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{{short description|Methods of body fat reduction}} |
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The main treatment for [[obesity]] consists of [[dieting]] and [[physical exercise]].<ref name=CADG2006>{{cite journal |author=Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E |title=2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary] |journal=CMAJ |volume=176 |issue=8 |pages=S1–13 |date=April 2007 |pmid=17420481 |pmc=1839777 |doi=10.1503/cmaj.061409 |url=|last2=Douketis |last3=Morrison |last4=Hramiak |last5=Sharma |last6=Ur |author7=Obesity Canada Clinical Practice Guidelines Expert Panel }}</ref> Diet programs may produce [[weight loss]] over the short term,<ref name=Strychar>{{cite journal |author=Strychar I |title=Diet in the management of weight loss |journal=CMAJ |volume=174 |issue=1 |pages=56–63 |date=January 2006 |pmid=16389240 |pmc=1319349 |doi=10.1503/cmaj.045037 |url=http://www.cmaj.ca/cgi/content/full/174/1/56}}</ref> but maintaining this weight loss is frequently difficult and often requires making exercise and a lower calorie diet a permanent part of an individual's lifestyle.<ref>{{cite journal |author=Shick SM, Wing RR, Klem ML, McGuire MT, Hill JO, Seagle H |title=Persons successful at long-term weight loss and maintenance continue to consume a low-energy, low-fat diet |journal=J Am Diet Assoc |volume=98 |issue=4 |pages=408–13 |date=April 1998 |pmid=9550162 |doi=10.1016/S0002-8223(98)00093-5|last2=Wing |last3=Klem |last4=McGuire |last5=Hill |last6=Seagle }}</ref><ref>{{cite journal |author=Tate DF, Jeffery RW, Sherwood NE, Wing RR |title=Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain? |journal=Am. J. Clin. Nutr. |volume=85 |issue=4 |pages=954–9 |date=1 April 2007|pmid=17413092 |url=http://www.ajcn.org/cgi/content/full/85/4/954 |last2=Jeffery |last3=Sherwood |last4=Wing }}</ref> Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2 to 20%.<ref>{{cite journal |author= Wing, Rena R; Phelan, Suzanne|title=Science-Based Solutions to Obesity: What are the Roles of Academia, Government, Industry, and Health Care? Proceedings of a symposium, Boston, Massachusetts, USA, 10–11 March 2004 and Anaheim, California, USA, 2 October 2004 |journal=Am. J. Clin. Nutr. |volume=82 |issue=1 Suppl |pages=207S–273S |date=1 July 2005|pmid=16002825 |url=http://www.ajcn.org/cgi/content/full/82/1/222S }}</ref> Dietary and lifestyle changes are effective in limiting excessive weight gain in [[pregnancy]] and improve outcomes for both the mother and the child.<ref>{{cite journal|last=Thangaratinam|first=S|author2=Rogozinska, E |author3=Jolly, K |author4=Glinkowski, S |author5=Roseboom, T |author6=Tomlinson, JW |author7=Kunz, R |author8=Mol, BW |author9=Coomarasamy, A |author10= Khan, KS |title=Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence.|journal=BMJ (Clinical research ed.)|date=May 16, 2012|volume=344|pages=e2088|pmid=22596383|pmc=3355191|doi=10.1136/bmj.e2088}}</ref> |
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{{Human body weight}} |
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'''Management of obesity''' can include lifestyle changes, medications, or surgery. Although many studies have sought effective interventions, there is currently no evidence-based, well-defined, and efficient intervention to prevent obesity.<ref>{{cite journal | vauthors = Chiolero A | title = Why causality, and not prediction, should guide obesity prevention policy | journal = The Lancet. Public Health | volume = 3 | issue = 10 | pages = e461–e462 | date = October 2018 | pmid = 30177480 | doi = 10.1016/S2468-2667(18)30158-0 | doi-access = free }}</ref> |
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Treatment for [[obesity]] often consists of [[weight loss]] via [[Healthy diet|healthy nutrition]] and increasing [[physical exercise]].<ref name="USDietaryGuidelines2015">{{cite web |author1=US Department of Health and Human Services. |title=2015–2020 Dietary Guidelines for Americans - health.gov |url=https://health.gov/dietaryguidelines/2015/ |website=health.gov |publisher=Skyhorse Publishing Inc. |access-date=30 September 2019 |date=2017}}</ref><ref name="AACAHA2019">{{cite journal | vauthors = Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B | display-authors = 6 | title = 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines | journal = Circulation | volume = 140 | issue = 11 | pages = e596–e646 | date = September 2019 | pmid = 30879355 | pmc = 7734661 | doi = 10.1161/CIR.0000000000000678 | doi-access = free | author-link3 = Michelle Albert }}</ref><ref name="USGuidelines2013">{{cite journal | vauthors = Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC, Tomaselli GF | display-authors = 6 | title = 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society | journal = Circulation | volume = 129 | issue = 25 Suppl 2 | pages = S102–S138 | date = June 2014 | pmid = 24222017 | pmc = 5819889 | doi = 10.1161/01.cir.0000437739.71477.ee }}</ref><ref name=CADG2006>{{cite journal | vauthors = Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E | title = 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary] | journal = CMAJ | volume = 176 | issue = 8 | pages = S1-13 | date = April 2007 | pmid = 17420481 | pmc = 1839777 | doi = 10.1503/cmaj.061409 | author7 = Obesity Canada Clinical Practice Guidelines Expert Panel }}</ref> |
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One medication, [[orlistat]] (Alli; Xenixal), is current widely available and approved for long term use. Weight loss however is modest with an average of 2.9 kg (6.4 lb) at 1 to 4 years and there is little information on how these drugs affect longer-term complications of obesity.<ref name=Orli07>{{cite journal |author=Rucker D, Padwal R, Li SK, Curioni C, Lau DC |title=Long term pharmacotherapy for obesity and overweight: Updated meta-analysis |journal=BMJ |volume=335 |issue=7631 |pages=1194–99 |year=2007 |pmid=18006966 |doi=10.1136/bmj.39385.413113.25 |url=http://www.bmj.com/cgi/content/full/335/7631/1194 |pmc=2128668|last2=Padwal |last3=Li |last4=Curioni |last5=Lau }}</ref> Its use is associated with high rates of gastrointestinal side effects.<ref name=Orli07/> |
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A 2007 review concluded that certain subgroups, such as those with [[type 2 diabetes]] and women who undergo weight loss, show long-term benefits in all-cause mortality, while long‐term outcomes for men are "not clear and need further investigation."<ref>{{cite journal | vauthors = Poobalan AS, Aucott LS, Smith WC, Avenell A, Jung R, Broom J | title = Long-term weight loss effects on all cause mortality in overweight/obese populations | journal = Obesity Reviews | volume = 8 | issue = 6 | pages = 503–513 | date = November 2007 | pmid = 17949355 | doi = 10.1111/j.1467-789X.2007.00393.x | s2cid = 42859237 }}</ref> |
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The most effective treatment for obesity is [[bariatric surgery]].<ref>{{cite journal| |
The most effective treatment for obesity is [[bariatric surgery]].<ref>{{cite journal | vauthors = Colquitt JL, Pickett K, Loveman E, Frampton GK | title = Surgery for weight loss in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 8 | pages = CD003641 | date = August 2014 | pmid = 25105982 | pmc = 9028049 | doi = 10.1002/14651858.CD003641.pub4 }}</ref> Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.<ref name="Sjöström L, Narbro K, Sjöström CD, et al. 2007 741–52">{{cite journal | vauthors = Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Agren G, Carlsson LM | display-authors = 6 | title = Effects of bariatric surgery on mortality in Swedish obese subjects | journal = The New England Journal of Medicine | volume = 357 | issue = 8 | pages = 741–752 | date = August 2007 | pmid = 17715408 | doi = 10.1056/NEJMoa066254 | s2cid = 20533869 | doi-access = free }}</ref> Another study also found reduced mortality in those who underwent bariatric surgery for severe obesity.<ref>{{cite journal | vauthors = Peeters A, O'Brien PE, Laurie C, Anderson M, Wolfe R, Flum D, MacInnis RJ, English DR, Dixon J | display-authors = 6 | title = Substantial intentional weight loss and mortality in the severely obese | journal = Annals of Surgery | volume = 246 | issue = 6 | pages = 1028–1033 | date = December 2007 | pmid = 18043106 | doi = 10.1097/SLA.0b013e31814a6929 | s2cid = 21151854 }}</ref> |
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In June 2021, the US Food and Drug Administration (FDA) approved [[semaglutide]] injection sold under the brand name Wegovy for long-term weight management in adults. It is associated with a loss of 6-12% body weight along with mild gastrointestinal side effects.<ref>{{Cite web | author = Office of the Commissioner |date=2021-06-21 |title=FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014 |url=https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014 |access-date=2022-07-21 |website=FDA |language=en}}</ref><ref>{{cite journal | vauthors = Wilding JP, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MT, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF | display-authors = 6 | title = Once-Weekly Semaglutide in Adults with Overweight or Obesity | journal = The New England Journal of Medicine | volume = 384 | issue = 11 | pages = 989–1002 | date = March 2021 | pmid = 33567185 | doi = 10.1056/NEJMoa2032183 | s2cid = 231883214 | doi-access = free }}</ref> |
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A 2007 review concluded that certain subgroups such as those with type 2 diabetes and women show long term benefits in all cause mortality, while outcomes for men do not seem to be improved with weight loss.<ref>{{cite journal |author=Poobalan AS, Aucott LS, Smith WC, Avenell A, Jung R, Broom J |title=Long-term weight loss effects on all cause mortality in overweight/obese populations |journal=Obes Rev |volume=8 |issue=6 |pages=503–13 |date=November 2007 |pmid=17949355 |doi=10.1111/j.1467-789X.2007.00393.x |url=|last2=Aucott |last3=Smith |last4=Avenell |last5=Jung |last6=Broom }}</ref> A subsequent study found benefits in mortality from intentional weight loss in those who have severe obesity.<ref>{{cite journal |author=Peeters A |title=Substantial intentional weight loss and mortality in the severely obese |journal=Ann. Surg. |volume=246 |issue=6 |pages=1028–33 |date=December 2007 |pmid=18043106 |doi=10.1097/SLA.0b013e31814a6929 |url=|author-separator=, |author2= O'Brien PE |author3= Laurie C |author4=and others |displayauthors=3 }}</ref> |
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Another medication, [[orlistat]], is widely available and approved for long-term use. Its use produces modest weight loss, with an average of {{convert|2.9|kg|lb|abbr=on}} at 1 to 4 years, but there is little information on how these medications affect longer-term complications of obesity.<ref name="Thom2017" /><ref name="Orli07">{{cite journal | vauthors = Rucker D, Padwal R, Li SK, Curioni C, Lau DC | title = Long term pharmacotherapy for obesity and overweight: updated meta-analysis | journal = BMJ | volume = 335 | issue = 7631 | pages = 1194–1199 | date = December 2007 | pmid = 18006966 | pmc = 2128668 | doi = 10.1136/bmj.39385.413113.25 }}</ref>{{update inline|date=July 2022}} Its use is associated with high rates of gastrointestinal side effects.<ref name="Orli07" /> |
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[[Dieting|Diet programs]] can produce short-term weight loss and, to a lesser extent, over the long-term. Greater weight loss results, including amongst [[Race and health in the United States|underserved populations]], are achieved when proper nutrition is regularly combined with physical exercise and counseling.<ref name="USGuidelines2013" /><ref name="Thom2017" /><ref name="Wing2005" /><ref name="Anderson2001" /><ref>{{cite journal | vauthors = Katzmarzyk PT, Martin CK, Newton RL, Apolzan JW, Arnold CL, Davis TC, Price-Haywood EG, Denstel KD, Mire EF, Thethi TK, Brantley PJ, Johnson WD, Fonseca V, Gugel J, Kennedy KB, Lavie CJ, Sarpong DF, Springgate B | display-authors = 6 | title = Weight Loss in Underserved Patients - A Cluster-Randomized Trial | journal = The New England Journal of Medicine | volume = 383 | issue = 10 | pages = 909–918 | date = September 2020 | pmid = 32877581 | pmc = 7493523 | doi = 10.1056/NEJMoa2007448 }}</ref> Dietary and lifestyle changes are effective in limiting excessive weight gain in [[pregnancy]] and improve outcomes for both the mother and the child.<ref>{{cite journal | vauthors = Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS | display-authors = 6 | title = Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence | journal = BMJ | volume = 344 | pages = e2088 | date = May 2012 | pmid = 22596383 | pmc = 3355191 | doi = 10.1136/bmj.e2088 }}</ref> |
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== Dieting == |
== Dieting == |
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{{Main|Dieting}} |
{{Main|Dieting}} |
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<!-- Clinical guidelines summary table (from NHLBI) --> |
