Viewpoints about obesity are changing.  What was once considered a  "disease with the primary causal factor being the individual's inability to control their eating" (Seto, 1998), is now seen as a "complex and multifactorial chronic disease that develops from an interaction of genotype and environment. Our understanding of how and why obesity develops is incomplete, but involves the integration of social, behavioral, cultural, physiological metabolic and genetic factors" (NIH/NHLBI, 1998, p vii).

A review of the literature reveals many articles about obesity and its associated problems. Guidelines have been provided by various organizations with suggestions for working with the obese clients, but the questions remain:  What works for women?  Can practitioners help motivate women to improve their health with constructive weight loss measures? What seems to be working?  What doesn't seem to be working ?  Can the results be lasting ?  What information and support is available for practitioners?

Available guidelines and discussions of appropriate obesity management are exploding with conflicting viewpoints about both causation and prevention.  This inquiry  investigates a variety of  recommendations by organizations concerned with obesity and its associated  problems, and then  develops strategies that will help practitioners work more effectively with their obese clients.  Specific strategies include nutritional recommendations,  lifestyle changes and specific educational approaches.

Insulin resistance (IR) and the glycemic index (GI) are two emerging concepts that appear to be helpful for practitioners working with their obese clients (Ammon, 1999).  IR or insulin sensitivity is defined as a reduced sensitivity of the body to insulin's effect on blood sugar (Bernstein, 1997, p 370).  The GI  is a standardized way of measuring the rise of blood glucose after the consumption of a particular food (Ammon, 1999, p 7).  Specific foods are compared with a reference food and then ranked with other foods based on their immediate effect on blood sugar levels (Miller, Wolever, Colagiuri, & Foster-Powell, 1999, p 24).

Evidenced Based Clinical Practice Guidelines (EBCPGs)  are available from the author with reference to current research.  These CPGs  help practitioners and consumers identify predisposing factors that contribute to obesity such as IR and  utilize tools that have been shown to help with the improvement of IR, health indicators (HI) and hopefully weight loss, such as the GI.   Readily available common clinical measures,  are discussed to assist the clinician working with at risk clients.

The National Institutes of Health/National Heart, Lung , and Blood Institute (NIH/NHLBI), estimates 97 million adults in the United States are overweight or obese (NIH, 1998, p vii).  Obesity is associated with an increased risk of coronary heart disease, stroke, hypertension, type 2 diabetes and dyslipidemia.  Obesity is the second most preventable cause of death, second only to smoking, and a major modifiable factor of cardiovascular disease (Robbins and Shair, 1999).  Recent surveys suggest 54.9% of adults are overweight and 22.3 % of U.S. adults are obese (Anderson, 1999).  One commonly accepted definition of obesity is defined as a Body Mass Index (BMI) of 30 kg/m2, while of overweight is: a BMI greater than 25 kg/m2 (Ammon, 1999).

Ammon, (1999, p2 ) cites associated risks of obesity:

Obesity contributes to other illnesses, such as hypertension, coronary artery disease, type 2 diabetes, cerebrovascular accident (CVA), dyslipidemia, gallbladder disease, osteoarthritis, sleep apnea, and endometrial, breast, prostate and colon cancers. In addition to the physical health risks associated with obesity, there is also a social stigma. One study showed that among women, obesity is associated with decreased use of health care services, possibly increasing their health risks.