.12.006
  • Ochner, C., Tsai, A., Kushner, R., & Wadden, T. (2015). Treating obesity seriously: when recommendations for lifestyle change confront biological adaptations. The Lancet: Diabetes and Endocrinology, 3(4), 232–234. Retrieved from http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00009-1/fulltext
  • Sabin, J. A., Marini, M., & Nosek, B. A. (2012). Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender. PLOS ONE, 7(11), e48448. https://doi.org/10.1371/journal.pone.0048448
  • Sahakyan, R., & Somers, V. (2015). Normal-weight central obesity: Implications for total and cardiovascular mortality. Annals of Internal Medicine, 163(11), 827–835. https://doi.org/10.7326/M14-2525
  • Seymour, E., Tanone, I., Urcuvo-Llanes, D., & et al. (2011). Blueberry intake alters skeletal muscle and adipose tissue peroxisome proliferator-activated receptor activity and reduces insulin resistance in obese rats. 14(12), 1511–1518. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21861718
  • Sharma, A., & Kushner, R. (2009). A proposed clinical staging system for obesity. 33(3), 289–295. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19188927
  • Smith, A. W., Borowski, L. A., Liu, B., Galuska, D. A., Signore, C., Klabunde, C., … Ballard-Barbash, R. (2011). U.S. primary care physicians’ diet-, physical activity-, and weight-related care of adult patients. American Journal of Preventive Medicine, 41(1), 33–42. https://doi.org/10.1016/j.amepre.2011.03.017
  • STOP Obesity Alliance. (2010). Provider/Patient Survey on Obesity in the Primary Care Setting. STOP Obesity Alliance. Retrieved from http://www.stopobesityalliance.org/research-and-policy/research-center/survey-results/
  • Sun, Q., Townsend, M., & Okereke, O. (2009). Adiposity and weight change in mid-life in relation to healthy survival after age 70 in women: prospective cohort study. BMJ, 339. Retrieved from http://www.bmj.com/content/339/bmj.b3796
  • Tanner, B. (2011). Improving Obesity Outcomes Through Interactive Web-Based Clinical Skills Training | SBIR.gov. Retrieved April 3, 2019, from https://www.sbir.gov/sbirsearch/detail/389149
  • U.S. Preventive Services Task Force. (2012). Screening for and Management of Obesity in Adults: U.S. Preventive Services Task Force Recommendation Statement. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/obesity-in-adults-screening-and-management
  • Wadden, T., Butryn, M., & Hong, P. (2014). Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA, 312, 1779–1791. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=1920976
  • Wetmore, C., & Mokdad, A. (2012). In denial: Misperceptions of weight change among adults in the United States. Preventive Medicine, 55(2), 93–100. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22781370
  • Wilke, J. (2014). In U.S., Majority “Not Overweight,” Not Trying to Lose Weight. Gallup. Retrieved from http://news.gallup.com/poll/171287/majority-not-overweight-not-trying-lose-weight.aspx
  • Wing, R., Bolin, P., Brancati, F., & et al. (2013). Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. The New England Journal of Medicine, 369, 145–154. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa1212914#t=article
  • World Health Organization. (2011). Obesity and overweight: Fact sheet [Informative]. Retrieved July 15, 2015, from World Health Organization website: http://www.who.int/mediacentre/factsheets/fs311/en/
  • Yannakoulia, M., Poulimeneas, D., Mamalaki, E., & Anastasiou, C. A. (2019). Dietary modifications for weight loss and weight loss maintenance. Metabolism: Clinical and Experimental, 92, 153–162. https://doi.org/10.1016/j.metabol.2019.01.001

Obesity Comorbidity Assessment

  • A.D.A.M. (2012). Obesity hypoventilation syndrome (OHS) [U.S. National Library of Medicine]. Retrieved April 2, 2014, from Medline Plus Medical Encyclopedia [Internet]. website: https://medlineplus.gov/ency/article/000085.htm
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