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Diets to promote weight loss are generally divided into four categories: [[low-fat diet|low-fat]], [[low-carbohydrate diet|low-carbohydrate]], low-calorie, and [[very low calorie diet|very low calorie]].<ref name=Strychar/> A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram (4.4–8.8 lb) weight loss in all studies.<ref name=Strychar/> At two years these three methods resulted in similar weight loss irrespective of the [[macronutrients]] emphasized.<ref>{{cite journal |author=Sacks FM |title=Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates |journal=N. Engl. J. Med. |volume=360 |issue=9 |pages=859–73 |date=February 2009 |pmid=19246357 |doi=10.1056/NEJMoa0804748 |url= |pmc=2763382|author-separator=, |author2= Bray GA |author3= Carey VJ |author4=and others |displayauthors=3 }}</ref> High protein diets do not appear to make any difference.<ref>{{cite journal|last1=Schwingshackl|first1=L|last2=Hoffmann|first2=G|title=Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis|journal=Nutrition journal|date=Apr 15, 2013|volume=12|pages=48|pmid=23587198|pmc=3636027|doi=10.1186/1475-2891-12-48}}</ref> A diet high in simple sugars such as those in soft drinks increases weight.<ref>{{cite journal|last1=Te Morenga|first1=L|last2=Mallard|first2=S|last3=Mann|first3=J|title=Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies.|journal=BMJ (Clinical research ed.)|date=Jan 15, 2012|volume=346|pages=e7492|pmid=23321486|doi=10.1136/bmj.e7492}}</ref> |
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{| class="wikitable floatright" style="text-align: center; font-size: 86%;" |
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|+Treatment selection based on BMI<ref>{{cite journal | vauthors = Matarese LE, Pories WJ | title = Adult weight loss diets: metabolic effects and outcomes | journal = Nutrition in Clinical Practice | volume = 29 | issue = 6 | pages = 759–767 | date = December 2014 | pmid = 25293593 | doi = 10.1177/0884533614550251 | type = Review }}</ref><ref>{{Cite book|url=https://archive.org/details/practicalguideid00nort|title=The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults|date=2000|publisher=National Institutes of Health, National Heart, Lung, and Blood Institute, NHLBI Obesity Education Initiative, North American Association for the Study of Obesity|language=en|type=National guidelines}}</ref> |
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!Treatment |
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!25-26.9 |
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!27-29.9 |
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!30-34.9 |
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!35-39.9 |
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!≥40 |
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|- |
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!Lifestyle intervention<br />(diet, physical activity,<br />behavior) |
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|Yes |
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|Yes |
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|Yes |
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|Yes |
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|Yes |
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|- |
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!Pharmacotherapy |
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|Not appropriate |
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|With co-morbidities |
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|Yes |
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|Yes |
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|Yes |
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|- |
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!Surgery |
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|Not appropriate |
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|Not appropriate |
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|Not appropriate |
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|With co-morbidities |
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|Yes |
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|} |
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Diets to promote weight loss can be divided into four categories: [[low-fat diet|low-fat]], [[low-carbohydrate diet|low-carbohydrate]], low-calorie, and [[very low calorie diet|very low calorie]].<ref name=Strychar>{{cite journal | vauthors = Strychar I | title = Diet in the management of weight loss | journal = CMAJ | volume = 174 | issue = 1 | pages = 56–63 | date = January 2006 | pmid = 16389240 | pmc = 1319349 | doi = 10.1503/cmaj.045037 }}</ref>{{better source needed|date=February 2022|reason=this is one study that categorized studies in this way, which does not necessarily mean that diets are generally categorized in this way}} Many dietary patterns are effective.<ref name="USGuidelines2013" /> A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate and low fat), with a {{convert|2|–|4|kg|lb}} weight loss in all studies.<ref name=Strychar/> At two years these three methods resulted in similar weight loss irrespective of the [[macronutrients]] emphasized.<ref>{{cite journal | vauthors = Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA | display-authors = 6 | title = Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates | journal = The New England Journal of Medicine | volume = 360 | issue = 9 | pages = 859–873 | date = February 2009 | pmid = 19246357 | pmc = 2763382 | doi = 10.1056/NEJMoa0804748 }}</ref> High protein diets do not appear to make any difference.<ref>{{cite journal | vauthors = Schwingshackl L, Hoffmann G | title = Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis | journal = Nutrition Journal | volume = 12 | pages = 48 | date = April 2013 | pmid = 23587198 | pmc = 3636027 | doi = 10.1186/1475-2891-12-48 | doi-access = free }}</ref> A diet high in added sugars such as those in soft drinks increases weight.<ref>{{cite journal | vauthors = Te Morenga L, Mallard S, Mann J | title = Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies | journal = BMJ | volume = 346 | pages = e7492 | date = January 2012 | pmid = 23321486 | doi = 10.1136/bmj.e7492 | doi-access = free | hdl = 20.500.12799/4871 | hdl-access = free }}</ref> There is evidence that dieting alone can be effective for weight loss and improving health for obese individuals.<ref name="USGuidelines2013" /><ref name="Thom2017">{{cite journal | vauthors = Thom G, Lean M | title = Is There an Optimal Diet for Weight Management and Metabolic Health? | journal = Gastroenterology | volume = 152 | issue = 7 | pages = 1739–1751 | date = May 2017 | pmid = 28214525 | doi = 10.1053/j.gastro.2017.01.056 | url = http://eprints.gla.ac.uk/137779/7/137779.pdf | type = Review }}</ref> However, a large study of adults found that obesity was associated with differences in brain structure, largely due to shared genetic factors, suggesting that interventions for obesity should not focus solely on energy content, but also take into account the neurobehavioral profile that obesity is genetically associated with.<ref name="Vainik Baker Dadar Zeighami 2018 pp. 9312–9317">{{cite journal | vauthors = Vainik U, Baker TE, Dadar M, Zeighami Y, Michaud A, Zhang Y, García Alanis JC, Misic B, Collins DL, Dagher A | display-authors = 6 | title = Neurobehavioral correlates of obesity are largely heritable | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 115 | issue = 37 | pages = 9312–9317 | date = September 2018 | pmid = 30154161 | pmc = 6140494 | doi = 10.1073/pnas.1718206115 | doi-access = free | bibcode = 2018PNAS..115.9312V }}</ref> |
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Dieting for [[calorie restriction]] is advised for overweight individuals by the [[Dietary Guidelines for Americans]] and United Kingdom's [[National Institute for Health and Care Excellence|NICE]].<ref name="USDietaryGuidelines2015" /><ref name="AACAHA2019" /><ref name="USGuidelines2013" /><ref name="NICE2019-obesity">{{cite web |title=Obesity: maintaining a healthy weight and preventing excess weight gain |url=https://pathways.nice.org.uk/pathways/obesity/obesity-maintaining-a-healthy-weight-and-preventing-excess-weight-gain#content=view-node%3Anodes-diet |website=pathways.nice.org.uk| date=8 March 2023 }}</ref> |
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Very low calorie diets provide 200–800 kcal/day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to [[starvation]] and produce an average weekly weight loss of 1.5–2.5 kilograms (3.3–5.5 lb). These diets are not recommended for general use as they are associated with [[Adverse effect (medicine)|adverse side effect]]s such as loss of lean muscle mass, increased risks of [[gout]], and [[electrolyte imbalance]]s. People attempting these diets must be monitored closely by a physician to prevent complications.<ref name=Strychar/> |
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== Exercise == |
== Exercise == |
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{{See also|Physical exercise}} |
{{See also|Physical exercise}} |
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With use, muscles consume energy derived from both fat and [[glycogen]]. Due to the large size of leg muscles, walking, running |
With use, muscles consume energy derived from both fat and [[glycogen]]. Due to the large size of leg muscles, walking, running and cycling are the most effective means of exercise to reduce body fat.<ref>{{cite journal | vauthors = Gwinup G | title = Weight loss without dietary restriction: efficacy of different forms of aerobic exercise | journal = The American Journal of Sports Medicine | volume = 15 | issue = 3 | pages = 275–279 | year = 1987 | pmid = 3618879 | doi = 10.1177/036354658701500317 | s2cid = 1973279 }}</ref> Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel.<ref>{{cite journal | vauthors = Sahlin K, Sallstedt EK, Bishop D, Tonkonogi M | title = Turning down lipid oxidation during heavy exercise--what is the mechanism? | journal = Journal of Physiology and Pharmacology | volume = 59 | issue = Suppl 7 | pages = 19–30 | date = December 2008 | pmid = 19258655 }}</ref><ref>{{cite journal | vauthors = Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A | display-authors = 6 | title = Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association | journal = Circulation | volume = 116 | issue = 9 | pages = 1081–1093 | date = August 2007 | pmid = 17671237 | doi = 10.1161/CIRCULATIONAHA.107.185649 | doi-access = free }}</ref> To maintain health, the [[American Heart Association]] recommends a minimum of 30 minutes of moderate exercise at least 5 days a week. |
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The [[Cochrane Collaboration]] found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1 kilogram weight loss over dieting alone. A 1.5 |
The [[Cochrane Collaboration]] found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1 kilogram weight loss over dieting alone. A {{convert|1.5|kg|lb|abbr=off}} loss was observed with a greater degree of exercise.<ref name="pmid17054187">{{cite journal | vauthors = Shaw K, Gennat H, O'Rourke P, Del Mar C | title = Exercise for overweight or obesity | journal = The Cochrane Database of Systematic Reviews | volume = 2006 | issue = 4 | pages = CD003817 | date = October 2006 | pmid = 17054187 | pmc = 9017288 | doi = 10.1002/14651858.CD003817.pub3 }}</ref> Even though exercise as carried out in the general population has only modest effects, a [[Dose-response relationship|dose response curve]] is found and very intense exercise can lead to substantial weight loss. During 20 weeks of basic military training with no dietary restriction, obese military recruits lost {{convert|12.5|kg|lb|abbr=on}}.<ref>{{cite journal | vauthors = Lee L, Kumar S, Leong LC | title = The impact of five-month basic military training on the body weight and body fat of 197 moderately to severely obese Singaporean males aged 17 to 19 years | journal = International Journal of Obesity and Related Metabolic Disorders | volume = 18 | issue = 2 | pages = 105–109 | date = February 1994 | pmid = 8148923 }}</ref> High levels of physical activity seem to be necessary to maintain weight loss.<ref name=Ben2008>{{cite journal | vauthors = Bessesen DH | title = Update on obesity | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 93 | issue = 6 | pages = 2027–2034 | date = June 2008 | pmid = 18539769 | doi = 10.1210/jc.2008-0520 | doi-access = free }}</ref> A [[pedometer]] appears useful for motivation. Over an average of 18-weeks of use, physical activity increased by 27% resulting in a 0.38 decrease in BMI.<ref>{{cite journal | vauthors = Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR | display-authors = 6 | title = Using pedometers to increase physical activity and improve health: a systematic review | journal = JAMA | volume = 298 | issue = 19 | pages = 2296–2304 | date = November 2007 | pmid = 18029834 | doi = 10.1001/jama.298.19.2296 | s2cid = 3008531 }}</ref> |
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Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population.<ref>{{cite journal | |
Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population.<ref>{{cite journal | vauthors = Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW, Corso P | display-authors = 6 | title = The effectiveness of interventions to increase physical activity. A systematic review | journal = American Journal of Preventive Medicine | volume = 22 | issue = 4 Suppl | pages = 73–107 | date = May 2002 | pmid = 11985936 | doi = 10.1016/S0749-3797(02)00434-8 }}</ref> The city of [[Bogota]], [[Colombia]], for example, blocks off {{convert|113|km|mi|sp=us}} of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These [[pedestrian zone]]s are part of an effort to combat chronic diseases, including obesity.<ref>{{cite web|url=http://www.paho.org/English/DD/PIN/ePersp001_article01.htm |title=www.paho.org |work=Pan American Health Organization |access-date=January 10, 2009}}</ref> |
