The Management of Obesity

Stunkard, Albert J.; Levine, Harold G.; Fox, Sonja

doi:10.1001/archinte.1970.00310060145021

Cited by 70 publications

(29 citation statements)

References 12 publications

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“…34 -36 Stunkard commented on this in 1958. 34 Kramer et al confirmed it in 1989. 35 Rosenbaum et al stated in 1997 that "approximately two thirds of persons who lose weight will regain it within one year, and almost all persons who lose weight will regain it within five years."…”

Section: Dietary Therapy For Obesity: An Emperor With No Clothesmentioning

confidence: 92%

“…21,27,29,34,36,47 In an era when we pride ourselves on practicing evidence-based medicine, why then does dietary and behavioral therapy still reign if it is "an emperor with no clothes"? I propose 4 reasons: (1) It is highly profitable for industry and academia; (2) It puts the responsibility for failure on the patient and not the physician; (3) We have not had effective and safe drug treatment for obesity; and (4) In the midst of an "epidemic", public health officials and physicians are loathe to acknowledge that we do not have effective prevention.…”

Section: The Paradox Of the Limitations And Dominance Of Dietary Therapymentioning

confidence: 99%

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Dietary Therapy for Obesity: An Emperor With No Clothes

Mark

2008

Hypertension

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T he prevalence of obesity has increased substantially in the past 3 decades and is projected to increase further in the years ahead. It increases the risk of diabetes mellitus, dyslipidemia, hypertension, cardiovascular disease, sleep apnea, nonalcoholic hepatic steatosis, gallbladder disease, osteoarthritis, and cancer. The prevention and treatment of obesity is, therefore, a leading challenge facing public health and medicine in the 21st century.Two stereotypes have dominated thinking in public health, medicine, and the media about obesity. The first stereotype is that the recent surge in prevalence of obesity reflects almost entirely environmental and psychological factors and excludes an important contribution of genetic biological factors. The second stereotype is that obesity should and can be treated primarily by diet and behavioral modification. In this review, I challenge these tenets.I summarize evidence for a strong genetic neurobiological contribution to adiposity and body weight and assert that common human obesity is, like essential hypertension, a complex multifactorial disease where genetic factors promote sensitivity or resistance to obesity in a toxic environment. This concept of a genetic resistance versus sensitivity to obesity helps explain why many people remain thin in a toxic environment whereas others develop profound obesity.I then discuss evidence that dietary therapy for obesity generally fails to achieve weight loss maintenance. There is mounting indication that the high rate of relapse from weight loss during dietary therapy occurs because of compensatory biological adaptations that promote lack of compliance and effectiveness. Relapse from weight loss during dietary therapy is not caused simply by lack of discipline and will power.Finally, I briefly discuss the alternatives to dietary and behavioral therapy, namely bariatric surgery and pharmacotherapy.As a prelude to my critique of dietary therapy, I begin with a discussion of the role of genetic neurobiological factors in obesity. Contributors to the Increase in Obesity: The Role of Genetic Neurobiological FactorsThe surge in the prevalence of obesity in recent decades, during a time when the gene pool has not changed, has led to the view that environmental changes are the overwhelming contributors to the so-called obesity epidemic. The "Big Two" environmental factors, are said to be: (1) Unending overnutrition related to ubiquitous abundance of low cost/high calorie foods and (2) increasingly sedentary occupations and immobilizing technologies including computers, automobiles, television, and elevators that decrease caloric expenditure. 1 The emphasis on a "toxic environment" in the obesity epidemic has overshadowed evidence for a strong genetic neurobiological contribution to adiposity and body mass in humans. Evidence is mounting that these two factors-a toxic environment and genetic influences-are not mutually exclusive contributors to obesity. Instead, genetic factors can promote either sensitivity or resistance to obesity ...

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Section: Dietary Therapy For Obesity: An Emperor With No Clothesmentioning

confidence: 92%

Section: The Paradox Of the Limitations And Dominance Of Dietary Therapymentioning

confidence: 99%

Dietary Therapy for Obesity: An Emperor With No Clothes

Mark

2008

Hypertension

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“…Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it'. 5 In 1993, Wadden updated this review and examined both the shortand long-term effectiveness of both moderate and severe caloric restriction on weight loss as determined by randomized controlled trials (RCTs). 6 He examined all the studies involving RCTs in four behavioural journals and compared his ®ndings to those of Stunkard.…”

Section: Introductionmentioning

confidence: 99%

The correlates of long-term weight loss: a group comparison study of obesity

Ogden

2000

Int J Obes

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OBJECTIVE: Although the majority of weight loss attempts are unsuccessful, a small minority succeed in both weight loss and maintenance. The present study aimed to explore the correlates of this success. METHOD: A group comparison design was used to examine differences between women who were classi®ed as either weight loss maintainers (had been obese (body mass index, BMI 30 kgam 2 ) and had lost weight to be considered non-obese (BMI`30 kgam 2 ) and maintained this weight loss for a minimum of 3 y; n 44), stable obese (maintained an obese weight (BMI 30 kgam 2 ) for longer than 3 y; n 58), and weight loss regainers (been obese (BMI 30 kgam 2 ), lost suf®cient weight to be considered non-obese (BMI`30 kgam 2 ) and regained it (BMI 30 kgam 2 ), n 40). In particular, the study examined differences in pro®le characteristics, historical factors, help-seeking behaviours and psychological factors. RESULTS: The results showed that in terms of pro®le and historical factors, the weight loss maintainers had been lighter, were currently older and had dieted for longer than the other groups but were matched in terms of age, class and ethnic group. In terms of help-seeking behaviours, the weight loss maintainers reported having tried healthy eating more frequently but were comparable to the other subjects in terms of professionals contacted. Finally, for psychological factors the weight loss maintainers reported less endorsement for medical causes of obesity, greater endorsement for psychological consequences and indicated that they had been motivated to lose weight for psychological reasons. CONCLUSIONS: Weight loss and maintenance is particularly correlated with a psychological model of obesity. This has implications for improving the effectiveness of interventions and the potential impact of current interest in medical approaches to obesity.

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“…Predictably, fasting produces short-term losses in adults and in adolescents56' 57 but recidivism prevails in the long-term follow-up with fasting with adolescents. Nathan and Pisula,58 in working with 15 adolescents ranging in age from 12 to 16 years, found that all but two regained weight after eight to 24 months. In fact, all but four equaled or excelled their admission weight.…”

Section: Therapeutic Starvationmentioning

confidence: 99%