Obesity in adults: Overview of management
- George A Bray, MD
George A Bray, MD
- Boyd Professor Emeritus, Pennington Biomedical Research Center/Louisiana State University
- Professor of Medicine Emeritus, Louisiana State University Health Science Center
- Leigh Perreault, MD
Leigh Perreault, MD
- Associate Professor of Medicine
- University of Colorado Anschutz Medical Campus
- Associate Professor of Epidemiology
- Colorado School of Public Health
- Section Editors
- F Xavier Pi-Sunyer, MD, MPH
F Xavier Pi-Sunyer, MD, MPH
- Section Editor — Obesity
- Professor of Medicine
- Columbia University College of Physicians and Surgeons
- Timothy O Lipman, MD
Timothy O Lipman, MD
- Section Editor — Nutrition
- GI-Hepatology-Nutrition Section
- Washington DC Veterans Affairs Medical Center
The morbidity and mortality associated with being overweight or obese have been known to the medical profession since the time of Hippocrates more than 2500 years ago. Overweight refers to a weight above the "normal" range, with normal defined on the basis of actuarial data. This is determined by calculating the body mass index (BMI, defined as the weight in kilograms divided by height in meters squared). Overweight is defined as a BMI of 25 to 29.9 kg/m2; obesity is defined as a BMI of ≥30 kg/m2. Severe obesity is defined as a BMI ≥40 kg/m2 (or ≥35 kg/m2 in the presence of comorbidities). Although these categorical definitions are clinically useful, it is clear that the risks imparted by increasing body mass follow a continuum.
An overview of the management of obesity is provided here. Information on screening, evaluation, health hazards associated with obesity, and specific therapies are reviewed in detail elsewhere.
- Jensen MD, Ryan DH, Apovian CM, et al. 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 2014; 129:S102.
- Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393.
- Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009; 374:1677.
- Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol 2015; 3:866.
- Horvath K, Jeitler K, Siering U, et al. Long-term effects of weight-reducing interventions in hypertensive patients: systematic review and meta-analysis. Arch Intern Med 2008; 168:571.
- Poobalan AS, Aucott LS, Smith WC, et al. Long-term weight loss effects on all cause mortality in overweight/obese populations. Obes Rev 2007; 8:503.
- Douketis JD, Macie C, Thabane L, Williamson DF. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 2005; 29:1153.
- Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273:219.
- Look AHEAD Research Group, Pi-Sunyer X, Blackburn G, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care 2007; 30:1374.
- Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369:145.
- Arterburn DE, O'Connor PJ. A look ahead at the future of diabetes prevention and treatment. JAMA 2012; 308:2517.
- Bray GA, Frühbeck G, Ryan DH, Wilding JP. Management of obesity. Lancet 2016; 387:1947.
- Vallis M. Quality of life and psychological well-being in obesity management: improving the odds of success by managing distress. Int J Clin Pract 2016; 70:196.
- Maynard LM, Serdula MK, Galuska DA, et al. Secular trends in desired weight of adults. Int J Obes (Lond) 2006; 30:1375.
- Rubino F, Nathan DM, Eckel RH, et al. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care 2016; 39:861.
- Diabetes Prevention Program (DPP) Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 2002; 25:2165.
- Leblanc ES, O'Connor E, Whitlock EP, et al. Effectiveness of primary care-relevant treatments for obesity in adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2011; 155:434.
- Jensen MD, Ryan DH, Apovian CM, et al. 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. J Am Coll Cardiol 2014; 63:2985.
- Perri MG, Nezu AM, McKelvey WF, et al. Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol 2001; 69:722.
- Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005; 293:43.
- The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf (Accessed on January 24, 2013).
- Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347:f5934.
- Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014; :CD003641.
- Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004; 350:2549.
- Lacey JM, Tershakovec AM, Foster GD. Acupuncture for the treatment of obesity: a review of the evidence. Int J Obes Relat Metab Disord 2003; 27:419.
- Hsu CH, Hwang KC, Chao CL, et al. Effects of electroacupuncture in reducing weight and waist circumference in obese women: a randomized crossover trial. Int J Obes (Lond) 2005; 29:1379.
- Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med 1995; 332:621.
- Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. Obesity (Silver Spring) 2016; 24:1612.
- Soini S, Mustajoki P, Eriksson JG. Weight loss methods and changes in eating habits among successful weight losers. Ann Med 2016; 48:76.
- Thomas JG, Bond DS, Phelan S, et al. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med 2014; 46:17.
- Weight management: lifestyle services for overweight or obese adults. NICE guidelines, May 2014. Available at: https://www.nice.org.uk/guidance/ph53 (Accessed on June 06, 2014).
- Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015; 100:342.
- IMPORTANCE OF WEIGHT LOSS
- APPROACH TO THERAPY
- Goals of treatment
- Identify candidates
- Initial treatment
- - Comprehensive lifestyle intervention
- - Dietary therapy
- - Exercise
- - Behavior modification
- Subsequent treatment
- - Drug therapy
- - Surgery
- - Liposuction
- - Complementary and alternative therapies
- Dietary supplements
- Risks of treatment
- Maintenance of weight loss
- CLINICAL GUIDELINES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS