The management of obesity

Abstract

The prevalence and incidence of obesity is rising as current ways of managing obesity are proving to be ineffective. The preferred approach is to induce an energy deficit by decreasing energy intake through a low calorie diet and increasing energy expenditure through exercise. In order to provoke body weight loss the changes in lifestyle that this approach involves have to be sustained and while some individuals have the motivation to do this the vast majority of the population has not. Very low calorie diets are ineffective as the body adapts to them by lowering energy expenditure and altering the macronutrient composition of low calorie diets has no additional effect. The anti-obesity drugs orlistat, sibutramine and rimonabant can provoke body weight loss but all suffer from side effects. However, the explosion in our understanding of the factors that regulate energy intake is likely to lead to the development of more effective drugs with fewer side effects. Bariatric or weight reducing surgery is highly effective at provoking body weight loss but there are obvious barriers to its widespread use.