Difficult to defeat obesity: An 8D approach.

This clinical practice aid describes an 8D approach to the evaluation of difficult-to-treat (or difficult to- defeat) obesity. It assesses various causes of resistance or refractoriness to weight loss strategies under two domains: Approach and Analysis (evaluation), as well as Management and Monitoring. Lack of meaningful Dialogue, incorrect Definition of Desired endpoints; missed Diagnosis of secondary obesity or characterization of Disease comorbidity/ Dysfunction; lack of Discipline, inappropriate Drug choice, dosage or administration; and Defective monitoring strategies or presence of "Dead weight" These causes, presented in a reader-friendly, pragmatic manner, make the concept relevant and useful for the obesity care provider.