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.[1]

Part of a series on
Human body weight
General concepts
Medical concepts
Measurements
Related conditions
Obesity-associated morbidity
Management of obesity
Social aspects

The main treatment for obesity 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% of 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] 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]

Dieting
Main article: Dieting
Treatment selection based on BMI[18][19]
Treatment 25-26.9 27-29.9 30-34.9 35-39.9 ≥40
Lifestyle intervention
(diet, physical activity,
behavior)		 Yes Yes Yes Yes Yes
Pharmacotherapy Not appropriate With co-morbidities Yes Yes Yes
Surgery Not appropriate Not appropriate Not appropriate With co-morbidities Yes

Diets to promote weight loss can be divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie.[20] Many dietary patterns are effective.[4] A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilograms (4.4–8.8 lb) weight loss in all studies.[20] At two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized.[21] High protein diets do not appear to make any difference.[22] A diet high in added sugars such as those in soft drinks increases weight.[23] There is evidence that dieting alone can be effective for weight loss and improving health for obese individuals.[4][12]

Dieting for calorie restriction is advised for overweight individuals by the Dietary Guidelines for Americans and United Kingdom's NICE.[2][3][4][24]

Exercise
See also: Physical 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.[25] Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel.[26][27] 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.[28] 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. During 20 weeks of basic military training with no dietary restriction, obese military recruits lost 12.5 kg (28 lb).[29] High levels of physical activity seem to be necessary to maintain weight loss.[30] A pedometer appears useful for motivation. Over an average of 18-weeks of use physical activity increased by 27% resulting in a 0.38 decreased in BMI.[31]

Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population.[32] The city of Bogota, Colombia for example blocks off 113 kilometers (70 mi) of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.[33]

In an effort to combat the issue, a primary school in Australia instituted a standing classroom in 2013.[34]

There is evidence that exercise alone is not sufficient to produce meaningful weight loss, but combining dieting and exercise provide the greatest health benefits and weight loss on the long term.[4][12]

Weight loss programs

Weight loss programs involve lifestyle changes including diet modifications, physical activity and behavior therapy. This may involve eating smaller meals, cutting down on certain types of food, and making a conscious effort to exercise more. These programs also enable people to connect with a group of others who are attempting to lose weight, in the hopes that participants will form mutually motivating and encouraging relationships.[35] Since 2013, the United States guidelines recommend to treat obesity as a disease and actively treat obese people for weight loss.[4]

A number of popular programs exist, including Weight Watchers, Overeaters Anonymous, and Jenny Craig. These appear to provide modest weight loss (2.9 kg; 6.4 lb) over dieting on one's own (0.2 kg; 0.44 lb) over a two-year period,[12][36][37][38][39] similarly to non-commercial diets.[4][12] Internet-based programs appear to be ineffective.[40] The Chinese government has introduced a number of "fat farms" where obese children go for reinforced exercise, and has passed a law which requires students to exercise or play sports for an hour a day at school (see Obesity in China).[41][42]

In a structured setting with a trained therapist, these interventions produce an average weight loss of up to 8 kg in 6 months to 1 year,[4] and 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later.[43] There is a gradual weight regain after the first year of about 1 to 2 kg per year, but on the long-term this still results in a weight loss.[4]

Attending group meetings for weight reduction programmes rather than receiving one-on-one support may increase the likelihood that obese people will lose weight. Those who participated in groups had more treatment time and were more likely to lose enough weight to improve their health. Study authors suggested that one explanation for the difference is that group participants spent more time with the clinician (or whoever delivered the programme) than those receiving one-on-one support.[44][45]

Comprehensive diet programs, providing counseling, targets for calorie intake and exercise, may be more efficient than dieting without guidance ("self-help"),[12][46][47] although the evidence is very limited.[48] Following comprehensive lifestyle modifications, the average maintained weight loss is more than 3 kg (6.6 lb) or 3% of total body mass, and could be sustained for five years,[15] and up to 20% of the individuals maintain a weight loss of at least 10% (average of 33 kg).[14] There is some evidence that fast weight loss produce greater long-term weight loss than gradual weight loss.[12][15] Moderate on-site comprehensive lifestyle changes produce a greater weight loss than usual care, of 2 to 4 kg on average in 6 to 12 months.[4] High-intensity comprehensive programs usually yield more weight loss than moderate or low-intensity, with about 35% to 60% of overweight individuals maintaining more than 5 kg weight loss after 2 years.[4]

The NICE devised a set of essential criteria to be met by commercial weight management organizations to be approved.[49]

The Transtheoretical Model (TTM) has been used as a framework to assist the design of lifestyle modification programmes, including weight management. A systematic review found that there is insufficient evidence to draw conclusions regarding the effects of TTM-based programs targeting weight loss that included dietary or physical activity interventions, or both (and also combined with other interventions), on sustainable weight loss (one year or longer) in overweight and obese adults. However, very low quality evidence points that this approach may induce positive changes in physical activity and dietary habits, such as increased in exercise duration and frequency, improvement in fruits and vegetables consumption, and reduced dietary fat intake.[50]

Medication
Main article: Anti-obesity medication
Orlistat (Xenical) the most commonly used medication to treat obesity and sibutramine (Meridia) a withdrawn medication due to cardiovascular side effects

Anti-obesity medications currently approved by the FDA for weight loss

Several anti-obesity medications are currently approved by the FDA for long term use.[51][52][53]

  • Semaglutide (Wegovy) is currently approved by the FDA for long-term use, being associated with a 6-12% loss in body weight compared to placebo.[54]
  • 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.[55]
  • Orlistat reduces intestinal fat absorption by inhibiting pancreatic lipase. Over the longer term, average weight loss on orlistat is 2.9 kg (6.4 lb). It leads to a reduced incidence of diabetes, and has some effect on cholesterol. However, there is little information on how it affects the longer-term complications or outcomes of obesity.[13]
  • Racemic amphetamine, phendimetrazine, diethylpropion, and phentermine are approved by the FDA for short term use.[52][56]

Other medications
  • Bupropion, topiramate, and zonisamide are sometimes used off-label for weight loss.[52][56]
  • The usefulness of certain drugs depends upon the comorbidities present. Metformin is preferred in overweight diabetics, as it may lead to mild weight loss in comparison to sulfonylureas or insulin.[57] The thiazolidinediones, on the other hand, may cause weight gain, but decrease central obesity.[58] Diabetics also achieve modest weight loss with fluoxetine and orlistat over 12–57 weeks. [59]
  • Rimonabant (Acomplia), another drug, had been withdrawn from the market. It worked via a specific blockade of the endocannabinoid system. It has been developed from the knowledge that cannabis smokers often experience hunger, which is often referred to as "the munchies". It had been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to safety concerns.[60][61] European Medicines Agency in October 2008 recommended the suspension of the sale of rimonabant as the risk seem to be greater than the benefits.[62]
  • Sibutramine (Meridia), which acts in the brain to inhibit deactivation of the neurotransmitters, thereby decreasing appetite was withdrawn from the UK market in January 2010 and United States and Canadian markets in October 2010 due to cardiovascular concerns.[53][63][64] In 2010 it was found that sibutramine increases the risk of heart attacks and strokes in people with a history of cardiovascular disease.[65][66]
  • Fenfluramine and dexfenfluramine were withdrawn from the market in 1997,[52] while ephedrine (found in the traditional Chinese herbal medicine má huáng made from the Ephedra sinica) was removed from the market in 2004.[67]
  • Lorcaserin used to be approved by the Food and Drug Administration for use in the treatment of obesity before being withdrawn due to cancer risk.[68]
  • Recombinant human leptin is very effective in those with obesity due to congenital complete leptin deficiency via decreasing energy intake and possibly increases energy expenditure. This condition is, however, rare and this treatment is not effective for inducing weight loss in the majority of people with obesity. It is being investigated to determine whether or not it helps with weight loss maintenance.[69]
  • Though hypothesized that supplementation of vitamin D may be an effective treatment for obesity, studies do not support this.[70] There is also no strong evidence to recommend herbal medicines for weight loss.[71]

Surgery
Main article: Bariatric 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 (e.g. by adjustable gastric banding and vertical banded gastroplasty), which produces an earlier sense of satiation, and reducing the length of bowel that comes into contact with food (e.g. by gastric bypass surgery or endoscopic duodenal-jejunal bypass surgery[72][73]), 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.[74]

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] A marked decrease in the risk of diabetes mellitus, cardiovascular disease and cancer has also been found after bariatric surgery.[75][76] Marked weight loss occurs during the first few months after surgery, and the loss is sustained in the long term. In one study there was an unexplained increase in deaths from accidents and suicide, but this did not outweigh the benefit in terms of disease prevention.[76] When the two main techniques are compared, gastric bypass procedures are found to lead to 30% more weight loss than banding procedures one year after surgery.[77] For obese individuals with non-alcoholic fatty liver disease (NAFLD), bariatric surgery improves or cures the liver.[78][79]

A preoperative diet such as low-calorie diets or very-low-calorie diet, is usually recommended to reduce liver volume by 16-20%, and preoperative weight loss is the only factor associated with postoperative weight loss.[80][81] Preoperative weight loss can reduce operative time and hospital stay.[80][82][83] although there is insufficient evidence whether preoperative weight loss may be beneficial to reduce long-term morbidity or complications.[83][84] Weight loss and decreases in liver size may be independent from the amount of calorie restriction.[81]

Ileojejunal bypass, in which the digestive tract is rerouted to bypass the small intestine, was an experimental surgery designed as a remedy for morbid obesity.

