A Review of Evidence‐Based Strategies to Treat Obesity in Adults

Abstract

Obesity, with its comorbidities, is a major public health problem. Population-based surveys estimate 2 of every 3 U.S. adults are overweight or obese. Despite billions of dollars spent annually on weight loss attempts, recidivism is high and long-term results are disappointing. In simplest terms, weight loss and maintenance depend on energy balance, and a combination of increased energy expenditure by exercise and decreased energy intake through caloric restriction is the mainstay of behavioral interventions. Many individuals successfully lose 5%-10% of body weight through behavioral approaches and thereby significantly improve health. Similar success occurs with some weight loss prescriptions, although evidence for successful weight loss with over-the-counter medications and supplements is weak. Commercial weight loss programs have helped many individuals achieve their goals, although few programs have been carefully evaluated and compared, limiting recommendations of one program over another. For the very obese, bariatric surgery is an option that leads to significant weight loss and improved health, although risks must be carefully weighed. Lifestyle changes, including regular physical activity, healthy food choices, and portion control, must be adopted, regardless of the weight loss approach, which requires ongoing support. Patients can best decide the appropriate approach working with a multidisciplinary team, including their health care provider and experts in nutrition, exercise, and behavioral intervention.

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

“…In both studies, the LVEFs of the surgery and control groups were normal at baseline and similar at follow-up. 231,248 Although severe HF or systolic dysfunction is considered a general contraindication to bariatric surgery, 228,249 a few notable studies have investigated its safety and efficacy in obese patients with HF. 232,243,244,250 In a retrospective study of 14 patients with HFrEF who underwent bariatric surgery (10 with laparoscopic Roux-en-Y gastric bypass) and had a decrease in mean BMI from 50.8 ± 2.04 to 36.8 ± 1.72 kg/m 2 , significant improvement in LVEF from 23±2% to 32±4% (P=0.04) was noted at 6 months.…”

“…Currently, only 3 weight-loss medications are approved by the US Food and Drug Administration for the long-term treatment of overweight and obesity (BMI ≥27 kg/m 2 ) in the US general population: orlistat, the recently approved lorcaserin, 231,[242][243][244] and the combination pill of phentermine and topiramate. 245 Orlistat, a lipase inhibitor, has been tested in a small population of obese patients with HF.…”

Psychologists partnering with obstetricians and gynecologists: Meeting the need for patient-centered models of women’s health care delivery.

“…For example, behavioral smoking cessation interventions have been found to reduce low birth weight and preterm births among pregnant women (Lumley et al, 2009). Moreover, multidisciplinary teams including the provider, psychologist, and specialists in nutrition and exercise have been found to be optimal for effective treatment of obesity (Laddu, Dow, Hingle, Thomson, & Going, 2011).…”

Effects of self-conditioning techniques in promoting weight loss in patients with severe obesity: a randomized controlled trial protocol

“…[2][3] Usually, overweight/obese individuals resume wrong lifestyle habits, such as overeating, unhealthy diets, and physical inactivity. the meals, often overcoming known homeostatic mechanisms, including gastrointestinal and central nervous system satiation signals.…”