Management of obesity

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Human body weight
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Obesity-associated morbidity
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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]

  1. ^ Chiolero A (October 2018). "Why causality, and not prediction, should guide obesity prevention policy". The Lancet. Public Health. 3 (10): e461–e462. doi:10.1016/S2468-2667(18)30158-0. PMID 30177480.
  2. ^ US Department of Health and Human Services. (2017). "2015–2020 Dietary Guidelines for Americans - health.gov". health.gov. Skyhorse Publishing Inc. Retrieved 30 September 2019.
  3. ^ Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. (September 2019). "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". Circulation. 140 (11): e596–e646. doi:10.1161/CIR.0000000000000678. PMC 7734661. PMID 30879355.
  4. ^ a b Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. (June 2014). "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". Circulation. 129 (25 Suppl 2): S102–S138. doi:10.1161/01.cir.0000437739.71477.ee. PMC 5819889. PMID 24222017.
  5. ^ Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]". CMAJ. 176 (8): S1-13. doi:10.1503/cmaj.061409. PMC 1839777. PMID 17420481.
  6. ^ Poobalan AS, Aucott LS, Smith WC, Avenell A, Jung R, Broom J (November 2007). "Long-term weight loss effects on all cause mortality in overweight/obese populations". Obesity Reviews. 8 (6): 503–513. doi:10.1111/j.1467-789X.2007.00393.x. PMID 17949355. S2CID 42859237.
  7. ^ Colquitt JL, Pickett K, Loveman E, Frampton GK (August 2014). "Surgery for weight loss in adults". The Cochrane Database of Systematic Reviews. 2014 (8): CD003641. doi:10.1002/14651858.CD003641.pub4. PMC 9028049. PMID 25105982.
  8. ^ Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al. (August 2007). "Effects of bariatric surgery on mortality in Swedish obese subjects". The New England Journal of Medicine. 357 (8): 741–752. doi:10.1056/NEJMoa066254. PMID 17715408. S2CID 20533869.
  9. ^ Peeters A, O'Brien PE, Laurie C, Anderson M, Wolfe R, Flum D, et al. (December 2007). "Substantial intentional weight loss and mortality in the severely obese". Annals of Surgery. 246 (6): 1028–1033. doi:10.1097/SLA.0b013e31814a6929. PMID 18043106. S2CID 21151854.
  10. ^ Office of the Commissioner (2021-06-21). "FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014". FDA. Retrieved 2022-07-21.
  11. ^ Wilding JP, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. (March 2021). "Once-Weekly Semaglutide in Adults with Overweight or Obesity". The New England Journal of Medicine. 384 (11): 989–1002. doi:10.1056/NEJMoa2032183. PMID 33567185. S2CID 231883214.
  12. ^ a b Cite error: The named reference Thom2017 was invoked but never defined (see the help page).
  13. ^ a b Rucker D, Padwal R, Li SK, Curioni C, Lau DC (December 2007). "Long term pharmacotherapy for obesity and overweight: updated meta-analysis". BMJ. 335 (7631): 1194–1199. doi:10.1136/bmj.39385.413113.25. PMC 2128668. PMID 18006966.
  14. ^ Cite error: The named reference Wing2005 was invoked but never defined (see the help page).
  15. ^ Cite error: The named reference Anderson2001 was invoked but never defined (see the help page).
  16. ^ Katzmarzyk PT, Martin CK, Newton RL, Apolzan JW, Arnold CL, Davis TC, et al. (September 2020). "Weight Loss in Underserved Patients - A Cluster-Randomized Trial". The New England Journal of Medicine. 383 (10): 909–918. doi:10.1056/NEJMoa2007448. PMC 7493523. PMID 32877581.
  17. ^ Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. (May 2012). "Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence". BMJ. 344: e2088. doi:10.1136/bmj.e2088. PMC 3355191. PMID 22596383.