A comprehensive approach to outpatient obesity management.

Obesity is a predominantly physiological disorder that has a poor success rate of treatment. Recent evidence suggests that body weight is defended from change and that obese human beings regulate at a higher body weight than do lean human beings. A comprehensive program, including nutrition education, behavior modification, increased activity, and psychological support, has been developed at the University of Virginia Medical Center. The program is administered by dietitians and nurses under a physician's supervision. The major emphasis of the program is on weight maintenance. Several diet options are offered, with a very-low-calorie ketogenic diet being the most drastic. Analysis of the first 4 years of operation shows that 39% of all patients who had entered the program were still active (i.e., still returning for checkups); their average weight loss was 21.4 kg, and the average time in the program was 12.1 months. Inactive patients averaged a loss of 14.6 kg and 8.9 months in the program. Those results suggest that nonphysicians provide excellent obesity treatment at a lower cost than physicians. The use of multidisciplinary teams to treat obesity may be preferable to primary physician care.