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In an effort to combat the issue, a primary school in Australia instituted a standing classroom in 2013.<ref>{{cite news| url=http://timesofindia.indiatimes.com/world/rest-of-world/Worlds-first-standing-classroom-launched-in-Australia/articleshow/27909324.cms | work=The Times Of India | title=World's first standing classroom launched in Australia - The Times of India}}</ref> |
In an effort to combat the issue, a primary school in Australia instituted a standing classroom in 2013.<ref>{{cite news| url=http://timesofindia.indiatimes.com/world/rest-of-world/Worlds-first-standing-classroom-launched-in-Australia/articleshow/27909324.cms | work=The Times Of India | title=World's first standing classroom launched in Australia - The Times of India}}</ref> |
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There is evidence that exercise alone is not sufficient to produce meaningful weight loss, but combining dieting and exercise provide the greatest health benefits and weight loss on the long term.<ref name="USGuidelines2013" /><ref name="Thom2017" /> |
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==Weight loss programs== |
==Weight loss programs== |
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Weight loss programs |
Weight loss programs involve lifestyle changes including diet modifications, physical activity and behavior therapy. This may involve eating [[portion size|smaller meals]], cutting down on certain types of food and making a conscious effort to exercise more. These programs also enable people to connect with a group of others who are attempting to lose weight, in the hopes that participants will form mutually motivating and encouraging relationships.<ref>{{cite journal | vauthors = Baron M | title = Commercial weight-loss programs | journal = Health Care Food & Nutrition Focus | volume = 21 | issue = 11 | pages = 8–9 | date = November 2004 | pmid = 15559885 | url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1090-2260&volume=21&issue=11&spage=8 }}</ref> Since 2013, the United States guidelines recommend treating obesity as a disease and actively treat obese people for weight loss.<ref name="USGuidelines2013" /> |
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A number of popular programs exist |
A number of popular programs exist including [[WW International|Weight Watchers]], [[Overeaters Anonymous]] and [[Jenny Craig, Inc.|Jenny Craig]]. These appear to provide modest weight loss ({{convert|2.9|kg|lb|abbr=on|disp=semicolon}}) over dieting on one's own ({{convert|0.2|kg|lb|abbr=on|disp=semicolon}}) over a two-year period,<ref name="Thom2017" /><ref>{{cite journal | vauthors = Heshka S, Anderson JW, Atkinson RL, Greenway FL, Hill JO, Phinney SD, Kolotkin RL, Miller-Kovach K, Pi-Sunyer FX | display-authors = 6 | title = Weight loss with self-help compared with a structured commercial program: a randomized trial | journal = JAMA | volume = 289 | issue = 14 | pages = 1792–1798 | date = April 2003 | pmid = 12684357 | doi = 10.1001/jama.289.14.1792 | doi-access = }}</ref><ref name="Atallah2014">{{cite journal | vauthors = Atallah R, Filion KB, Wakil SM, Genest J, Joseph L, Poirier P, Rinfret S, Schiffrin EL, Eisenberg MJ | display-authors = 6 | title = Long-term effects of 4 popular diets on weight loss and cardiovascular risk factors: a systematic review of randomized controlled trials | journal = Circulation: Cardiovascular Quality and Outcomes | volume = 7 | issue = 6 | pages = 815–827 | date = November 2014 | pmid = 25387778 | doi = 10.1161/CIRCOUTCOMES.113.000723 | type = Systematic review of RCTs | doi-access = }}</ref><ref>{{cite journal | vauthors = Vakil RM, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Lee CJ, Bleich SN, Clark JM, Gudzune KA | display-authors = 6 | title = Direct comparisons of commercial weight-loss programs on weight, waist circumference, and blood pressure: a systematic review | journal = BMC Public Health | volume = 16 | pages = 460 | date = June 2016 | pmid = 27246464 | pmc = 4888663 | doi = 10.1186/s12889-016-3112-z | type = Systematic review | doi-access = free }}</ref><ref>{{cite journal | vauthors = Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, Lee CJ, Bleich SN, Clark JM | display-authors = 6 | title = Efficacy of commercial weight-loss programs: an updated systematic review | journal = Annals of Internal Medicine | volume = 162 | issue = 7 | pages = 501–512 | date = April 2015 | pmid = 25844997 | pmc = 4446719 | doi = 10.7326/M14-2238 | type = Systematic review }}</ref> similarly to non-commercial diets.<ref name="USGuidelines2013" /><ref name="Thom2017" /> As of 2005, there was insufficient scientific evidence to determine whether Internet-based programs produce effective weight loss.<ref>{{cite journal | vauthors = Tsai AG, Wadden TA | title = Systematic review: an evaluation of major commercial weight loss programs in the United States | journal = Annals of Internal Medicine | volume = 142 | issue = 1 | pages = 56–66 | date = January 2005 | pmid = 15630109 | doi = 10.7326/0003-4819-142-1-200501040-00012 | s2cid = 2589699 }}</ref> |
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The [[Government of the People's Republic of China|Chinese government]] has introduced a number of "fat farms" where obese children go for reinforced exercise |
The [[Government of the People's Republic of China|Chinese government]] has introduced a number of "fat farms" where obese children go for reinforced exercise and has passed a law which requires students to exercise or play sports for an hour a day at school (see [[Obesity in China]]).<ref name="BBC">{{cite news| vauthors = Hewitt D |url=http://news.bbc.co.uk/2/hi/health/760787.stm|title=China battles obesity|publisher=[[BBC]]|date=May 23, 2000|access-date=August 8, 2009}}</ref><ref name="USA Today">{{cite news| vauthors = MacLeod C |url=https://www.usatoday.com/news/world/2007-01-08-chinese-obesity_x.htm|title=Obesity of China's kids stuns officials|work=[[USA Today]]|date=August 1, 2007|access-date=August 8, 2009}}</ref> |
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In a structured setting, 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later.<ref>{{cite journal | |
In a structured setting with a trained therapist, these interventions produce an average weight loss of up to 8 kg in 6 months to 1 year,<ref name="USGuidelines2013" /> and 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later.<ref>{{cite journal | vauthors = Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK | title = Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002 | journal = American Journal of Preventive Medicine | volume = 33 | issue = 1 | pages = 34–40 | date = July 2007 | pmid = 17572309 | doi = 10.1016/j.amepre.2007.02.040 | url = https://zenodo.org/record/1258706 }}</ref> There is a gradual weight regain after the first year of about 1 to 2 kg per year, but on the long-term this still results in weight loss.<ref name="USGuidelines2013" /> Risk factors for cardiovascular disease and for diabetes are reduced for several years after taking part in a weight management programme, even if people regained weight.<ref>{{Cite web |last=Fischer |first=Kathrin |date=2023-09-25 |title=Weight regain does not eliminate the benefits of weight management programmes |url=https://evidence.nihr.ac.uk/alert/weight-regain-does-not-eliminate-the-long-term-benefits-of-weight-management-programmes/ |access-date=2023-09-25 |website=NIHR Evidence |language=en-GB}}</ref><ref>{{Cite journal |last=Hartmann-Boyce |first=Jamie |last2=Theodoulou |first2=Annika |last3=Oke |first3=Jason L. |last4=Butler |first4=Ailsa R. |last5=Bastounis |first5=Anastasios |last6=Dunnigan |first6=Anna |last7=Byadya |first7=Rimu |last8=Cobiac |first8=Linda J. |last9=Scarborough |first9=Peter |last10=Hobbs |first10=F.D. Richard |last11=Sniehotta |first11=Falko F. |last12=Jebb |first12=Susan A. |last13=Aveyard |first13=Paul |date=April 2023 |title=Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis |url=https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.009348 |journal=Circulation: Cardiovascular Quality and Outcomes |language=en |volume=16 |issue=4 |doi=10.1161/CIRCOUTCOMES.122.009348 |issn=1941-7713 |pmc=10106109 |pmid=36974678}}</ref> |
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Attending group meetings for [[Weight loss|weight reduction]] programmes rather than receiving one-on-one support may increase the likelihood that obese people will lose weight. Those who participated in groups had more treatment time and were more likely to lose enough weight to improve their health. Study authors suggested that one explanation for the difference is that group participants spent more time with the clinician (or whoever delivered the programme) than those receiving one-on-one support.<ref>{{Cite journal |date=2021-08-27 |title=Group programmes for weight loss may be more effective than one-to-one sessions |url=https://evidence.nihr.ac.uk/alert/group-weight-loss-programmes-more-effective-than-one-to-one-sessions/ |journal=NIHR Evidence |type=Plain English summary |language=en |doi=10.3310/alert_47460|s2cid=241732368 }}</ref><ref>{{cite journal | vauthors = Abbott S, Smith E, Tighe B, Lycett D | title = Group versus one-to-one multi-component lifestyle interventions for weight management: a systematic review and meta-analysis of randomised controlled trials | journal = Journal of Human Nutrition and Dietetics | volume = 34 | issue = 3 | pages = 485–493 | date = June 2021 | pmid = 33368624 | doi = 10.1111/jhn.12853 | s2cid = 229691531 | url = https://eprints.mdx.ac.uk/33369/1/JHND_Manuscript.pdf }}</ref> |
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==Medication== |
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{{Main|Anti-obesity medication}} |
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[[File:Obesity Med2008.JPG|thumb|alt=The cardboard packaging of two medications used to treat obesity. Orlistat is shown above under the brand name Xenical in a white package with Roche branding. Sibutramine is below under the brand name Meridia. Orlistat is also available as Alli in the United Kingdom. The A of the Abbott Laboratories logo is on the bottom half of the package.|right|[[Orlistat]] (Xenical) the most commonly used medication to treat obesity and [[sibutramine]] (Meridia) a withdrawn medication due to cardiovascular side effects]] |
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Comprehensive diet programs, providing counseling, targets for calorie intake and exercise, may be more efficient than dieting without guidance ("self-help"),<ref name="Thom2017" /><ref>{{cite journal | vauthors = Kernan WN, Inzucchi SE, Sawan C, Macko RF, Furie KL | title = Obesity: a stubbornly obvious target for stroke prevention | journal = Stroke | volume = 44 | issue = 1 | pages = 278–286 | date = January 2013 | pmid = 23111440 | doi = 10.1161/STROKEAHA.111.639922 | type = Review | doi-access = free }}</ref><ref name=Gud2015>{{cite journal | vauthors = Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, Lee CJ, Bleich SN, Clark JM | display-authors = 6 | title = Efficacy of commercial weight-loss programs: an updated systematic review | journal = Annals of Internal Medicine | volume = 162 | issue = 7 | pages = 501–512 | date = April 2015 | pmid = 25844997 | pmc = 4446719 | doi = 10.7326/M14-2238 }}</ref> although the evidence is very limited.<ref name="Allan2018">{{cite book | vauthors = Allan K | veditors = Hankey C |title=Advanced nutrition and dietetics in obesity |date=2018 |publisher=Wiley |isbn=9780470670767 |pages=164–168 |language=en |chapter=4.4 Group‐based interventions for weight loss in obesity.}}</ref> Following comprehensive lifestyle modifications, the average maintained weight loss is more than {{convert|3|kg|lb|abbr=on}} or 3% of total body mass, and could be sustained for five years,<ref name="Anderson2001">{{cite journal | vauthors = Anderson JW, Konz EC, Frederich RC, Wood CL | title = Long-term weight-loss maintenance: a meta-analysis of US studies | journal = The American Journal of Clinical Nutrition | volume = 74 | issue = 5 | pages = 579–584 | date = November 2001 | pmid = 11684524 | doi = 10.1093/ajcn/74.5.579 | type = Meta-analysis | doi-access = free }}</ref> and up to 20% of the individuals maintain a weight loss of at least 10% (average of 33 kg).<ref name="Wing2005">{{cite journal | vauthors = Wing RR, Phelan S | title = Long-term weight loss maintenance | journal = The American Journal of Clinical Nutrition | volume = 82 | issue = 1 Suppl | pages = 222S–225S | date = July 2005 | pmid = 16002825 | doi = 10.1093/ajcn/82.1.222S | doi-access = free }}</ref> There is some evidence that fast weight loss produce greater long-term weight loss than gradual weight loss.<ref name="Thom2017" /><ref name="Anderson2001" /> Moderate on-site comprehensive lifestyle changes produce a greater weight loss than usual care, of 2 to 4 kg on average in 6 to 12 months.<ref name="USGuidelines2013" /> High-intensity comprehensive programs usually yield more weight loss than moderate or low-intensity, with about 35% to 60% of overweight individuals maintaining more than 5 kg weight loss after 2 years.<ref name="USGuidelines2013" /> |
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Several anti-obesity medications are currently approved by the FDA for long term use.<ref name=FDA2012/><ref name=Meds2009>{{cite web |url=http://win.niddk.nih.gov/publications/prescription.htm#fdameds |title=WIN – Publication – Prescription Medications for the Treatment of Obesity |publisher=[[National Institutes of Health]]|work=National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) |accessdate=January 14, 2009}}</ref><ref name=Meridia2010>{{cite web |url=http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm |title=www.fda.gov |work= |accessdate=}}</ref> Orlistat reduces intestinal fat absorption by inhibiting pancreatic [[lipase]]. |