The effects of liposuction on obesity are less well determined. Some small studies show benefits[85] while others show none.[86] A treatment involving the placement of an intragastric balloon via gastroscopy has shown promise. One type of balloon led to a weight loss of 5.7 BMI units over 6 months or 14.7 kg (32 lb). Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.[87]

An implantable nerve simulator which improves the feeling of fullness was approved by the FDA in 2015.[88]

In 2016 the FDA approved an aspiration therapy device that siphons food from the stomach to the outside and decreases caloric intake.[89] As of 2015 one trial shows promising results.[90]

Clinical protocols

Much of the Western world has created clinical practice guidelines in an attempt to address rising rates of obesity. Australia,[91] Canada,[5] the European Union,[92] and the United States[93] have all published statements since 2004.

In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:[93]

  1. People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
  2. If these goals are not achieved, pharmacotherapy can be offered. The person needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
  3. Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide.
  4. In people with a BMI over 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The person needs to be aware of the potential complications.
  5. Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.

A clinical practice guideline by the US Preventive Services Task Force (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a healthy diet in unselected people in primary care settings, but that intensive behavioral dietary counseling is recommended in those with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.[94][95]

Canada developed and published evidence-based practice guidelines in 2006. The guidelines attempt to address the prevention and management of obesity at both the individual and population levels in both children and adults.[5] The European Union published clinical practice guidelines in 2008 in an effort to address the rising rates of obesity in Europe.[92] Australia came out with practice guidelines in 2004.[91]

