1. Principles of Weight Management by R.Daniel Braun,MD Indiana U. School of Medicine

4. Long Term Behavioral Rx Study Maximum Loss Loss last Treatment visit Perri 14% @ wk 20 13% @ wk 72 Viegener 9% @ wk 26 9% @ wk 52 Wadden 14% @ wk 52 12% @ wk 78 Wing 13% @ wk 26 10% @ wk 52

5. Long Term Pharmacotherapy Study Maximum Loss Loss last Treatment visit Andersen 15% @ wk 26 11% @ wk 52 Finer 12% @ wk 8 17% @ wk 34 14% @ wk 52 Guy-Grand 11% @ wk 34 10% @ wk 52 Weintraub 16% @ wk 34 15% @ wk 54 11% @ wk 156

9. Phenotype of Obese 1. Family is more likely to be overweight. 2. Poorer fitness than the lean, and lesser tendency to exercise. 3. Age group at onset: infant, teen, or adult 4. Immigrants or those becoming westernized in their own natural surroundings tend to become overweight. 5. Many efforts and failures to lose weight. Many excuses for not being able to change habits or weight. 6. Overeating (binge eating) typically under stress.

14. Treatment Decision and Selection BMI Category Health Risked based on BMI <25 Minimal 25>27 Low 27<30 Moderate 30<35 High 35<40 Very High >40 Extremely High Presence of a co-morbid condition or other risk factor jumps patient to next level of risk based on BMI. Shapeup America

15. Treatment Decision and Selection Health Risk Treatment Options Minimal & Low Healthful eating &/or moderate deficit diet, Increased physical activity Lifestyle change Moderate All of above plus low calorie diet High & Very High All of above plus pharmacotherapy or very low calorie diet (VLCD) Extremely High All of above plus surgical intervention

16. Goal Setting Dream Weight What you would like to weigh. Happy Weight A weight you would be happy with. Acceptable Weight Less than above but “OK” Disappointed Less than current, but more than Weight above.

17. Goal Setting 60 women mean age 40 years, BMI of 36.3 Current Weight 99.1 kg Dream Weight 61.4 kg (-38%) Happy Weight 68 kg (-31%) Acceptable Weight 74 kg (-25%) Disappointed Weight 82 kg (-17%)

18. Goal Setting Weight Goal % Achieving Dream Weight 0% Happy Weight 9% Acceptable Weight 24% Disappointed Weight 20% Less than Disappointed 47% Foster et.al. J Consult Clin Psychol, 1996