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The [[National Institute for Health and Care Excellence|NICE]] devised a set of essential criteria to be met by commercial weight management organizations to be approved.<ref name="Avery2018">{{cite book | vauthors = Avery A | veditors = Hankey C |title=Advanced nutrition and dietetics in obesity |date=2018 |publisher=Wiley |isbn=9780470670767 |pages=177–182 |language=en |chapter=4.7 Commercial weight management organisations for weight loss in obesity.}}</ref> |
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[[Lorcaserin]] has been found to be effective in the treatment of obesity with a weight loss of 5.8 kg at one year as opposed to 2.2 kg with placebo<ref name="Astrup-2010">{{Cite journal | last1 = Astrup | first1 = A. | title = Drug management of obesity--efficacy versus safety | url = http://content.nejm.org/cgi/content/short/363/3/288 | journal = N Engl J Med | volume = 363 | issue = 3 | pages = 288–90 |date=Jul 2010 | doi = 10.1056/NEJMe1004076 | pmid = 20647205 }}</ref><ref>{{cite journal|last=Bays|first=HE|title=Lorcaserin: drug profile and illustrative model of the regulatory challenges of weight-loss drug development.|journal=Expert review of cardiovascular therapy|date=March 2011|volume=9|issue=3|pages=265–77|pmid=21438803|doi=10.1586/erc.10.22}}</ref> and it is approved by the [[Food and Drug Administration]] for use in the treatment of obesity.<ref name="latimes">{{cite news | url = http://www.latimes.com/health/boostershots/la-heb-obesity-drug-approved-fda-20120627,0,7045690.story | title = FDA approves lorcaserin, first weight-loss drug OK'd since 1999 | publisher = ''Los Angeles Times'' | date = June 27, 2012 | first1=Melissa | last1=Healy | first2=/ | last2=For}}</ref> Side effects may include [[serotonin syndrome]].<ref name=FDA2012>{{cite web|title=FDA approves Belviq to treat some overweight or obese adults|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm309993.htm|work=FDA|accessdate=8 July 2012|date=June 27, 2012}}</ref> |
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The [[Transtheoretical model|Transtheoretical Model]] (TTM) has been used as a framework to assist the design of lifestyle modification programmes, including weight management. A systematic review found that there is insufficient evidence to draw conclusions regarding the effects of TTM-based programs targeting weight loss that included dietary or [[physical activity]] interventions, or both (and also combined with other interventions), on sustainable [[weight loss]] (one year or longer) in [[overweight]] and obese adults. However, very low quality evidence points that this approach may induce positive changes in physical activity and dietary habits, such as increased in [[exercise]] duration and frequency, improvement in fruits and vegetables consumption, and reduced dietary fat intake.<ref>{{cite journal | vauthors = Mastellos N, Gunn LH, Felix LM, Car J, Majeed A | title = Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 2 | pages = CD008066 | date = February 2014 | pmid = 24500864 | doi = 10.1002/14651858.CD008066.pub3 | pmc = 10088065 | collaboration = Cochrane Metabolic and Endocrine Disorders Group }}</ref> |
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The [[combination drug]] [[phentermine/topiramate]] (Qsymia) is approved by the FDA as an addition to a reduced-calorie diet and exercise for chronic weight management.<ref>{{Cite web | url = http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312468.htm | title = FDA approves weight-management drug Qsymia | publisher = [[Food and Drug Administration]] | date = July 17, 2012}}</ref> |
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==Medication== |
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[[Rimonabant]] (Acomplia), another drug, had been withdrawn from the market. It worked via a specific blockade of the [[endocannabinoid]] system. It has been developed from the knowledge that [[Cannabis (drug)|cannabis]] smokers often experience hunger, which is often referred to as "the munchies". It had been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to safety concerns.<ref>{{cite news |url=http://www.cbc.ca/news/technology/anti-obesity-drug-no-magic-bullet-1.674506 |title=Anti-obesity drug no magic bullet |accessdate=2008-09-19 |work=[[Canadian Broadcasting Corporation]]|publisher= |date=January 2, 2007 }}</ref><ref>{{cite web |url=http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4306b1-fda-backgrounder.pdf |format=PDF|title=FDA Briefing Document NDA 21-888 Zimulti (rimonabant) Tablets, 20 mg Sanofi Aventis Advisory Committee |accessdate=2008-09-19 |work= |publisher=[[Food and Drug Administration]] |date=June 13, 2007 }}</ref> [[European Medicines Agency]] in October 2008 recommended the suspension of the sale of rimonabant as the risk seem to be greater than the benefits.<ref>{{cite web |url=http://www.emea.europa.eu/humandocs/PDFs/EPAR/acomplia/53777708en.pdf |title=www.emea.europa.eu |format= |work= |accessdate=}}</ref> [[Sibutramine]] (Meridia), which acts in the brain to inhibit deactivation of the [[neurotransmitter]]s, thereby decreasing appetite was withdrawn from the UK market in January 2010 and United States and Canadian markets in October 2010 due to cardiovascular concerns.<ref name=Meridia2010/><ref>{{cite web |url=http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_169-eng.php |title=Abbott Laboratories Voluntarily Withdraws Weight-loss Drug Sibutramine (Meridia) from the Canadian Market - Health Canada Information Update 2010-10-08 |format= |work= |accessdate=}}</ref><ref>{{cite web |url=http://www.nice.org.uk/nicemedia/live/11000/30364/30364.pdf |title=www.nice.org.uk |format= |work= |accessdate=}}</ref> |
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{{Main|Anti-obesity medication}} |
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[[File:Obesity Med2008.JPG|thumb|alt=The cardboard packaging of two medications used to treat obesity. Orlistat is shown above under the brand name Xenical in a white package with Roche branding. Sibutramine is below under the brand name Meridia. Orlistat is also available as Alli in the United Kingdom. The A of the Abbott Laboratories logo is on the bottom half of the package.|right|[[Orlistat]] (Xenical), the most commonly used medication to treat obesity and [[sibutramine]] (Meridia), a withdrawn medication due to cardiovascular side effects]] |
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Weight loss with these drugs is modest. Over the longer term, average weight loss on orlistat is 2.9 kg (6.4 lb), sibutramine is 4.2 kg (9.3 lb) and rimonabant is 4.7 kg (10.4 lb). Orlistat and rimonabant lead to a reduced incidence of diabetes, and all three drugs have some effect on [[cholesterol]]. However, there is little information on how these drugs affect the longer-term complications or outcomes of obesity.<ref name="Orli07"/> In 2010 it was found that sibutramine increases the risk of [[heart attacks]] and [[strokes]] in people with a history of cardiovascular disease.<ref>{{cite web |url=http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm198221.htm |title=Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review |work= |accessdate=}}</ref><ref>{{cite journal |author=James WP |title=Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects |journal=N. Engl. J. Med. |volume=363 |issue=10 |pages=905–17 |date=September 2010 |pmid=20818901 |doi=10.1056/NEJMoa1003114 |url=|author-separator=, |author2= Caterson ID |author3= Coutinho W |author4=and others |displayauthors=3 }}</ref> |
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=== Anti-obesity medications currently approved by the FDA for weight loss === |
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There are a number of less commonly used medications. Some are only approved for short term use, others are used [[off-label]], and still others are used illegally. Most are appetite suppressants that act on one or more neurotransmitters.<ref>{{cite journal |author=Li Z |title=Meta-analysis: pharmacologic treatment of obesity |journal=Annals of Internal Medicine |volume=142 |issue=7 |pages=532–46 |date=April 2005 |pmid=15809465 |doi= 10.7326/0003-4819-142-7-200504050-00012|url=http://www.annals.org/cgi/content/full/142/7/532|author-separator=, |author2= Maglione M |author3= Tu W |author4=and others |displayauthors=3 }}</ref> [[Phendimetrazine]] (Bontril), [[diethylpropion]] (Tenuate), and [[phentermine]] (Adipex-P) are approved by the FDA for short term use, while [[bupropion]] (Wellbutrin), [[topiramate]] (Topamax), and [[zonisamide]] (Zonegran) are sometimes used off-label.<ref name=Meds2009/> [[Recombinant DNA|Recombinant]] human [[leptin]] is very effective in those with obesity due to congenital complete leptin deficiency via decreasing energy intake and possibly increases energy expenditure. This condition is, however, rare and this treatment is not effective for inducing weight loss in the majority of people with obesity. It is being investigated to determine whether or not it helps with weight loss maintenance.<ref>{{cite journal |author=Kelesidis T, Kelesidis I, Chou S, Mantzoros CS |title=Narrative review: the role of leptin in human physiology: emerging clinical applications |journal=Annals of Internal Medicine |volume=152 |issue=2 |pages=93–100 |date=January 2010 |pmid=20083828 |pmc=2829242 |doi=10.1059/0003-4819-152-2-201001190-00008 |last2=Kelesidis |last3=Chou |last4=Mantzoros |doi_brokendate=2015-02-01 }}</ref> |
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Several anti-obesity medications are currently approved by the FDA for long term use.<ref name="FDA2012">{{cite web |date=June 27, 2012 |title=FDA approves Belviq to treat some overweight or obese adults |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm309993.htm |access-date=8 July 2012 |work=FDA}}</ref><ref name="Meds2009">{{cite web |url=http://win.niddk.nih.gov/publications/prescription.htm#fdameds |title=WIN – Publication – Prescription Medications for the Treatment of Obesity |publisher=[[National Institutes of Health]] |work=National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) |access-date=January 14, 2009 |archive-url=https://web.archive.org/web/20090113185440/http://win.niddk.nih.gov/publications/prescription.htm#fdameds |archive-date=January 13, 2009 |url-status=dead }}</ref><ref name="Meridia2010">{{cite web |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm |title=www.fda.gov |website=[[Food and Drug Administration]] }}</ref> |
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* Semaglutide (Wegovy) is currently approved by the FDA for long-term use, being associated with a 6-12% loss in body weight compared to placebo.<ref>{{Cite web | author = Office of the Commissioner|date=2021-06-21 |title=FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014 |url=https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014 |access-date=2022-07-19 |website=FDA |language=en}}</ref> |
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* The [[combination drug]] [[phentermine/topiramate]] (Qsymia) is approved by the FDA as an addition to a reduced-calorie diet and exercise for chronic [[weight management]].<ref>{{Cite web | url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312468.htm | title = FDA approves weight-management drug Qsymia | publisher = [[Food and Drug Administration]] | date = July 17, 2012}}</ref> |
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* Orlistat reduces intestinal fat absorption by inhibiting pancreatic [[lipase]]. Over the longer term, average weight loss on orlistat is {{convert|2.9|kg|lb|abbr=on}}. It leads to a reduced incidence of diabetes, and has some effect on [[cholesterol]]. However, there is little information on how it affects the longer-term complications or outcomes of obesity.<ref name="Orli07" /> |
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* [[Racemic amphetamine]], [[phendimetrazine]], [[diethylpropion]], and [[phentermine]] are approved by the FDA for short term use.<ref name="Meds2009" /><ref name="Evekeo">{{cite web |date=April 2014 |title=Evekeo Prescribing Information |url=https://www.evekeo.com/assets/evekeo-pi.pdf |access-date=11 August 2015 |publisher=Arbor Pharmaceuticals LLC |pages=1–2}}</ref> |
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=== Other medications === |
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The usefulness of certain drugs depends upon the comorbidities present. [[Metformin]] (Glucophage) is preferred in overweight diabetics, as it may lead to mild weight loss in comparison to [[sulfonylurea]]s or [[insulin]].<ref name = UKPDS>{{cite journal | author =UK Prospective Diabetes Study (UKPDS) Group | title = Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) | journal = Lancet | volume = 352 | issue = 9131 | pages = 854–65 | year = 1998 | pmid=9742977 |doi=10.1016/S0140-6736(98)07037-8}}</ref> The [[thiazolidinedione]]s, on the other hand, may cause weight gain, but decrease central obesity.<ref>{{cite journal |author=Fonseca V |title=Effect of thiazolidinediones on body weight in patients with diabetes mellitus |journal=Am. J. Med. |volume=115 Suppl 8A |issue= 8|pages=42S–48S |year=2003 |pmid=14678865 |doi=10.1016/j.amjmed.2003.09.005}}</ref> Diabetics also achieve modest weight loss with [[fluoxetine]] (Prozac), orlistat and sibutramine over 12–57 weeks. Preliminary evidence has however found higher number of [[cardiovascular events]] in people taking sibutramine verses control (11.4% vs. 10.0%).<ref>{{cite web |url=http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm191650.htm |title=Early Communication about an Ongoing Safety Review of Meridia (sibutramine hydrochloride) |work=FDA |accessdate=Nov 23, 2009}}</ref> The long-term health benefits of these treatments remain unclear.<ref name="pmid15674929">{{cite journal |author=Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J |title=Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus |journal=Cochrane database of systematic reviews (Online) |volume= |issue=1 |pages=CD004096 |year=2005 |pmid=15674929 |doi=10.1002/14651858.CD004096.pub2|last2=Zhang |last3=Avenell |last4=Gregg |last5=Schmid |last6=Lau }}</ref> |