References
  1. Chiolero, Arnaud (2018-10-01). "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. ISSN 2468-2667. 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, Donna K.; Blumenthal, Roger S.; Albert, Michelle A.; Buroker, Andrew B.; Goldberger, Zachary D.; Hahn, Ellen J.; Himmelfarb, Cheryl D.; Khera, Amit; Lloyd-Jones, Donald; McEvoy, J. William; Michos, Erin D.; Miedema, Michael D.; Muñoz, Daniel; Smith, Sidney C.; Virani, Salim S.; Williams, Kim A.; Yeboah, Joseph; Ziaeian, Boback (17 March 2019). "2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease". Circulation. 140 (11): e596–e646. doi:10.1161/CIR.0000000000000678. PMC 7734661. PMID 30879355.
  4. Jensen, MD; Ryan, DH; Apovian, CM; Ard, JD; Comuzzie, AG; Donato, KA; Hu, FB; Hubbard, VS; Jakicic, JM; Kushner, RF; Loria, CM; Millen, BE; Nonas, CA; Pi-Sunyer, FX; Stevens, J; Stevens, VJ; Wadden, TA; Wolfe, BM; Yanovski, SZ; Jordan, HS; Kendall, KA; Lux, LJ; Mentor-Marcel, R; Morgan, LC; Trisolini, MG; Wnek, J; Anderson, JL; Halperin, JL; Albert, NM; Bozkurt, B; Brindis, RG; Curtis, LH; DeMets, D; Hochman, JS; Kovacs, RJ; Ohman, EM; Pressler, SJ; Sellke, FW; Shen, WK; Smith SC, Jr; Tomaselli, GF (24 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): S102-38. 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; Douketis; Morrison; Hramiak; Sharma; Ur; Obesity Canada Clinical Practice Guidelines Expert Panel (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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. Poobalan AS, Aucott LS, Smith WC, Avenell A, Jung R, Broom J; Aucott; Smith; Avenell; Jung; Broom (November 2007). "Long-term weight loss effects on all cause mortality in overweight/obese populations". Obes Rev. 8 (6): 503–13. doi:10.1111/j.1467-789X.2007.00393.x. PMID 17949355. S2CID 42859237.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. Colquitt, JL; Pickett, K; Loveman, E; Frampton, GK (Aug 8, 2014). "Surgery for weight loss in adults". The Cochrane Database of Systematic Reviews. 8 (8): CD003641. doi:10.1002/14651858.CD003641.pub4. PMC 9028049. PMID 25105982.
  8. Sjöström L; Narbro K; Sjöström CD; et al. (August 2007). "Effects of bariatric surgery on mortality in Swedish obese subjects". N. Engl. J. Med. 357 (8): 741–52. doi:10.1056/NEJMoa066254. PMID 17715408. S2CID 20533869.
  9. Peeters A; O'Brien PE; Laurie C; et al. (December 2007). "Substantial intentional weight loss and mortality in the severely obese". Ann. Surg. 246 (6): 1028–33. doi:10.1097/SLA.0b013e31814a6929. PMID 18043106. S2CID 21151854.
  10. Commissioner, Office of the (2021-06-21). "FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014". FDA. Retrieved 2022-07-21.
  11. Wilding, John P.H.; Batterham, Rachel L.; Calanna, Salvatore; Davies, Melanie; Van Gaal, Luc F.; Lingvay, Ildiko; McGowan, Barbara M.; Rosenstock, Julio; Tran, Marie T.D.; Wadden, Thomas A.; Wharton, Sean (2021-03-18). "Once-Weekly Semaglutide in Adults with Overweight or Obesity". New England Journal of Medicine. 384 (11): 989–1002. doi:10.1056/NEJMoa2032183. ISSN 0028-4793. PMID 33567185. S2CID 231883214.
  12. Thom, G; Lean, M (May 2017). "Is There an Optimal Diet for Weight Management and Metabolic Health?" (PDF). Gastroenterology (Review). 152 (7): 1739–1751. doi:10.1053/j.gastro.2017.01.056. PMID 28214525.
  13. Rucker D, Padwal R, Li SK, Curioni C, Lau DC; Padwal; Li; Curioni; Lau (2007). "Long term pharmacotherapy for obesity and overweight: Updated meta-analysis". BMJ. 335 (7631): 1194–99. doi:10.1136/bmj.39385.413113.25. PMC 2128668. PMID 18006966.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. Wing, Rena R; Phelan, Suzanne (1 July 2005). "Science-Based Solutions to Obesity: What are the Roles of Academia, Government, Industry, and Health Care? Proceedings of a symposium, Boston, Massachusetts, USA, 10–11 March 2004 and Anaheim, California, USA, 2 October 2004". Am. J. Clin. Nutr. 82 (1 Suppl): 207S–273S. doi:10.1093/ajcn/82.1.222S. PMID 16002825.
  15. Anderson JW, Konz EC, Frederich RC, Wood CL; Konz; Frederich; Wood (1 November 2001). "Long-term weight-loss maintenance: A meta-analysis of US studies". Am. J. Clin. Nutr. (Meta-analysis). 74 (5): 579–84. doi:10.1093/ajcn/74.5.579. PMID 11684524.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. Katzmarzyk, Peter T.; Martin, Corby K.; Newton, Robert L.; Apolzan, John W.; Arnold, Connie L.; Davis, Terry C.; Price-Haywood, Eboni G.; Denstel, Kara D.; Mire, Emily F.; Thethi, Tina K.; Brantley, Phillip J.; Johnson, William D.; Fonseca, Vivian; Gugel, Jonathan; Kennedy, Kathleen B. (2020-09-03). "Weight Loss in Underserved Patients — A Cluster-Randomized Trial". New England Journal of Medicine. 383 (10): 909–918. doi:10.1056/NEJMoa2007448. ISSN 0028-4793. PMC 7493523. PMID 32877581.
