As rates of obesity have increased this disease has become a common problem that physicians are faced with treating. This paper aims to review the different options for patients and determine the best treatments for obesity. Modalities that are considered include dietary treatment, exercise, pharmacologic treatment, and weight loss surgery. This study compares reduced calorie diets, low fat diets, low glycemic index/load diets, the Mediterranean diet, and low carbohydrate diets. The validity of exercise as an effective prescription for obesity is evaluated and debunked. Pharmacologic treatments that are contrasted include those drug therapies that are currently approved by the United States Food and Drug Administration for the long-term treatment of obesity. Those are orlistat, lorcaserin and phentermine/topiramate. The surgical treatments reviewed include vertical banded gastroplasty, adjustable gastric banding, Roux-en Y gastric bypass, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch. After a comprehensive review of the literature the conclusion reached was that treatment for obesity should begin with the least invasive options and those that have the least potential for harm. That is, diet should be a first course of action. Among diets a Mediterranean diet or another culturally adapted low glycemic index/load diet is best. However, more studies are needed to determine how to translate the diets for different cultures and individual tastes. When diets are unable to produce enough weight loss, pharmacologic treatments are considered. Among them, lorcaserin and phentermine/topiramate do not have enough long-term studies to warrant a strong recommendation as of the publishing of this paper. The only other option available, orlistat, comes with many uncomfortable gastrointestinal side effects, so it is also not an ideal option. In addition, orlistat does not produce the amount of weight loss that is seen with surgical procedures. Patients and physicians considering surgical treatment for obesity will find that the best option is laparoscopic adjustable gastric banding.

In an unselected series of mentally retarded children in the county of Västerbotten, Sweden, the annual incidence of children with severe mental retardation (SMR) (IQ &lt; 50) and alive at the age of one year decreased from 5.3 per 1,000 in 1959 - 1963 to 3.1 per 1,000 in 1967 -1970. This was mainly due to a decrease in the incidence of Down's syndrome. In parallel the proportion of mothers 35 years of age or more at the birth of the child decreased significantly. The prevalence of children with SMR in 1976 was 3.5 per 1,000. The main cause of the SMR was prenatal in 70 percent, perinatal in 8 percent and postnatal in 1 percent. The cause of the SMR was untraceable in 20 percent of the cases. Associated CNS-handicaps occurred in 52 percent of the cases. The annual incidence of mildly mentally retarded children (IQ 50 - 69) registered at the Bureau for Provision and Services for Mentally Retarded was 4.2 per 1,000 and the prevalence in 1979 was 3.8 per 1,000. The cause of the mild mental retardation (MMR) was untraceable in 43 percent. Prenatal causes were identified in as many as 43 percent. Perinatal causes were found in 7 percent and postnatal causes in 5 percent of the cases. Associated CNS-handicaps occurred in 30 percent of the cases.A syndrome of mental retardation with X-linked inheritance not recognized previously in Sweden was characterized clinically (mainly in boys, machro-orchidism, verbal disabilities) and cytogenetically (a fragile site on the X-chromosomes seen after cui turing in special folic acid deficient media) and found to have a prevalence of 6 percent in the population of severely mentally retarded boys. This makes this syndrome the next most common cause of SMR in boys after Down's syndrome. The chromosomal fragility was also identified in female carriers, which has implications for genetic counselling.Through identification of an untreated Phenylketonurie mother giving birth to five severely mentally retarded children, attention was focused on the risks for the fetus of the growing number of Phenylketonurie women identified neonatally and treated di etarily but untreated after the age of 10 - 15 years.Great improvement in intellectual and social ability was seen in a boy with phenylketonuria although the dietary treatment was not introduced until the age of eight years.Heavy irradiation of a fetus late in gestation caused mental retardation, microcephaly, stunted growth, and eye and teeth abnormalities, although such abnormalities are thought not to result from irradiation after 20 weeks of pregnancy. / <p>Endast s.1-71: sammanfattningen (kappan) i fulltexten.</p><p>Ej med i fulltexten s.72-145: 7 delar.</p> / digitalisering@umu