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* [[Bupropion]], [[topiramate]], and [[zonisamide]] are sometimes used off-label for weight loss.<ref name="Meds2009" /><ref name="Evekeo" /> |
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* The usefulness of certain drugs depends upon the comorbidities present. [[Metformin]] is preferred in overweight diabetics and for those gaining weight because taking [[clozapine]] for schizophrenia, as it may lead to mild weight loss in comparison to [[sulfonylurea]]s or [[insulin]].<ref>{{cite journal | vauthors = Siskind DJ, Leung J, Russell AW, Wysoczanski D, Kisely S | title = Metformin for Clozapine Associated Obesity: A Systematic Review and Meta-Analysis | journal = PLOS ONE | volume = 11 | issue = 6 | pages = e0156208 | date = 2016-06-15 | pmid = 27304831 | pmc = 4909277 | doi = 10.1371/journal.pone.0156208 | bibcode = 2016PLoSO..1156208S | doi-access = free | veditors = Holscher C }}</ref><ref name="UKPDS">{{cite journal | vauthors = ((UK Prospective Diabetes Study (UKPDS) Group)) | title = Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group | journal = Lancet | volume = 352 | issue = 9131 | pages = 854–865 | date = September 1998 | pmid = 9742977 | doi = 10.1016/S0140-6736(98)07037-8 | s2cid = 19208426 }}</ref> The [[thiazolidinedione]]s, on the other hand, may cause weight gain, but decrease central obesity.<ref>{{cite journal | vauthors = Fonseca V | title = Effect of thiazolidinediones on body weight in patients with diabetes mellitus | journal = The American Journal of Medicine | volume = 115 | issue = Suppl 8A | pages = 42S–48S | date = December 2003 | pmid = 14678865 | doi = 10.1016/j.amjmed.2003.09.005 }}</ref> Diabetics also achieve modest weight loss with [[fluoxetine]] and orlistat over 12–57 weeks.<ref>{{cite journal | vauthors = Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J | title = Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus | journal = The Cochrane Database of Systematic Reviews | volume = 2005 | issue = 1 | pages = CD004096 | date = January 2005 | pmid = 15674929 | pmc = 6718205 | doi = 10.1002/14651858.CD004096.pub2 }}</ref> |
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[[Fenfluramine]] and [[dexfenfluramine]] were withdrawn from the market in 1997,<ref name=Meds2009/> while [[ephedrine]] (found in the traditional Chinese herbal medicine ''má huáng'' made from the ''[[Ephedra sinica]]'') was removed from the market in 2004.<ref>{{cite journal |author=Rados C |title=Ephedra ban: no shortage of reasons |journal=FDA Consum |volume=38 |issue=2 |pages=6–7 |year=2004 |pmid=15101356 |doi= |url=}}</ref> [[Dexamphetamines]] are not approved by the FDA for the treatment of obesity<ref>{{cite book |author=Boss, Olivier; Karl G. Hofbauer |title=Pharmacotherapy of obesity: options and alternatives |publisher=CRC Press |location=Boca Raton |year=2004 |pages=286 |isbn=0-415-30321-4 |oclc= |doi= |url=http://books.google.com/?id=v7o5e8aSXB0C&pg=PA286&lpg=PA286&dq=Amphetamines+are+not+FDA+approved+to+treat+obesity|accessdate=January 14, 2009}}</ref> due to concerns regarding [[Substance use disorder|addiction]] and [[substance abuse|abuse potential]].<ref name=Meds2009/> The use of these drugs is not recommended due to potential side effects.<ref>{{cite journal |author=Flanagan CM, Kaesberg JL, Mitchell ES, Ferguson MA, Haigney MC |title=Coronary artery aneurysm and thrombosis following chronic ephedra use |journal=Int. J. Cardiol. |volume= 139|issue= 1|pages= e11–3|date=August 2008 |pmid=18718687 |doi=10.1016/j.ijcard.2008.06.081 |url=|last2=Kaesberg |last3=Mitchell |last4=Ferguson |last5=Haigney }}</ref> However, people do occasionally use these drugs illegally.<ref>{{cite journal |author=Cohen PA, McCormick D, Casey C, Dawson GF, Hacker KA |title=Imported Compounded Diet Pill Use Among Brazilian Women Immigrants in the United States |journal=J Immigr Minor Health |volume= 11|issue= 3|pages= 229–36|date=December 2007 |pmid=18066718 |doi=10.1007/s10903-007-9099-x |url=|last2=McCormick |last3=Casey |last4=Dawson |last5=Hacker }}</ref> |
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* [[Rimonabant]] (Acomplia), another drug, had been withdrawn from the market. It worked via a specific blockade of the [[endocannabinoid]] system. It has been developed from the knowledge that [[Cannabis (drug)|cannabis]] smokers often experience hunger, which is often referred to as "the munchies". It had been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to safety concerns.<ref>{{cite news |date=January 2, 2007 |title=Anti-obesity drug no magic bullet |work=[[Canadian Broadcasting Corporation]] |url=http://www.cbc.ca/news/technology/anti-obesity-drug-no-magic-bullet-1.674506 |access-date=2008-09-19}}</ref><ref>{{cite web |date=June 13, 2007 |title=FDA Briefing Document NDA 21-888 Zimulti (rimonabant) Tablets, 20 mg Sanofi Aventis Advisory Committee |url=https://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4306b1-fda-backgrounder.pdf |access-date=2008-09-19 |publisher=[[Food and Drug Administration]]}}</ref> [[European Medicines Agency]] in October 2008 recommended the suspension of the sale of rimonabant as the risk seem to be greater than the benefits.<ref>{{cite web |title=www.emea.europa.eu |url=http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2009/11/WC500014774.pdf}}</ref> |
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* [[Sibutramine]] (Meridia), which acts in the brain to inhibit deactivation of the [[neurotransmitter]]s, thereby decreasing appetite was withdrawn from the UK market in January 2010 and United States and Canadian markets in October 2010 due to cardiovascular concerns.<ref name="Meridia2010" /><ref>{{cite web |date=2012-10-23 |title=Abbott Laboratories Voluntarily Withdraws Weight-loss Drug Sibutramine (Meridia) from the Canadian Market - Health Canada Information Update 2010-10-08 |url=http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_169-eng.php}}</ref><ref>{{cite web |title=www.nice.org.uk |url=http://www.nice.org.uk/nicemedia/live/11000/30364/30364.pdf |url-status=dead |archive-url=https://web.archive.org/web/20101106130516/http://www.nice.org.uk/nicemedia/live/11000/30364/30364.pdf |archive-date=2010-11-06}}</ref> In 2010 it was found that sibutramine increases the risk of [[heart attacks]] and [[strokes]] in people with a history of cardiovascular disease.<ref>{{cite web |title=Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm198221.htm |website=[[Food and Drug Administration]]}}</ref><ref>{{cite journal | vauthors = James WP, Caterson ID, Coutinho W, Finer N, Van Gaal LF, Maggioni AP, Torp-Pedersen C, Sharma AM, Shepherd GM, Rode RA, Renz CL | display-authors = 6 | title = Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects | journal = The New England Journal of Medicine | volume = 363 | issue = 10 | pages = 905–917 | date = September 2010 | pmid = 20818901 | doi = 10.1056/NEJMoa1003114 | hdl-access = free | hdl = 2437/111825 | url = https://researchonline.lshtm.ac.uk/id/eprint/19574/1/Effect%20of%20sibutramine%20on%20cardiovascular%20outcomes%20in%20overweight%20and%20obese%20subjects.pdf }}</ref> |
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* [[Fenfluramine]] and [[dexfenfluramine]] were withdrawn from the market in 1997,<ref name="Meds2009" /> while [[ephedrine]] (found in the traditional Chinese herbal medicine ''má huáng'' made from the ''[[Ephedra sinica]]'') was removed from the market in 2004.<ref>{{cite journal | vauthors = Rados C | title = Ephedra ban: no shortage of reasons | journal = FDA Consumer | volume = 38 | issue = 2 | pages = 6–7 | year = 2004 | pmid = 15101356 }}</ref> |
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* [[Lorcaserin]] used to be approved by the [[Food and Drug Administration]] for use in the treatment of obesity before being withdrawn due to cancer risk.<ref>{{Cite web |title=Lorcaserin (Belviq) Withdrawn From US Market Due to Cancer Risk |url=http://www.medscape.com/viewarticle/925253 |access-date=2022-07-19 |website=Medscape |language=en}}</ref> |
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* [[Recombinant DNA|Recombinant]] human [[leptin]] is very effective in those with obesity due to congenital complete leptin deficiency via decreasing energy intake and possibly increases energy expenditure. This condition is, however, rare and this treatment is not effective for inducing weight loss in the majority of people with obesity. It is being investigated to determine whether or not it helps with weight loss maintenance.<ref>{{cite journal | vauthors = Kelesidis T, Kelesidis I, Chou S, Mantzoros CS | title = Narrative review: the role of leptin in human physiology: emerging clinical applications | journal = Annals of Internal Medicine | volume = 152 | issue = 2 | pages = 93–100 | date = January 2010 | pmid = 20083828 | pmc = 2829242 | doi = 10.7326/0003-4819-152-2-201001190-00008 }}</ref> |
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* Though hypothesized that supplementation of vitamin D may be an effective treatment for obesity, studies do not support this.<ref>{{cite journal | vauthors = Pathak K, Soares MJ, Calton EK, Zhao Y, Hallett J | title = Vitamin D supplementation and body weight status: a systematic review and meta-analysis of randomized controlled trials | journal = Obesity Reviews | volume = 15 | issue = 6 | pages = 528–537 | date = June 2014 | pmid = 24528624 | doi = 10.1111/obr.12162 | s2cid = 8660739 }}</ref> There is also no strong evidence to recommend herbal medicines for weight loss.<ref>{{cite journal | vauthors = Maunder A, Bessell E, Lauche R, Adams J, Sainsbury A, Fuller NR | title = Effectiveness of herbal medicines for weight loss: A systematic review and meta-analysis of randomized controlled trials | journal = Diabetes, Obesity & Metabolism | volume = 22 | issue = 6 | pages = 891–903 | date = June 2020 | pmid = 31984610 | doi = 10.1111/dom.13973 | doi-access = }}</ref> |
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==Surgery== |
==Surgery== |
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{{Main|Bariatric surgery}} |
{{Main|Bariatric surgery}} |
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Bariatric surgery ("weight loss surgery") is the use of surgical intervention in the treatment of obesity. As every operation may have complications, surgery is only recommended for severely obese people (BMI > 40) who have failed to lose weight following dietary modification and pharmacological treatment. Weight loss surgery relies on various principles: the two most common approaches are reducing the volume of the stomach (e.g. by [[adjustable gastric band]]ing and [[Vertical banded gastroplasty surgery|vertical banded gastroplasty]]), which produces an earlier sense of satiation, and reducing the length of bowel that comes into contact with food (e.g. by [[gastric bypass surgery]] or [[Duodenal-jejunal bypass liner|endoscopic duodenal-jejunal bypass surgery]]<ref name="SullivanEndo15">{{cite book |chapter-url=https://books.google.com/books?id=IXLdBgAAQBAJ&pg=PA70 |chapter=Endoscopic Treatment of Obesity |title=Gastrointestinal Endoscopy: New Technologies and Changing Paradigms | vauthors = Sullivan S | veditors = Jonnalagadda SS |publisher=Springer |pages=61–82 |year=2015 |isbn=9781493920327 |access-date=18 March 2016}}</ref><ref name="MunozEndo15">{{cite book |chapter-url=https://books.google.com/books?id=HHmBCgAAQBAJ&pg=PA494 |chapter=Chapter 51: Endoscopic Duodenal-Jejunal Bypass Sleeve Treatment for Obesity |title=Obesity, Bariatric and Metabolic Surgery: A Practical Guide | vauthors = Muñoz R, Escalona A | veditors = Agrawal S |publisher=Springer |pages=493–498 |year=2015 |isbn=9783319043432 |access-date=18 March 2016}}</ref>), which directly reduces absorption. Band surgery is reversible, while bowel shortening operations are not. Some procedures can be performed [[laparoscopic surgery|laparoscopically]]. Complications from weight loss surgery are frequent.<ref name="pmid16862031">{{cite journal | vauthors = Encinosa WE, Bernard DM, Chen CC, Steiner CA | title = Healthcare utilization and outcomes after bariatric surgery | journal = Medical Care | volume = 44 | issue = 8 | pages = 706–712 | date = August 2006 | pmid = 16862031 | doi = 10.1097/01.mlr.0000220833.89050.ed | s2cid = 8434284 }}</ref> |
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Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.<ref name="Sjöström L, Narbro K, Sjöström CD, et al. 2007 741–52"/> A marked decrease in the risk of [[diabetes mellitus]], [[cardiovascular disease]] and [[cancer]] has also been found after bariatric surgery.<ref name=" |
Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.<ref name="Sjöström L, Narbro K, Sjöström CD, et al. 2007 741–52"/> A marked decrease in the risk of [[diabetes mellitus]], [[cardiovascular disease]] and [[cancer]] has also been found after bariatric surgery.<ref name="Sjöström L, Narbro K, Sjöström CD, et al. 2007 741–52"/><ref name="pmid17715409">{{cite journal | vauthors = Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC | display-authors = 6 | title = Long-term mortality after gastric bypass surgery | journal = The New England Journal of Medicine | volume = 357 | issue = 8 | pages = 753–761 | date = August 2007 | pmid = 17715409 | doi = 10.1056/NEJMoa066603 | s2cid = 8710295 | doi-access = free }}</ref> Marked weight loss occurs during the first few months after surgery, and the loss is sustained in the long term. In one study there was an unexplained increase in deaths from accidents and suicide, but this did not outweigh the benefit in terms of disease prevention.<ref name="pmid17715409"/> When the two main techniques are compared, gastric bypass procedures are found to lead to 30% more weight loss than banding procedures one year after surgery.<ref>{{cite journal | vauthors = Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD | title = Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures | journal = The American Journal of Medicine | volume = 121 | issue = 10 | pages = 885–893 | date = October 2008 | pmid = 18823860 | doi = 10.1016/j.amjmed.2008.05.036 }}</ref> For obese individuals with [[non-alcoholic fatty liver disease|non-alcoholic fatty liver disease (NAFLD)]], bariatric surgery improves or cures the liver.<ref name="AsiaPacific2017-2">{{cite journal | vauthors = Chitturi S, Wong VW, Chan WK, Wong GL, Wong SK, Sollano J, Ni YH, Liu CJ, Lin YC, Lesmana LA, Kim SU, Hashimoto E, Hamaguchi M, Goh KL, Fan J, Duseja A, Dan YY, Chawla Y, Farrell G, Chan HL | display-authors = 6 | title = The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 2: Management and special groups | journal = Journal of Gastroenterology and Hepatology | volume = 33 | issue = 1 | pages = 86–98 | date = January 2018 | pmid = 28692197 | doi = 10.1111/jgh.13856 | s2cid = 29648173 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK | title = Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis | journal = Clinical Gastroenterology and Hepatology | volume = 6 | issue = 12 | pages = 1396–1402 | date = December 2008 | pmid = 18986848 | doi = 10.1016/j.cgh.2008.08.012 }}</ref> |
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A preoperative diet such as [[calorie restriction|low-calorie diets]] or [[very-low-calorie diet]], is usually recommended to reduce liver volume by 16-20%, and preoperative weight loss is the only factor associated with postoperative weight loss.<ref name="ERAS2016">{{cite journal | vauthors = Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, Vignaud M, Alvarez A, Singh PM, Lobo DN | display-authors = 6 | title = Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations | journal = World Journal of Surgery | volume = 40 | issue = 9 | pages = 2065–2083 | date = September 2016 | pmid = 26943657 | doi = 10.1007/s00268-016-3492-3 | type = Professional society guidelines | doi-access = free }}</ref><ref name="Holderbaum2018">{{cite journal | vauthors = Holderbaum M, Casagrande DS, Sussenbach S, Buss C | title = Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review | journal = Surgery for Obesity and Related Diseases | volume = 14 | issue = 2 | pages = 237–244 | date = February 2018 | pmid = 29239795 | doi = 10.1016/j.soard.2017.09.531 | type = Systematic review }}</ref> Preoperative weight loss can reduce operative time and hospital stay.<ref name="ERAS2016" /><ref>{{cite journal | vauthors = Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Gibbons MM | display-authors = 6 | title = Does weight loss immediately before bariatric surgery improve outcomes: a systematic review | journal = Surgery for Obesity and Related Diseases | volume = 5 | issue = 6 | pages = 713–721 | date = 2008 | pmid = 19879814 | doi = 10.1016/j.soard.2009.08.014 }}</ref><ref name="Roman2019">{{cite journal | vauthors = Roman M, Monaghan A, Serraino GF, Miller D, Pathak S, Lai F, Zaccardi F, Ghanchi A, Khunti K, Davies MJ, Murphy GJ | display-authors = 6 | title = Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes | journal = The British Journal of Surgery | volume = 106 | issue = 3 | pages = 181–189 | date = February 2019 | pmid = 30328098 | doi = 10.1002/bjs.11001 | type = Meta-analysis | doi-access = free | hdl = 2381/43636 | hdl-access = free }}</ref> although there is insufficient evidence whether preoperative weight loss may be beneficial to reduce long-term morbidity or complications.<ref name="Roman2019" /><ref>{{cite journal | vauthors = Cassie S, Menezes C, Birch DW, Shi X, Karmali S | title = Effect of preoperative weight loss in bariatric surgical patients: a systematic review | journal = Surgery for Obesity and Related Diseases | volume = 7 | issue = 6 | pages = 760–7; discussion 767 | date = 2010 | pmid = 21978748 | doi = 10.1016/j.soard.2011.08.011 | type = Systematic review }}</ref> Weight loss and decreases in liver size may be independent from the amount of calorie restriction.<ref name="Holderbaum2018" /> |
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[[Ileojejunal bypass]], in which the digestive tract is rerouted to bypass the small intestine, was an experimental surgery designed as a remedy for morbid obesity. |
[[Ileojejunal bypass]], in which the digestive tract is rerouted to bypass the small intestine, was an experimental surgery designed as a remedy for morbid obesity. |
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The effects of [[liposuction]] on obesity are less well determined. |
The effects of [[liposuction]] on obesity are less well determined. Some small studies show benefits<ref>{{cite journal | vauthors = Giugliano G, Nicoletti G, Grella E, Giugliano F, Esposito K, Scuderi N, D'Andrea F | title = Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women | journal = British Journal of Plastic Surgery | volume = 57 | issue = 3 | pages = 190–194 | date = April 2004 | pmid = 15006519 | doi = 10.1016/j.bjps.2003.12.010 }}</ref> while others show none.<ref>{{cite journal | vauthors = Klein S, Fontana L, Young VL, Coggan AR, Kilo C, Patterson BW, Mohammed BS | title = Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease | journal = The New England Journal of Medicine | volume = 350 | issue = 25 | pages = 2549–2557 | date = June 2004 | pmid = 15201411 | doi = 10.1056/NEJMoa033179 | doi-access = free }}</ref> A treatment involving the placement of an [[intragastric balloon]] via [[gastroscopy]] has shown promise. One type of balloon led to a weight loss of 5.7 BMI units over 6 months or {{convert|14.7|kg|lb|abbr=on}}. Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.<ref name=balloon2008>{{cite journal | vauthors = Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J | title = Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis | journal = Obesity Surgery | volume = 18 | issue = 7 | pages = 841–846 | date = July 2008 | pmid = 18459025 | doi = 10.1007/s11695-007-9331-8 | s2cid = 10220216 }}</ref> |
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An implantable nerve simulator which improves the feeling of fullness was approved by the FDA in 2015.<ref name=FDA2015Sim>{{cite web|title=FDA approves first-of-kind device to treat obesity|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm430223.htm|website=fda.gov|access-date=18 January 2015|date=January 14, 2015}}</ref> |
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In 2016 the FDA approved an [[aspiration therapy]] device that siphons food from the stomach to the outside and decreases caloric intake.<ref name=fda>[https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm506625.htm FDA release. June 14, 2016]</ref> As of 2015 one trial shows promising results.<ref>{{cite journal | vauthors = Kumar N | title = Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration | journal = World Journal of Gastrointestinal Endoscopy | volume = 7 | issue = 9 | pages = 847–859 | date = July 2015 | pmid = 26240686 | pmc = 4515419 | doi = 10.4253/wjge.v7.i9.847 | doi-access = free }}</ref> |
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== Health policy == |
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Obesity is a complex public health and policy problem because of its prevalence, costs, and health effects.<ref>{{cite book | vauthors = Satcher D |url=https://www.ncbi.nlm.nih.gov/books/NBK44206/ |title=The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity |publisher=U.S. Dept. of Health and Human Services, Public Health Service, Office of Surgeon General |year=2001 |isbn=978-0-16-051005-2 |series=Publications and Reports of the Surgeon General|pmid=20669513 }}</ref> As such, managing it requires changes in the wider societal context and effort by communities, local authorities, and governments.<ref>{{cite journal | vauthors = Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Grossman DC, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW, Wong JB | display-authors = 6 | title = Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 320 | issue = 11 | pages = 1163–1171 | date = September 2018 | pmid = 30326502 | doi = 10.1001/jama.2018.13022 | doi-access = free }}</ref> Public health efforts seek to understand and correct the [[Obesity and the environment|environmental factors]] responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct [[Junk food|junk]] [[food marketing]] to children,<ref>{{cite news | vauthors = Barnes B |date=18 July 2007 |title=Limiting Ads of Junk Food to Children |work=The New York Times |url=https://www.nytimes.com/2007/07/18/business/18food.html |access-date=24 July 2008}}</ref> and decreasing access to sugar-sweetened beverages in schools.<ref>{{cite web |title=Fewer Sugary Drinks Key to Weight Loss |url=http://www.healthfinder.gov/news/newsstory.aspx?docID=625759 |access-date=18 October 2009 |website=U.S. Department of Health and Human Services}}</ref> The World Health Organization recommends the taxing of sugary drinks.<ref>{{cite web |title=WHO urges global action to curtail consumption and health impacts of sugary drinks |url=https://www.who.int/mediacentre/news/releases/2016/curtail-sugary-drinks/en/ |access-date=13 October 2016 |website=WHO}}</ref> When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.<ref>{{cite journal | vauthors = Brennan Ramirez LK, Hoehner CM, Brownson RC, Cook R, Orleans CT, Hollander M, Barker DC, Bors P, Ewing R, Killingsworth R, Petersmarck K, Schmid T, Wilkinson W | display-authors = 6 | title = Indicators of activity-friendly communities: an evidence-based consensus process | journal = American Journal of Preventive Medicine | volume = 31 | issue = 6 | pages = 515–524 | date = December 2006 | pmid = 17169714 | doi = 10.1016/j.amepre.2006.07.026 | type = Research Support | doi-access = free }}</ref> |
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[[Mass media]] campaigns seem to have limited effectiveness in changing behaviors that influence obesity. At the same time they can increase knowledge and awareness regarding physical activity and diet, which might lead to changes in the long term. Campaigns might also be able to reduce the amount of time spent [[Sedentary lifestyle|sitting or lying down]] and positively affect the intention to be active physically.<ref>{{cite journal | vauthors = Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, Lewis S, Thomas J, Campbell M, Young B, Bauld L | display-authors = 6 | title = Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence | language = EN | journal = Public Health Research | volume = 7 | issue = 8 | pages = 1–206 | date = 2019-05-02 | pmid = 31046212 | doi = 10.3310/phr07080 | doi-access = free }}</ref><ref>{{Cite journal |date=19 May 2022 |title=How can local authorities reduce obesity? Insights from NIHR research |url=https://evidence.nihr.ac.uk/how-local-authorities-can-reduce-obesity/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research}}</ref> [[Nutrition facts label|Nutritional labelling]] with energy information on menus might be able to help reducing energy intake while dining in restaurants.<ref>{{cite journal | vauthors = Crockett RA, King SE, Marteau TM, Prevost AT, Bignardi G, Roberts NW, Stubbs B, Hollands GJ, Jebb SA | display-authors = 6 | title = Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | pages = CD009315 | date = February 2018 | pmid = 29482264 | pmc = 5846184 | doi = 10.1002/14651858.CD009315.pub2 }}</ref> |
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Since there is a relationship between obesity and automobile travel, interventions relating to transportation infrastructure (for example, policy aimed at encouraging the use of public transportation) could potentially reduce obesity.<ref>{{cite journal |last1=King |first1=Douglas M. |last2=Jacobson |first2=Sheldon H. |title=What Is Driving Obesity? A Review on the Connections Between Obesity and Motorized Transportation |journal=Current Obesity Reports |date=1 March 2017 |volume=6 |issue=1 |pages=3–9 |doi=10.1007/s13679-017-0238-y |url=https://link.springer.com/article/10.1007/s13679-017-0238-y |language=en |issn=2162-4968}}</ref><ref>{{cite journal |last1=McCormack |first1=Gavin R. |last2=Virk |first2=Jagdeep S. |title=Driving towards obesity: A systematized literature review on the association between motor vehicle travel time and distance and weight status in adults |journal=Preventive Medicine |date=1 September 2014 |volume=66 |pages=49–55 |doi=10.1016/j.ypmed.2014.06.002 |url=https://www.sciencedirect.com/science/article/abs/pii/S0091743514002023 |issn=0091-7435|hdl=1880/115549 |hdl-access=free }}</ref> |
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An implantable nerve simulator which improves the feeling of fullness was approved by the FDA in 2015.<ref name=FDA2015Sim>{{cite web|title=FDA approves first-of-kind device to treat obesity|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm430223.htm|website=fda.gov|accessdate=18 January 2015|date=January 14, 2015}}</ref> |
