Doctor

AACE/ACE POSITION STATEMENT ON THE PREVENTION, DIAGNOSIS, AND TREATMENT OF OBESITY (1998 Revision)
AACE/ACE Obesity Task Force Richard A. Dickey, M.D., F.A.C.E., Chairman Doris G. Bartuska, M.D., F.A.C.E. George W. Bray, M.D., M.A.C.E. C. Wayne Callaway, M.D., F.A.C.E. Eugene T. Davidson, M.D., M.A.C.E. Stanley Feld, M.D., M.A.C.E. Robert T. Ferraro, M.D. Stephen F. Hodgson, M.D., F.A.C.E. PaulS. Jellinger, M.D., F.A.C.E. Frank P. Kennedy, M.D. Ann M. Lawrence, M.D., Ph.D., M.A.C.E. Pasquale J. Palumbo, M.D., F.A.C.E. John A. Seibel, M.D., F.A.C.E. Adam F. Spitz, M.D., F.A.C.E. Reviewers Rhoda H. Cobin, M.D., F.A.C.E. Yank D. Coble, Jr., M.D., M.A.C.E. Samuel E. Crockett, M.D., F.A.C.E. Daniel Einhorn, M.D., F.A.C.E. Hossein Gharib, M.D., F.A.C.E. Carlos R. Hamilton, Jr., M.D., F.A.C.E.John J. Janick, M.D., F.A.C.E. Philip Levy, M.D., F.A.C.E. Steven M. Petak, M.D., F.A.C.E. Krishna M. Pinnamaneni, M.D., F.A.C.E. Helena W. Rodbard, M.D., F.A.C.E. Paul H. Saenger, M.D. John B. Tourtelot, M.D. David A. Westbrock, M.D., F.A.C.E.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all thefacts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and practice patterns evolve. This report reflects the views of the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) Obesity Task Force and reports in the scientific literature as of February 1998.

ENDOCRINE PRACTICE Vol.4 No. 5 September/October 1998 297

INTRODUCTION TO 1998 REVISION
Richard A. Dickey, M.D., F.A.C.E., F.A.C.P., and George A. Bray, M.D., M.A.C.E., M.A.C.P.

The goal of this revised document is to update the original statement (1), which was intended to provide physicians and associates with guidance on the treatment options for obesity and the procedures for selecting patients for thesetreatments. During the past year, two antiobesity agents were withdrawn from the market because of findings of unusual, serious, and unexpected abnormalities of heart valves in patients treated with fenfluramine or dexfenfluramine, usually in combination with phentermine (2-8). Consequently, use of combined therapy with fenfluramine and phentermine was discontinued, a practice that evolved primarilyas a result of the 1992 publication of a long-term study of this combination drug regimen (9). The recommendations for the care of patients who have taken fenfluramine or dexfenfluramine (alone or in a combination with other agents) are now widely known. Such patients are advised to request an assessment from their physician about the possible effects of the use of these antiobesity agents.Echocardiography should be performed on all patients who have cardiopulmonary signs (including a new heart murmur), who exhibit symptoms suggestive of valvular heart disease (for example, dyspnea or congestive heart failure), or who are anticipating any invasive procedure for which antimicrobial endocarditis prophylaxis is recommended by 1997 American Heart Association guidelines (10,11). Additionally,one new antiobesity agent (sibutramine) has been approved and marketed for use in appropriate patients, and another (orlistat) is expected to be approved soon. Accordingly, these revised guidelines may serve as a useful reference to remind the reader of the essential elements of management of obesity—evaluation of the patient’s risk and assignment of treatment based on these risks and thepatient’s preferences. Because obesity is a chronic disorder that is increasing in prevalence, involving the patient in all decisions is important; the patient must make a long-term commitment. Moreover, physicians and support staff should have a compassionate view of this stigmatized condition (12). The importance of providing guidance for physicians, nonphysician therapists, and regulatory agencies...