  17. Thangaratinam, S; Rogozinska, E; Jolly, K; Glinkowski, S; Roseboom, T; Tomlinson, JW; Kunz, R; Mol, BW; Coomarasamy, A; Khan, KS (May 16, 2012). "Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence". BMJ (Clinical Research Ed.). 344: e2088. doi:10.1136/bmj.e2088. PMC 3355191. PMID 22596383.
  18. Matarese, Laura E.; Pories, Walter J. (December 2014). "Adult weight loss diets: metabolic effects and outcomes". Nutrition in Clinical Practice (Review). 29 (6): 759–767. doi:10.1177/0884533614550251. ISSN 1941-2452. PMID 25293593.
  19. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (National guidelines). National Institutes of Health, National Heart, Lung, and Blood Institute, NHLBI Obesity Education Initiative, North American Association for the Study of Obesity. 2000.
  20. Strychar I (January 2006). "Diet in the management of weight loss". CMAJ. 174 (1): 56–63. doi:10.1503/cmaj.045037. PMC 1319349. PMID 16389240.
  21. Sacks FM; Bray GA; Carey VJ; et al. (February 2009). "Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates". N. Engl. J. Med. 360 (9): 859–73. doi:10.1056/NEJMoa0804748. PMC 2763382. PMID 19246357.
  22. Schwingshackl, L; Hoffmann, G (Apr 15, 2013). "Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis". Nutrition Journal. 12: 48. doi:10.1186/1475-2891-12-48. PMC 3636027. PMID 23587198.
  23. Te Morenga, L; Mallard, S; Mann, J (Jan 15, 2012). "Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies". BMJ (Clinical Research Ed.). 346: e7492. doi:10.1136/bmj.e7492. PMID 23321486.
  24. "Obesity: maintaining a healthy weight and preventing excess weight gain". pathways.nice.org.uk.
  25. Gwinup G (1987). "Weight loss without dietary restriction: Efficacy of different forms of aerobic exercise". Am J Sports Med. 15 (3): 275–9. doi:10.1177/036354658701500317. PMID 3618879. S2CID 1973279.
  26. Sahlin K, Sallstedt EK, Bishop D, Tonkonogi M (2008). "Turning down lipid oxidation during heavy exercise—what is the mechanism?". J. Physiol. Pharmacol. 59 (Suppl 7): 19–30. PMID 19258655.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  27. Haskell WL, Lee IM, Pate RR; et al. (August 2007). "Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association". Circulation. 116 (9): 1081–93. doi:10.1161/CIRCULATIONAHA.107.185649. PMID 17671237.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  28. Shaw K, Gennat H, O'Rourke P, Del Mar C; Gennat; O'Rourke; Del Mar (2006). "Exercise for overweight or obesity". Cochrane Database of Systematic Reviews. 2010 (4): 1–112. doi:10.1002/14651858.CD003817.pub3. PMC 9017288. PMID 17054187.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. Lee L, Kumar S, Leong LC; Kumar; Leong (February 1994). "The impact of five-month basic military training on the body weight and body fat of 197 moderately to severely obese Singaporean males aged 17 to 19 years". Int. J. Obes. Relat. Metab. Disord. 18 (2): 105–9. PMID 8148923.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. Bessesen DH (June 2008). "Update on obesity". J. Clin. Endocrinol. Metab. 93 (6): 2027–34. doi:10.1210/jc.2008-0520. PMID 18539769.
  31. Bravata DM; Smith-Spangler C; Sundaram V; et al. (November 2007). "Using pedometers to increase physical activity and improve health: a systematic review". JAMA: The Journal of the American Medical Association. 298 (19): 2296–304. doi:10.1001/jama.298.19.2296. PMID 18029834. S2CID 3008531.
  32. Kahn EB; Ramsey LT; Brownson RC; et al. (May 2002). "The effectiveness of interventions to increase physical activity. A systematic review". Am J Prev Med. 22 (4 Suppl): 73–107. doi:10.1016/S0749-3797(02)00434-8. PMID 11985936.
  33. "www.paho.org". Pan American Health Organization. Retrieved January 10, 2009.
  34. "World's first standing classroom launched in Australia - The Times of India". The Times Of India.
  35. Baron M (November 2004). "Commercial weight-loss programs". Health Care Food Nutr Focus. 21 (11): 8–9. PMID 15559885.
  36. Heshka S; Anderson JW; Atkinson RL; et al. (April 2003). "Weight loss with self-help compared with a structured commercial program: a randomized trial". JAMA. 289 (14): 1792–8. doi:10.1001/jama.289.14.1792. PMID 12684357.