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== Clinical protocols == |
== Clinical protocols == |
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Much of the Western world has created [[clinical practice guidelines]] in an attempt to address rising rates of obesity. Australia,<ref name=Aus2004>{{cite web |url=http://www.health.gov.au/internet/main/publishing.nsf/Content/obesityguidelines-index.htm |title=Obesity Guidelines Website |work=Australian Government Department of Health and Ageing | |
Much of the Western world has created [[clinical practice guidelines]] in an attempt to address rising rates of obesity. Australia,<ref name=Aus2004>{{cite web |url=http://www.health.gov.au/internet/main/publishing.nsf/Content/obesityguidelines-index.htm |title=Obesity Guidelines Website |work=Australian Government Department of Health and Ageing |access-date=Oct 25, 2009}}</ref> Canada,<ref name=CADG2006/> the European Union,<ref name=EuroG2008>{{cite journal | vauthors = Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, Micic D, Maislos M, Roman G, Schutz Y, Toplak H, Zahorska-Markiewicz B | display-authors = 6 | title = Management of obesity in adults: European clinical practice guidelines | journal = Obesity Facts | volume = 1 | issue = 2 | pages = 106–116 | date = April 2008 | pmid = 20054170 | pmc = 6452117 | doi = 10.1159/000126822 | author13 = Obesity Management Task Force of the European Association for the Study of Obesity }}</ref> and the United States<ref name=Snow2005/> have all published statements since 2004. |
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In a clinical practice guideline by the [[American College of Physicians]], the following five recommendations are made:<ref name=Snow2005>{{cite journal | |
In a clinical practice guideline by the [[American College of Physicians]], the following five recommendations are made:<ref name=Snow2005>{{cite journal | vauthors = Snow V, Barry P, Fitterman N, Qaseem A, Weiss K | title = Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians | journal = Annals of Internal Medicine | volume = 142 | issue = 7 | pages = 525–531 | date = April 2005 | pmid = 15809464 | doi = 10.7326/0003-4819-142-7-200504050-00011 | doi-access = | collaboration = Clinical Efficacy Assessment Subcommittee of the American College of Physicians }} [http://www.annals.org/cgi/content/full/142/7/525 Fulltext].</ref>{{update inline|date=July 2022}} |
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# People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss. |
# People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss. |
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# If these goals are not achieved, pharmacotherapy can be offered. The person needs to be informed of the possibility of [[Adverse effect (medicine)|side-effects]] and the unavailability of long-term safety and efficacy data. |
# If these goals are not achieved, pharmacotherapy can be offered. The person needs to be informed of the possibility of [[Adverse effect (medicine)|side-effects]] and the unavailability of long-term safety and efficacy data. |
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# Drug therapy may consist of [[sibutramine]], [[orlistat]], [[phentermine]], [[diethylpropion]], [[fluoxetine]], and [[bupropion]] |
# Drug therapy may consist of [[sibutramine]], [[orlistat]], [[phentermine]], [[diethylpropion]], [[fluoxetine]], and [[bupropion]]. Evidence is not sufficient to recommend [[sertraline]], [[topiramate]], or [[zonisamide]]. |
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# In people with a BMI over 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for [[bariatric surgery]] may be indicated. The person needs to be aware of the potential complications. |
# In people with a BMI over 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for [[bariatric surgery]] may be indicated. The person needs to be aware of the potential complications. |
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# Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications. |
# Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications. |
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A [[clinical practice guideline]] by the [[US Preventive Services Task Force]] (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a [[healthy diet]] in unselected people in primary care settings, but that intensive behavioral dietary counseling is recommended in those with [[hyperlipidemia]] and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.<ref name=paradox2003>{{cite journal | |
A [[clinical practice guideline]] by the [[US Preventive Services Task Force]] (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a [[healthy diet]] in unselected people in primary care settings, but that intensive behavioral dietary counseling is recommended in those with [[hyperlipidemia]] and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.<ref name=paradox2003>{{cite journal | title = Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale | journal = American Family Physician | volume = 67 | issue = 12 | pages = 2573–2576 | date = June 2003 | pmid = 12825847 | url = http://www.uspreventiveservicestaskforce.org/3rduspstf/diet/dietrr.htm | access-date = 2014-02-24 | url-status = dead | archive-url = https://archive.today/20140224143303/http://www.uspreventiveservicestaskforce.org/3rduspstf/diet/dietrr.htm | archive-date = 2014-02-24 | author1 = U.S. Preventive Services Task Force }}</ref><ref name="pmid12554027">{{cite journal | vauthors = Pignone MP, Ammerman A, Fernandez L, Orleans CT, Pender N, Woolf S, Lohr KN, Sutton S | display-authors = 6 | title = Counseling to promote a healthy diet in adults: a summary of the evidence for the U.S. Preventive Services Task Force | journal = American Journal of Preventive Medicine | volume = 24 | issue = 1 | pages = 75–92 | date = January 2003 | pmid = 12554027 | doi = 10.1016/S0749-3797(02)00580-9 }}</ref> A survey of primary care physicians in the United States<ref>{{cite journal | vauthors = Mathur MB, Mathur VS | title = Primary Care Physicians' Perceptions of the Effects of Being Overweight on All-cause Mortality | language = en-US | journal = Epidemiology | volume = 34 | issue = 3 | pages = e19–e20 | date = May 2023 | pmid = 36727941 | doi = 10.1097/EDE.0000000000001590 | s2cid = 256499920 | pmc = 10368371 }}</ref> found that although clinical guidelines do not consider overweight to be a risk factor that increases mortality,<ref>{{cite journal | vauthors = Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC, Tomaselli GF | display-authors = 6 | title = 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society | journal = Circulation | volume = 129 | issue = 25 Suppl 2 | pages = S102–S138 | date = June 2014 | pmid = 24222017 | pmc = 5819889 | doi = 10.1161/01.cir.0000437739.71477.ee }}</ref> physicians often report believing that being overweight increases all-cause mortality. |
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Canada developed and published evidence-based practice guidelines in 2006. The guidelines attempt to address the prevention and management of obesity at both the individual and population levels in both children and adults.<ref name=CADG2006/> The [[European Union]] published clinical practice guidelines in 2008 in an effort to address the rising rates of obesity in Europe.<ref name=EuroG2008/> Australia came out with practice guidelines in 2004.<ref name=Aus2004/> |
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== References == |
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Canada developed and published evidence-based practice guidelines in 2006. The guidelines attempt to address the prevention and management of obesity at both the individual and population levels in both children and adults.<ref name=CADG2006/> The [[European Union]] published clinical practice guidelines in 2008 in an effort to address the rising rates of obesity in Europe.<ref name=EuroG2008/> Australia came out with practice guidelines in 2004.<ref name=Aus2004/> |
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{{reflist}} |
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== |
== External links == |
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* {{Commons category-inline}} |
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Temporary, controllable gastric [[pseudo-bezoar]]s (swallowable, swellable foreign bodies in the stomach meant to reduce gastric volume from inside the organ) are being tested.<ref>{{cite journal |doi=10.1088/0967-3334/31/2/001 |author=Mintchev MP, Deneva MG, Aminkov BI, Fattouche M, Yadid-Pecht O, Bray RC| title=Pilot study of temporary controllable gastric pseudobezoars for dynamic non-invasive gastric volume reduction |journal=Physiol. Meas. |volume=31 |issue=2 |pages=131–44 |date=1 February 2010|pmid=20009188 |url=http://iopscience.iop.org/0967-3334/31/2/001/ |last2=Deneva|last3=Aminkov|last4=Fattouche|last5=Yadid-Pecht|last6=Bray|bibcode=2010PhyM...31..131M}}</ref> |
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Treatment with [[naltrexone]] plus [[bupropion]] in a [[phase three trial]] resulted in a weight lose of 5–6% versus 1% for a placebo.<ref>{{cite web |url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960888-4/fulltext |title=Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial : The Lancet |format= |work= |accessdate=}}</ref> |
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{{Obesity}} |
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==References== |
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{{Reflist|2}} |
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[[Category:Management of obesity| ]] |
[[Category:Management of obesity| ]] |
Revision as of 04:27, 25 April 2024
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Human body weight |
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Management of obesity can include lifestyle changes, medications, or surgery. Although many studies have sought effective interventions, there is currently no evidence-based, well-defined, and efficient intervention to prevent obesity.[1]
Treatment for obesity often consists of weight loss via healthy nutrition and increasing physical exercise.[2][3][4][5] A 2007 review concluded that certain subgroups, such as those with type 2 diabetes and women who undergo weight loss, show long-term benefits in all-cause mortality, while long‐term outcomes for men are "not clear and need further investigation."[6]
The most effective treatment for obesity is bariatric surgery.[7] Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[8] Another study also found reduced mortality in those who underwent bariatric surgery for severe obesity.[9]
In June 2021, the US Food and Drug Administration (FDA) approved semaglutide injection sold under the brand name Wegovy for long-term weight management in adults. It is associated with a loss of 6-12% body weight along with mild gastrointestinal side effects.[10][11]
Another medication, orlistat, is widely available and approved for long-term use. Its use produces modest weight loss, with an average of 2.9 kg (6.4 lb) at 1 to 4 years, but there is little information on how these medications affect longer-term complications of obesity.[12][13][needs update] Its use is associated with high rates of gastrointestinal side effects.[13]
Diet programs can produce short-term weight loss and, to a lesser extent, over the long-term. Greater weight loss results, including amongst underserved populations, are achieved when proper nutrition is regularly combined with physical exercise and counseling.[4][12][14][15][16] Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child.[17]
Dieting
Treatment | 25-26.9 | 27-29.9 | 30-34.9 | 35-39.9 | ≥40 |
---|---|---|---|---|---|
Lifestyle intervention (diet, physical activity, behavior) |
Yes | Yes | Yes | Yes | Yes |
Pharmacotherapy | Not appropriate | With co-morbidities | Yes | Yes | Yes |
Surgery | Not appropriate | Not appropriate | Not appropriate | With co-morbidities | Yes |
Diets to promote weight loss can be divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie.[20][better source needed] Many dietary patterns are effective.[4] A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate and low fat), with a 2–4 kilograms (4.4–8.8 lb) weight loss in all studies.[20] At two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized.[21] High protein diets do not appear to make any difference.[22] A diet high in added sugars such as those in soft drinks increases weight.[23] There is evidence that dieting alone can be effective for weight loss and improving health for obese individuals.[4][12] However, a large study of adults found that obesity was associated with differences in brain structure, largely due to shared genetic factors, suggesting that interventions for obesity should not focus solely on energy content, but also take into account the neurobehavioral profile that obesity is genetically associated with.[24]
Dieting for calorie restriction is advised for overweight individuals by the Dietary Guidelines for Americans and United Kingdom's NICE.[2][3][4][25]
Exercise
With use, muscles consume energy derived from both fat and glycogen. Due to the large size of leg muscles, walking, running and cycling are the most effective means of exercise to reduce body fat.[26] Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel.[27][28] To maintain health, the American Heart Association recommends a minimum of 30 minutes of moderate exercise at least 5 days a week.
