CONTENT

.. 2557 ( 25 ./..)
1.9 ( 30 ./..) 600
39 (1)

.. 2552(2) 57
9
30 -35 ./..
2-4 40-50 ./.. 8-10
22.5-25 ./..

(obesity-related comorbidity)



/

> 20 > 30

CONTENT

DEXA scan


= (2 ) (2 ) = x 703
[ ()]
[ ()]
(abdominal fat)

(metabolic syndrome)
(waist circumference)

1. (3, 4)

*
() ()

2
2
/ /
**

< 18.5
< 18.5
18.5 -24.9
18.5 -22.9

25.0-29.9
23.0-24.9

1
30.0-34.9
25.0-29.9

2
35.0-39.9
30

3
40.0
_

*
** > 102 > 88
** > 94 > 80
** > 90 > 80

1. (5)

574

CONTENT

( 2)

2.

binge eating disorder, bulimia nervosa

2.

(obesity-related comorbidity)

(iliac crest) National Institute
of Health (iliac crest)

575

CONTENT

3.

polysomnography (sleep test) ()
(cardiopulmonary fitness) maximal treadmill
exercise test
4.
(lifestyle
modification) 3(3)
3.

(./..)
25-26.9
27-29.9
30-34.9
35-39.9 40

+
+
+

+
+
+

+

4.1 (lifestyle modification)
4.1.1

(1-2 ) ::

2-3
576

CONTENT

500 -1000 kcal/ deficit

500 -1,000
0.5-1
( 45-65% 20-35% 10-35% )
portion size

(caloric dense diet)

(meal replacement)
1-2 (skip meal)

500 -1,000




Low calorie diets (LCDs) 800-1,200

Very low calorie diets (VLCDs) 800

LCDs VLCDs 1-1.5 ./

ideal body weight
VLCDs 2-3 ( 20-30 .)

(CPAP)
1.5 ./

4.1.2 (physical activity therapy)

(maintenance of weight loss)

(moderate intensity) 300

577

CONTENT

1. /(5)
4. /

(light < 3 METs)

(moderate 3-6 METs)

4.8 ./ .

(vigorous > 6 METs)

7.2 ./ .
>8 ./ .

15-18 ./ . >18 ./ .

()
()

METs: ratio of work metabolic rate to resting metabolic rate

578

CONTENT

( 1 4)
4.1.3 (behavioral therapy)(5)
(self-monitoring)
()

(stimulus control)




4.2 (pharmacotherapy)
30 ./.. 27 ./..
(
5-10 6-12 ) (
) 5
5-10 3-6

fenfluramine
dexfenfluramine rimonabont sibutramine

579

CONTENT

5.

Phentermine
()

sympathomimethic

Diethylpropion

()
sympathomimethic

Orlistat

Lorcaserin


selective serotonin receptor agonist
Phentermine/ Topiramate ER
Paresthesia
topiramate
Bupropion/Naltrexone


dopamine and norepinephrine
reuptake inhibitor /opioid
antagonist
Liraglutide
GLP-1 agonist
()
delayed gastric
emptying

4.3 (bariatric surgery)

/
morbid obesity 40 ./..
35 ./..
30 ./..
30 ./..
(6)

laparoscopic adjustable gastric banding

(LAGB) , laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass
(RYGB), laparoscopic biliopancreatic diversion (BPD) BPD with duodenal switch
(BPD-DS)


580

CONTENT

RYGB
BPD/BPD-DS 50-70 1-2

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2015 [cited 2015 Apr 17]. Available from: http://www.who.int/mediacentre/
factsheets/fs311/en/
2. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al.
Body-mass index and cause-specific mortality in 900 000 adults: collaborative
analyses of 57 prospective studies. Lancet 2009;373:1083-96.
3. NHLBI Obesity Education Initiative.The Practical Guide : Identification,Evaluation,
and Treatment of Overweight and Obesity in Adults [Online]. 2000 [cited 2015
Apr 17]. Available from: http://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.
pdf
4. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome--a new worldwide definition.
Lancet 2005;366:1059-62.
5. Kushner R. Clinical Management of the Obese Individual. In: Kushner R, Lawarence
V, Kumar S, editors. Practical Manual of Clinical Obesity: Wiley-Blackwell; 2013.
p. 51-108.
6. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et
al. Clinical practice guidelines for the perioperative nutritional, metabolic, and
nonsurgical support of the bariatric surgery patient--2013 update: cosponsored
by American Association of Clinical Endocrinologists, The Obesity Society, and
American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring, Md).
2013;21 Suppl 1:S1-27.

581