  37. Atallah, R.; Filion, K. B.; Wakil, S. M.; Genest, J.; Joseph, L.; Poirier, P.; Rinfret, S.; Schiffrin, E. L.; Eisenberg, M. J. (11 November 2014). "Long-Term Effects of 4 Popular Diets on Weight Loss and Cardiovascular Risk Factors: A Systematic Review of Randomized Controlled Trials". Circulation: Cardiovascular Quality and Outcomes (Systematic review of RCTs). 7 (6): 815–827. doi:10.1161/CIRCOUTCOMES.113.000723. PMID 25387778.
  38. Vakil, RM; Doshi, RS; Mehta, AK; Chaudhry, ZW; Jacobs, DK; Lee, CJ; Bleich, SN; Clark, JM; Gudzune, KA (1 June 2016). "Direct comparisons of commercial weight-loss programs on weight, waist circumference, and blood pressure: a systematic review". BMC Public Health (Systematic review). 16: 460. doi:10.1186/s12889-016-3112-z. PMC 4888663. PMID 27246464.
  39. Gudzune, KA; Doshi, RS; Mehta, AK; Chaudhry, ZW; Jacobs, DK; Vakil, RM; Lee, CJ; Bleich, SN; Clark, JM (7 April 2015). "Efficacy of commercial weight-loss programs: an updated systematic review". Annals of Internal Medicine (Systematic review). 162 (7): 501–12. doi:10.7326/M14-2238. PMC 4446719. PMID 25844997.
  40. Tsai AG, Wadden TA; Wadden (January 2005). "Systematic review: an evaluation of major commercial weight loss programs in the United States". Annals of Internal Medicine. 142 (1): 56–66. doi:10.7326/0003-4819-142-1-200501040-00012. PMID 15630109. S2CID 2589699.
  41. Hewitt, Duncan (May 23, 2000). "China battles obesity". BBC. Retrieved August 8, 2009.
  42. MacLeod, Calum (August 1, 2007). "Obesity of China's kids stuns officials". USA Today. Retrieved August 8, 2009.
  43. Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK; Galuska; Kettel Khan; Gillespie; Serdula (July 2007). "Weight regain in U.S. adults who experienced substantial weight loss, 1999–2002". Am J Prev Med. 33 (1): 34–40. doi:10.1016/j.amepre.2007.02.040. PMID 17572309.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  44. "Group programmes for weight loss may be more effective than one-to-one sessions". NIHR Evidence (Plain English summary). 2021-08-27. doi:10.3310/alert_47460. S2CID 241732368.
  45. Abbott, S.; Smith, E.; Tighe, B.; Lycett, D. (2020-12-28). "Group versus one‐to‐one multi‐component lifestyle interventions for weight management: a systematic review and meta‐analysis of randomised controlled trials". Journal of Human Nutrition and Dietetics. 34 (3): 485–493. doi:10.1111/jhn.12853. ISSN 0952-3871. PMID 33368624. S2CID 229691531.
  46. Kernan, Walter N.; Inzucchi, Silvio E.; Sawan, Carla; Macko, Richard F.; Furie, Karen L. (January 2013). "Obesity - A Stubbornly Obvious Target for Stroke Prevention". Stroke (Review). 44 (1): 278–286. doi:10.1161/STROKEAHA.111.639922. PMID 23111440.
  47. Gudzune, KA; Doshi, RS; Mehta, AK; Chaudhry, ZW; Jacobs, DK; Vakil, RM; Lee, CJ; Bleich, SN; Clark, JM (April 7, 2015). "Efficacy of commercial weight-loss programs: an updated systematic review". Annals of Internal Medicine. 162 (7): 501–512. doi:10.7326/M14-2238. PMC 4446719. PMID 25844997.
  48. Allan, Karen (2018). "4.4 Group‐based interventions for weight loss in obesity.". In Hankey, Catherine (ed.). Advanced nutrition and dietetics in obesity. Wiley. pp. 164–168. ISBN 9780470670767.
  49. Avery, Amanda (2018). "4.7 Commercial weight management organisations for weight loss in obesity.". In Hankey, Catherine (ed.). Advanced nutrition and dietetics in obesity. Wiley. pp. 177–182. ISBN 9780470670767.
  50. Mastellos, Nikolaos; Gunn, Laura H; Felix, Lambert M; Car, Josip; Majeed, Azeem (2014-02-05). Cochrane Metabolic and Endocrine Disorders Group (ed.). "Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults". Cochrane Database of Systematic Reviews (2): CD008066. doi:10.1002/14651858.CD008066.pub3. PMID 24500864.
  51. "FDA approves Belviq to treat some overweight or obese adults". FDA. June 27, 2012. Retrieved 8 July 2012.
  52. "WIN – Publication – Prescription Medications for the Treatment of Obesity". National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. Archived from the original on January 13, 2009. Retrieved January 14, 2009.
  53. "www.fda.gov". Food and Drug Administration.
  54. Commissioner, Office of the (2021-06-21). "FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014". FDA. Retrieved 2022-07-19.
  55. "FDA approves weight-management drug Qsymia". Food and Drug Administration. July 17, 2012.
  56. "Evekeo Prescribing Information" (PDF). Arbor Pharmaceuticals LLC. April 2014. pp. 1–2. Retrieved 11 August 2015.
  57. UK Prospective Diabetes Study (UKPDS) Group (1998). "Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34)". Lancet. 352 (9131): 854–65. doi:10.1016/S0140-6736(98)07037-8. PMID 9742977. S2CID 19208426.
