Abstract
Obesity is a chronic disease that has become more common in America during the last 20 years (1). The prevalence of overweight adults in the United States is 65%, with obesity affecting at least 31% of American adult population (1). These increases in overweight and obesity are observed in all ethnic groups and both sexes in this country (1). Increases in the prevalence of obesity are also being seen among the children and adolescents (2,3). Obesity is a known risk factor for several medical comorbidities and is the most common risk factor associated with obstructive sleep apnea syndrome (OSAS) (4). Although the exact mechanisms linking excess body weight to the pathophysiology of OSAS are not totally clear, most population-based and cross-sectional studies have found a strong association between OSAS and excess body weight (5–10). Whereas excess weight has been clearly linked to OSAS, there is presently no consensus that any particular body habitus phenotype is the most important in the pathophysiology of OSAS.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Flegal KM, Carroll MD, Ogden CL, et al. (2002) Prevalence and trends in obesity among US adults, 1999-2000. JAMA 288:1723–1727.
Hedley AA, Ogden CL, Johnson CL, et al. (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291:2847–2850.
Ogden CL, Flegal KM, Carroll MD, et al. (2002) Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 288:1728–1732.
Young T, Peppard PE, Gottlieb D (2002) Epidemiology of obstructive sleep apnea. Am J Respir Crit Care Med 165:1217–1239.
Levinson P, McGarvey S, Carlisle C, et al. (1993) Adiposity and cardiovascular risk factors in men with obstructive sleep apnea. Chest 103:1336–1342.
Millman R, Carlisle C, McGarvey S, et al. (1995) Body fat distribution and sleep apnea severity in women. Chest 107:362–366.
Newman AB, Nieto FJ, Guidry U, et al. (2001) Relation of sleep-disordered breathing to cardiovascular disease risk factors: The Sleep Heart Health Study. Am J Epidemiol 154:50–59.
Mortimore IL, Marshall I, Wraith PK, et al. (1998) Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 157:280–283.
Kiselak J, Clark M, Pera V, et al. (1993) The association between hypertension and sleep apnea in obese patients. Chest 104:775–780.
Peppard PE, Young T, Palta M, et al. (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021.
Smith P, Gold A, Meyers D, et al. (1985) Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 103:850–855.
Noseda A, Kempenaers C, Kerkhofs M, et al. (1996) Sleep apnea after 1 year domiciliary nasalcontinuous positive airway pressure and attempted weight reduction: potential for weaning from continuous positive airway pressure. Chest 109:138–143.
Suratt P, McTier R, Findley L, et al. (1987) Changes in breathing and the pharynx after weight loss in obstructive sleep apnea. Chest 92:631–637.
Suratt P, McTier R, Findley L, et al. (1992) Effect of very-low-calorie diets with weight loss on obstructive sleep apnea. Am J Clin Nutr 56:182S–184S.
Harman E, Wynne J, Block A (1982) The effect of weight loss on sleep-disordered breathing and oxygen desaturation in morbidly obese men. Chest 82:291–294.
Pillar G, Peled R, Lavie P (1994) Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery. Chest 106:1702–1704.
Aubert-Tulkens G, Culee C, Rodenstein D (1989) Cure of sleep apnea syndrome after long-term nasal continuous positive airway pressure therapy and weight loss. Sleep 12:216–222.
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report; National Institutes of Health. (1998) Obes Res 6(Suppl 2): 51S–209S.
Obesity: Preventing and Managing the Global Epidemic. World Health Organization, Geneva, Switzerland, 1997.
McTigue KM, Harris R, Hemphill B, et al. (2003) Screening and interventions for obesity in adults: summary of the evidence for the U.S. preventive services task force. Ann Intern Med 139:933–949.
Calle EE, Thun MJ, Petrelli JM, et al. (1999) Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341:1097–1105.
Stuart R (1967) Behavioral control of overeating. Behav Res Ther 5:357.
Foreyt JP, Goodrick GK (1993) Evidence for success of behavior modification in weight loss and control. Ann Intern Med 119:698–701.
