Management Of Obesity

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. The main treatment for obesity consists of weight loss via healthy nutrition and increasing physical exercise. The most effective treatment for obesity is bariatric surgery. Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.

Dieting

Diets to promote weight loss can be divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low-calorie. Many dietary patterns are effective. A meta-analysis of six randomized controlled trials found no difference between three of the main diet types with a 2–4 kilograms (4.4–8.8 lb) weight loss in all studies. At two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized. High protein diets do not appear to make any difference. A diet high in added sugars such as those in soft drinks increases weight. There is evidence that dieting alone can be effective for weight loss and improving health for obese individuals.

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. Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel. 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. 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.

Medication

Several anti-obesity medications are currently approved by the FDA for long-term use. Orlistat reduces intestinal fat absorption by inhibiting pancreatic lipase. 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 and it is approved by the Food and Drug Administration for use in the treatment of obesity. Side effects may include serotonin syndrome. 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.

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, which produces an earlier sense of satiation, and reducing the length of bowel that comes into contact with food, 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.