  58. Fonseca V (2003). "Effect of thiazolidinediones on body weight in patients with diabetes mellitus". Am. J. Med. 115 Suppl 8A (8): 42S–48S. doi:10.1016/j.amjmed.2003.09.005. PMID 14678865.
  59. Norris, Susan L; Zhang, Xuanping; Avenell, Alison; Gregg, Edward; Schmid, Christopher H; Lau, Joseph (2005-01-24). "Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus". The Cochrane Database of Systematic Reviews. 2005 (1): CD004096. doi:10.1002/14651858.CD004096.pub2. ISSN 1469-493X. PMC 6718205. PMID 15674929.
  60. "Anti-obesity drug no magic bullet". Canadian Broadcasting Corporation. January 2, 2007. Retrieved 2008-09-19.
  61. "FDA Briefing Document NDA 21-888 Zimulti (rimonabant) Tablets, 20 mg Sanofi Aventis Advisory Committee" (PDF). Food and Drug Administration. June 13, 2007. Retrieved 2008-09-19.
  62. "www.emea.europa.eu" (PDF).
  63. "Abbott Laboratories Voluntarily Withdraws Weight-loss Drug Sibutramine (Meridia) from the Canadian Market - Health Canada Information Update 2010-10-08". 2012-10-23.
  64. "www.nice.org.uk" (PDF). Archived from the original (PDF) on 2010-11-06.
  65. "Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review". Food and Drug Administration.
  66. James WP; Caterson ID; Coutinho W; et al. (September 2010). "Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects" (PDF). N. Engl. J. Med. 363 (10): 905–17. doi:10.1056/NEJMoa1003114. hdl:2437/111825. PMID 20818901.
  67. Rados C (2004). "Ephedra ban: no shortage of reasons". FDA Consum. 38 (2): 6–7. PMID 15101356.
  68. "Lorcaserin (Belviq) Withdrawn From US Market Due to Cancer Risk". Medscape. Retrieved 2022-07-19.
  69. Kelesidis T, Kelesidis I, Chou S, Mantzoros CS; Kelesidis; Chou; Mantzoros (January 2010). "Narrative review: the role of leptin in human physiology: emerging clinical applications". Annals of Internal Medicine. 152 (2): 93–100. doi:10.7326/0003-4819-152-2-201001190-00008. PMC 2829242. PMID 20083828.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  70. Pathak, K.; Soares, M. J.; Calton, E. K.; Zhao, Y.; Hallett, J. (2014-06-01). "Vitamin D supplementation and body weight status: a systematic review and meta-analysis of randomized controlled trials". Obesity Reviews. 15 (6): 528–537. doi:10.1111/obr.12162. ISSN 1467-789X. PMID 24528624. S2CID 8660739.
  71. Maunder, Alison; Bessell, Erica; Lauche, Romy; Adams, Jon; Sainsbury, Amanda; Fuller, Nicholas R. (2020-01-27). "Effectiveness of herbal medicines for weight loss: systematic review and meta-analysis of randomized controlled trials". Diabetes, Obesity & Metabolism. 22 (6): 891–903. doi:10.1111/dom.13973. ISSN 1463-1326. PMID 31984610.
  72. Sullivan, S. (2015). "Endoscopic Treatment of Obesity". In Jonnalagadda, S.S. (ed.). Gastrointestinal Endoscopy: New Technologies and Changing Paradigms. Springer. pp. 61–82. ISBN 9781493920327. Retrieved 18 March 2016.
  73. Muñoz, R.; Escalona, A. (2015). "Chapter 51: Endoscopic Duodenal-Jejunal Bypass Sleeve Treatment for Obesity". In Agrawal, S. (ed.). Obesity, Bariatric and Metabolic Surgery: A Practical Guide. Springer. pp. 493–498. ISBN 9783319043432. Retrieved 18 March 2016.
  74. Encinosa WE, Bernard DM, Chen CC, Steiner CA; Bernard; Chen; Steiner (2006). "Healthcare utilization and outcomes after bariatric surgery". Medical Care. 44 (8): 706–12. doi:10.1097/01.mlr.0000220833.89050.ed. PMID 16862031. S2CID 8434284.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  75. Sjöström L; Narbro K; Sjöström CD; et al. (2007). "Effects of bariatric surgery on mortality in Swedish obese subjects". N. Engl. J. Med. 357 (8): 741–52. doi:10.1056/NEJMoa066254. PMID 17715408. S2CID 20533869.
  76. Adams TD; Gress RE; Smith SC; et al. (2007). "Long-term mortality after gastric bypass surgery". N. Engl. J. Med. 357 (8): 753–61. doi:10.1056/NEJMoa066603. PMID 17715409. S2CID 8710295.
  77. Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD; Karliner; Walsh; Petersen; Feldman (October 2008). "Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures". Am. J. Med. 121 (10): 885–93. doi:10.1016/j.amjmed.2008.05.036. PMID 18823860.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  78. Chitturi, Shiv; Wong, Vincent Wai-Sun; Chan, Wah-Kheong; Wong, Grace Lai-Hung; Wong, Simon Kin-Hung; Sollano, Jose; Ni, Yen-Hsuan; Liu, Chun-Jen; Lin, Yu-Cheng; Lesmana, Laurentius Adrianto; Kim, Seung Up (2018-07-10). "The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 2: Management and special groups". Journal of Gastroenterology and Hepatology. 33 (1): 86–98. doi:10.1111/jgh.13856. ISSN 1440-1746. PMID 28692197. S2CID 29648173.