Kajaste S, Brander P, Telakivi T, et al. (2004) A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med 5:125–131.
Stradling J, Roberts D, Wilson A, et al. (1998) Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea. Int J Obes 28:278–281.
Bray G (2004) Behavior modification in the treatment of obesity. Up To Date 12:1–7.
Heshka S, Greenway F, Anderson J, et al. (2000) Self-help weight loss versus a structured commercial program after 26 weeks: a randomized controlled study. Am J Med 109:282–287.
Ravussin E, Lillioja S, Knowler W, et al. (1988) Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med 318:467–472.
Robinson TN (1999) Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA 282:1561–1567.
Slentz CA, Duscha BD, Johnson JL, et al. (2004) Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE; a randomized controlled study. Arch Intern Med164:31–39.
Ross R, Dagnone D, Jones PJH, et al. (2000) Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men: a randomized, controlled trial. Ann Intern Med 133:92–103.
Jakicic JM, Winters C, Lang W, et al. (1999) Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. JAMA 282:1554–1560.
Jakicic JM, Marcus BH, Gallagher KI, et al. (2003) Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. JAMA 290:1323–1330.
Miller W, Koceja D, Hamilton E (1997) A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes 21:941–947.
Acheson KJ (2004) Carbohydrate and weight control: where do we stand? Curr Opin Clin Nutr Metab Care 7:485–492.
Stamler J, Beard R, Connor W, et al. (1972) Report of inter-society commission for heart disease resources: prevention of cardiovascular disease; primary prevention of the atherosclerotic diseases. Circulation 42:A55–A95.
Schwartz A, Gold A, Schubert N, et al. (1991) Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med 144:494–498.
Rubenstein I, Colapinto N, Rotstein L, et al. (1988) Improvement in upper airway function after weight loss in patients with obstructive sleep apnea. Am Rev Respir Crit Care Med 138:1192–1195.
Rajala R, Partinen M, Sane T, et al. (1991) Obstructive sleep apnea in morbidly obese patients. J Intern Med 230:125–129.
Lojander J, Mustajoki P, Ronka S, et al. (1998) A nurse-managed weight reduction programme for obstructive sleep apnoea syndrome. J Intern Med 244:251–255.
Kansanen M, Vanninen E, Tuunainen A, et al. (1998) The effect of very-low calorie diet-induced weight loss on the severity of obstructive sleep apnea and autonomic nervous function in obese patients with obstructive sleep apnoea syndrome. Clin Physiol 18:377–385.
Pasquali R, Colella P, Cirignotta F, et al. (1990) Treatment of obese patients with obstructive sleep apnea syndrome (OSAS): effect of weight loss and interference of otorhinolaryngoiatric pathology. Int J Obes 14:207–217.
Wadden T, Foster G (2000) Behavioral treatment of Obesity. Med Clin North Am 84:441–461, vii.
Champagne CM, Bray GA, Kurtz AA, et al. (2002) Energy intake and energy expenditure: a controlled study comparing dietitians and non-dietitians. J Am Diet Assoc 102:1428–1432.
Lin P-H, Proschan MA, Bray GA, et al. (2003) Estimation of energy requirements in a controlled feeding trial. Am J Clin Nutr 77:639–645.
Leibel RL, Rosenbaum M, Hirsch J (1995) Changes in energy expenditure resulting from altered body weight. N Engl J Med 332:621–628.
Seidell J (2000) Obesity, insulin resistance and diabetes: a worldwide epidemic. Br J Nutr 83:S5–S8.
Samaha FF, Iqbal N, Seshadri P, et al. (2003) A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 348:2074–2081.
Foster GD, Wyatt HR, Hill JO, et al. (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348:2082–2090.
Westman E, Yancy W, Edman J, et al. (2002) Effect of 6-month adherence to a very low carbohydrate diet program. Am J Med 113:30–36.
Yanovski SZ, Yanovski JA (2002) Obesity: drug therapy. N Engl J Med 346:591–602.