The Cochrane Collaboration found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1 kilogram weight loss over dieting alone. A 1.5 kilograms (3.3 pounds) loss was observed with a greater degree of exercise.[29] Even though exercise as carried out in the general population has only modest effects, a dose response curve is found and very intense exercise can lead to substantial weight loss. During 20 weeks of basic military training with no dietary restriction, obese military recruits lost 12.5 kg (28 lb).[30] High levels of physical activity seem to be necessary to maintain weight loss.[31] A pedometer appears useful for motivation. Over an average of 18-weeks of use, physical activity increased by 27% resulting in a 0.38 decrease in BMI.[32]
Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population.[33] The city of Bogota, Colombia, for example, blocks off 113 kilometers (70 mi) of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.[34]
In an effort to combat the issue, a primary school in Australia instituted a standing classroom in 2013.[35]
There is evidence that exercise alone is not sufficient to produce meaningful weight loss, but combining dieting and exercise provide the greatest health benefits and weight loss on the long term.[4][12]
Weight loss programs
Weight loss programs involve lifestyle changes including diet modifications, physical activity and behavior therapy. This may involve eating smaller meals, cutting down on certain types of food and making a conscious effort to exercise more. These programs also enable people to connect with a group of others who are attempting to lose weight, in the hopes that participants will form mutually motivating and encouraging relationships.[36] Since 2013, the United States guidelines recommend treating obesity as a disease and actively treat obese people for weight loss.[4]
A number of popular programs exist including Weight Watchers, Overeaters Anonymous and Jenny Craig. These appear to provide modest weight loss (2.9 kg; 6.4 lb) over dieting on one's own (0.2 kg; 0.44 lb) over a two-year period,[12][37][38][39][40] similarly to non-commercial diets.[4][12] As of 2005, there was insufficient scientific evidence to determine whether Internet-based programs produce effective weight loss.[41] The Chinese government has introduced a number of "fat farms" where obese children go for reinforced exercise and has passed a law which requires students to exercise or play sports for an hour a day at school (see Obesity in China).[42][43]
In a structured setting with a trained therapist, these interventions produce an average weight loss of up to 8 kg in 6 months to 1 year,[4] and 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later.[44] There is a gradual weight regain after the first year of about 1 to 2 kg per year, but on the long-term this still results in weight loss.[4] Risk factors for cardiovascular disease and for diabetes are reduced for several years after taking part in a weight management programme, even if people regained weight.[45][46]
Attending group meetings for weight reduction programmes rather than receiving one-on-one support may increase the likelihood that obese people will lose weight. Those who participated in groups had more treatment time and were more likely to lose enough weight to improve their health. Study authors suggested that one explanation for the difference is that group participants spent more time with the clinician (or whoever delivered the programme) than those receiving one-on-one support.[47][48]
Comprehensive diet programs, providing counseling, targets for calorie intake and exercise, may be more efficient than dieting without guidance ("self-help"),[12][49][50] although the evidence is very limited.[51] Following comprehensive lifestyle modifications, the average maintained weight loss is more than 3 kg (6.6 lb) or 3% of total body mass, and could be sustained for five years,[15] and up to 20% of the individuals maintain a weight loss of at least 10% (average of 33 kg).[14] There is some evidence that fast weight loss produce greater long-term weight loss than gradual weight loss.[12][15] Moderate on-site comprehensive lifestyle changes produce a greater weight loss than usual care, of 2 to 4 kg on average in 6 to 12 months.[4] High-intensity comprehensive programs usually yield more weight loss than moderate or low-intensity, with about 35% to 60% of overweight individuals maintaining more than 5 kg weight loss after 2 years.[4]
The NICE devised a set of essential criteria to be met by commercial weight management organizations to be approved.[52]
The Transtheoretical Model (TTM) has been used as a framework to assist the design of lifestyle modification programmes, including weight management. A systematic review found that there is insufficient evidence to draw conclusions regarding the effects of TTM-based programs targeting weight loss that included dietary or physical activity interventions, or both (and also combined with other interventions), on sustainable weight loss (one year or longer) in overweight and obese adults. However, very low quality evidence points that this approach may induce positive changes in physical activity and dietary habits, such as increased in exercise duration and frequency, improvement in fruits and vegetables consumption, and reduced dietary fat intake.[53]
Medication
Anti-obesity medications currently approved by the FDA for weight loss
Several anti-obesity medications are currently approved by the FDA for long term use.[54][55][56]
- Semaglutide (Wegovy) is currently approved by the FDA for long-term use, being associated with a 6-12% loss in body weight compared to placebo.[57]
- The combination drug phentermine/topiramate (Qsymia) is approved by the FDA as an addition to a reduced-calorie diet and exercise for chronic weight management.[58]
- Orlistat reduces intestinal fat absorption by inhibiting pancreatic lipase. Over the longer term, average weight loss on orlistat is 2.9 kg (6.4 lb). It leads to a reduced incidence of diabetes, and has some effect on cholesterol. However, there is little information on how it affects the longer-term complications or outcomes of obesity.[13]
- Racemic amphetamine, phendimetrazine, diethylpropion, and phentermine are approved by the FDA for short term use.[55][59]
Other medications
- Bupropion, topiramate, and zonisamide are sometimes used off-label for weight loss.[55][59]
- The usefulness of certain drugs depends upon the comorbidities present. Metformin is preferred in overweight diabetics and for those gaining weight because taking clozapine for schizophrenia, as it may lead to mild weight loss in comparison to sulfonylureas or insulin.[60][61] The thiazolidinediones, on the other hand, may cause weight gain, but decrease central obesity.[62] Diabetics also achieve modest weight loss with fluoxetine and orlistat over 12–57 weeks.[63]
- Rimonabant (Acomplia), another drug, had been withdrawn from the market. It worked via a specific blockade of the endocannabinoid system. It has been developed from the knowledge that cannabis smokers often experience hunger, which is often referred to as "the munchies". It had been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to safety concerns.[64][65] European Medicines Agency in October 2008 recommended the suspension of the sale of rimonabant as the risk seem to be greater than the benefits.[66]
- Sibutramine (Meridia), which acts in the brain to inhibit deactivation of the neurotransmitters, thereby decreasing appetite was withdrawn from the UK market in January 2010 and United States and Canadian markets in October 2010 due to cardiovascular concerns.[56][67][68] In 2010 it was found that sibutramine increases the risk of heart attacks and strokes in people with a history of cardiovascular disease.[69][70]
- Fenfluramine and dexfenfluramine were withdrawn from the market in 1997,[55] while ephedrine (found in the traditional Chinese herbal medicine má huáng made from the Ephedra sinica) was removed from the market in 2004.[71]
- Lorcaserin used to be approved by the Food and Drug Administration for use in the treatment of obesity before being withdrawn due to cancer risk.[72]
- Recombinant human leptin is very effective in those with obesity due to congenital complete leptin deficiency via decreasing energy intake and possibly increases energy expenditure. This condition is, however, rare and this treatment is not effective for inducing weight loss in the majority of people with obesity. It is being investigated to determine whether or not it helps with weight loss maintenance.[73]
- Though hypothesized that supplementation of vitamin D may be an effective treatment for obesity, studies do not support this.[74] There is also no strong evidence to recommend herbal medicines for weight loss.[75]
Surgery
Bariatric surgery ("weight loss surgery") is the use of surgical intervention in the treatment of obesity. As every operation may have complications, surgery is only recommended for severely obese people (BMI > 40) who have failed to lose weight following dietary modification and pharmacological treatment. Weight loss surgery relies on various principles: the two most common approaches are reducing the volume of the stomach (e.g. by adjustable gastric banding and vertical banded gastroplasty), which produces an earlier sense of satiation, and reducing the length of bowel that comes into contact with food (e.g. by gastric bypass surgery or endoscopic duodenal-jejunal bypass surgery[76][77]), which directly reduces absorption. Band surgery is reversible, while bowel shortening operations are not. Some procedures can be performed laparoscopically. Complications from weight loss surgery are frequent.[78]
Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[8] A marked decrease in the risk of diabetes mellitus, cardiovascular disease and cancer has also been found after bariatric surgery.[8][79] Marked weight loss occurs during the first few months after surgery, and the loss is sustained in the long term. In one study there was an unexplained increase in deaths from accidents and suicide, but this did not outweigh the benefit in terms of disease prevention.[79] When the two main techniques are compared, gastric bypass procedures are found to lead to 30% more weight loss than banding procedures one year after surgery.[80] For obese individuals with non-alcoholic fatty liver disease (NAFLD), bariatric surgery improves or cures the liver.[81][82]
A preoperative diet such as low-calorie diets or very-low-calorie diet, is usually recommended to reduce liver volume by 16-20%, and preoperative weight loss is the only factor associated with postoperative weight loss.[83][84] Preoperative weight loss can reduce operative time and hospital stay.[83][85][86] although there is insufficient evidence whether preoperative weight loss may be beneficial to reduce long-term morbidity or complications.[86][87] Weight loss and decreases in liver size may be independent from the amount of calorie restriction.[84]
Ileojejunal bypass, in which the digestive tract is rerouted to bypass the small intestine, was an experimental surgery designed as a remedy for morbid obesity.
The effects of liposuction on obesity are less well determined. Some small studies show benefits[88] while others show none.[89] A treatment involving the placement of an intragastric balloon via gastroscopy has shown promise. One type of balloon led to a weight loss of 5.7 BMI units over 6 months or 14.7 kg (32 lb). Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.[90]
An implantable nerve simulator which improves the feeling of fullness was approved by the FDA in 2015.[91]
In 2016 the FDA approved an aspiration therapy device that siphons food from the stomach to the outside and decreases caloric intake.[92] As of 2015 one trial shows promising results.[93]
Health policy
Obesity is a complex public health and policy problem because of its prevalence, costs, and health effects.[94] As such, managing it requires changes in the wider societal context and effort by communities, local authorities, and governments.[95] Public health efforts seek to understand and correct the environmental factors responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct junk food marketing to children,[96] and decreasing access to sugar-sweetened beverages in schools.[97] The World Health Organization recommends the taxing of sugary drinks.[98] When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.[99]
Mass media campaigns seem to have limited effectiveness in changing behaviors that influence obesity. At the same time they can increase knowledge and awareness regarding physical activity and diet, which might lead to changes in the long term. Campaigns might also be able to reduce the amount of time spent sitting or lying down and positively affect the intention to be active physically.[100][101] Nutritional labelling with energy information on menus might be able to help reducing energy intake while dining in restaurants.[102]
Since there is a relationship between obesity and automobile travel, interventions relating to transportation infrastructure (for example, policy aimed at encouraging the use of public transportation) could potentially reduce obesity.[103][104]
Clinical protocols
Much of the Western world has created clinical practice guidelines in an attempt to address rising rates of obesity. Australia,[105] Canada,[5] the European Union,[106] and the United States[107] have all published statements since 2004.
In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:[107][needs update]
- People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
- If these goals are not achieved, pharmacotherapy can be offered. The person needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
- Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide.
- In people with a BMI over 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The person needs to be aware of the potential complications.
- Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.
A clinical practice guideline by the US Preventive Services Task Force (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a healthy diet in unselected people in primary care settings, but that intensive behavioral dietary counseling is recommended in those with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.[108][109] A survey of primary care physicians in the United States[110] found that although clinical guidelines do not consider overweight to be a risk factor that increases mortality,[111] physicians often report believing that being overweight increases all-cause mortality.
Canada developed and published evidence-based practice guidelines in 2006. The guidelines attempt to address the prevention and management of obesity at both the individual and population levels in both children and adults.[5] The European Union published clinical practice guidelines in 2008 in an effort to address the rising rates of obesity in Europe.[106] Australia came out with practice guidelines in 2004.[105]
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External links
Media related to Management of obesity at Wikimedia Commons