  79. Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK (December 2008). "Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis". Clinical Gastroenterology and Hepatology. 6 (12): 1396–402. doi:10.1016/j.cgh.2008.08.012. PMID 18986848.
  80. Thorell, A; MacCormick, AD; Awad, S; Reynolds, N; Roulin, D; Demartines, N; Vignaud, M; Alvarez, A; Singh, PM; Lobo, DN (September 2016). "Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations". World Journal of Surgery (Professional society guidelines). 40 (9): 2065–83. doi:10.1007/s00268-016-3492-3. PMID 26943657.
  81. Holderbaum, M; Casagrande, DS; Sussenbach, S; Buss, C (February 2018). "Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review". Surgery for Obesity and Related Diseases (Systematic review). 14 (2): 237–244. doi:10.1016/j.soard.2017.09.531. PMID 29239795.
  82. Livhits, M; Mercado, C; Yermilov, I; Parikh, JA; Dutson, E; Mehran, A; Ko, CY; Gibbons, MM (2008). "Does weight loss immediately before bariatric surgery improve outcomes: a systematic review". Surgery for Obesity and Related Diseases. 5 (6): 713–21. doi:10.1016/j.soard.2009.08.014. PMID 19879814.
  83. Roman, M; Monaghan, A; Serraino, GF; Miller, D; Pathak, S; Lai, F; Zaccardi, F; Ghanchi, A; Khunti, K; Davies, MJ; Murphy, GJ (February 2019). "Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes". The British Journal of Surgery (Meta-analysis). 106 (3): 181–189. doi:10.1002/bjs.11001. hdl:2381/43636. PMID 30328098.
  84. Cassie, S; Menezes, C; Birch, DW; Shi, X; Karmali, S (2010). "Effect of preoperative weight loss in bariatric surgical patients: a systematic review". Surgery for Obesity and Related Diseases (Systematic review). 7 (6): 760–7, discussion 767. doi:10.1016/j.soard.2011.08.011. PMID 21978748.
  85. Giugliano G; Nicoletti G; Grella E; et al. (April 2004). "Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women". Br J Plast Surg. 57 (3): 190–4. doi:10.1016/j.bjps.2003.12.010. PMID 15006519.
  86. Klein S; Fontana L; Young VL; et al. (June 2004). "Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease". N. Engl. J. Med. 350 (25): 2549–57. doi:10.1056/NEJMoa033179. PMID 15201411.
  87. Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J; Martínez-Cervell; García-Alvarez; Sendra-Gutiérrez; González-Enríquez (July 2008). "Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis". Obes Surg. 18 (7): 841–6. doi:10.1007/s11695-007-9331-8. PMID 18459025. S2CID 10220216.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  88. "FDA approves first-of-kind device to treat obesity". fda.gov. January 14, 2015. Retrieved 18 January 2015.
  89. FDA release. June 14, 2016
  90. Kumar, N (25 July 2015). "Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration". World Journal of Gastrointestinal Endoscopy. 7 (9): 847–59. doi:10.4253/wjge.v7.i9.847. PMC 4515419. PMID 26240686.
  91. "Obesity Guidelines Website". Australian Government Department of Health and Ageing. Retrieved Oct 25, 2009.
  92. Tsigosa Constantine; Hainer, Vojtech; Basdevant, Arnaud; Finer, Nick; Fried, Martin; Mathus-Vliegen, Elisabeth; Micic, Dragan; Maislos, Maximo; et al. (April 2008). "Management of Obesity in Adults: European Clinical Practice Guidelines". The European Journal of Obesity. 1 (2): 106–16. doi:10.1159/000126822. PMC 6452117. PMID 20054170.
  93. Snow V, Barry P, Fitterman N, Qaseem A, Weiss K; Barry; Fitterman; Qaseem; Weiss; Clinical Efficacy Assessment Subcommittee of the American College of Physicians (2005). "Pharmacologic and surgical management of obesity in primary care: A clinical practice guideline from the American College of Physicians". Annals of Internal Medicine. 142 (7): 525–31. doi:10.7326/0003-4819-142-7-200504050-00011. PMID 15809464.{{cite journal}}: CS1 maint: multiple names: authors list (link) Fulltext.
  94. U.S. Preventive Services Task Force (June 2003). "Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale". Am Fam Physician. 67 (12): 2573–6. PMID 12825847. Archived from the original on 2014-02-24. Retrieved 2014-02-24.
  95. Pignone MP; Ammerman A; Fernandez L; et al. (2003). "Counseling to promote a healthy diet in adults: A summary of the evidence for the U.S. Preventive Services Task Force". American Journal of Preventive Medicine. 24 (1): 75–92. doi:10.1016/S0749-3797(02)00580-9. PMID 12554027.
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