The Physicians’ Desk Reference. 55th ed. Medical Economics, Montvale, NJ, 2004.
Inoue S (1995) Clinical studies with mazindol. Obes Res 3(Suppl 4):549S–552S.
Enzi G, Baritussio A, Marchiori E, et al. (1976) Short-term and long-term evaluation of a nonamphetaminic anorexiant (mazindol) in the treatment of obesity. J Int Med Res 4:305–318.
Steel J, Munro J, Duncan L (1973) A comparative trial of different regimens of fenfluramine and phentermine in obesity. Practitioner 211:232–236.
Connolly HM, Crary JL, McGoon MD, et al. (1997) Valvular heart disease associated with fenfluraminephentermine. N Engl J Med 337:581–588.
Kernan WN, Viscoli CM, Brass LM, et al. (2000) Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 343:1826–1832.
Fanghanel G, Cortinas L, Sanchez-Reyes L, et al. (2000) A clinical trial of sibutramine for the treatment of patients suffering essential obesity. Int J Obes Relat Metab Disord 24:144–150.
Bray G, Blackburn G, Ferguson J, et al. (1999) Sibutramine produces dose-related weight loss. Obes Res 7:189–198.
McMahon FG, Fujioka K, Singh BN, et al. (2000) Efficacy and safety of sibutramine in obese white and African American patients with hypertension: a 1-year, double-blind, placebo-controlled, multicenter trial. Arch Intern Med 160:2185–2191.
Ryan D (2000) Use of sibutramine and other noradrenergic drugs in the management of obesity. Endocrine 2:175–187.
James W, Astrup A, Finer N, et al. (2000) Effect of sibutramine on weight maintenance after weight loss: a randomized trial. Lancet 356:2119–2125.
Apfelbaum M, Vague P, Ziegler O, et al. (1999) Long-term maintenance of weight loss after a verylow calorie diet: a randomized blinded trial of the efficacy and tolerability of sibutramine. Am J Med 106:179–184.
Davidson MH, Hauptman J, DiGirolamo M, et al. (1999) Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA 281:235–242.
Hauptman J, Lucas C, Boldrin MN, et al. (2000) Orlistat in the long-term treatment of obesity in primary care settings. Arch Fam Med 9:160–167.
Rossner S, Sjostrom L, Noack R, et al. (2000) Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. Obes Res 8:49–61.
Hill JO, Hauptman J, Anderson JW, et al. (1999) Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study. Am J Clin Nutr 69:1108–1116.
NIH conference: gastrointestinal surgery for severe obesity; Consensus Development Conference Panel. (1991) Ann Intern Med 115:956–961.
Steinbrook R (2004) Surgery for severe obesity. N Engl J Med 350:1075–1079.
Sjostrom CD, Peltonen M, Wedel H, et al. (2000) Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 36:20–25.
Sjostrom C, Lissner L, Wedel H, et al. (1999) Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res 7:477–484.
Peiser J, Lavie P, Ovnat A, et al. (1984) Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery. Ann Surg 199:112–115.
Sugerman H, Fairman R, Sood R, et al. (1992) Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 55:597S–601S.
Charuzi I, Ovnat A, Peiser J (1985) The effect of surgical weight reduction on sleep quality in obesity related sleep apnea syndrome. Surgery 97:535–538.
Ip MS, Lam KS, Ho C, et al. (2000) Serum leptin and vascular risk factors in obstructive sleep apnea. Chest 118:580–586.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Freedman, N.S. (2007). Overview of the Treatment of Obesity. In: Pagel, J.F., Pandi-Perumal, S.R. (eds) Primary Care Sleep Medicine. Current Clinical Practice. Humana Press. https://doi.org/10.1007/978-1-59745-421-6_15
Download citation
DOI: https://doi.org/10.1007/978-1-59745-421-6_15
Publisher Name: Humana Press
Print ISBN: 978-1-58829-992-5
Online ISBN: 978-1-59745-421-6
eBook Packages: MedicineMedicine (R0)