Treating obesity - is diet enough?
Keywords:
obesity, diet, obesity treatment, obesity prevention
Abstract
Obesity is prevalent, complex chronic disease, which can lead to more than 200 diseases, including diabetes, cardiovascular and malignant diseases. Weight bias, stigmatization and discrimination are widespread and with serious consequences for people living with obesity. Approved methods for obesity treatment are: 1. Nutrition improvement; 2. Physical activity; 3. Psychotherapy; 4. Pharmacotherapy; and 5. Surgical therapy.
Nutrition interventions and medical nutrition therapy are core treatment for obesity. Nutrition interventions that are safe, effective, nutritionally adequate, culturally acceptable and affordable for long-term adherence, should be considered for adults living with obesity. However, to date, no single best nutrition intervention has been shown to sustain weight loss long-term.
Physical activity, psychotherapy, pharmacotherapy and surgical therapy can considerably improve results of treatment, but all together, treating of obesity is complex, expensive and with limited results. It has been suggested that primary prevention is the most cost-effective option for addressing obesity. Therefore, prevention of obesity and related health consequences should be a focus of every healthcare systems.
References
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40. Public Health England. Whole systems approach to obesity: A guide to support local approaches to promoting a healthy weight. 2019.(https://assets.publishing.service.gov.uk/media/5d396e7140f0b604de59fde9/Whole_systems_approach_to_obesity_guide.pdf).
2. Health service delivery framework for prevention and management of obesity. Geneva: World Health Organization; 2023.(https://iris.who.int/bitstream/handle/10665/367784/9789240073234-eng.pdf?sequence=1).
3. Milić N, Stanisavljević D, Krstić M, urednici. Istraživanje zdravlja stanovništva Srbije 2019. Beograd: Omnia Bgd;2021. (https://www.stat.gov.rs/sr-latn/publikacije/publication/?p=13005)
4. WHO European Regional Obesity Report 2022. Copenhagen: WHO Regional Office for Europe; 2022.(https://www.who.int/europe/publications/i/item/9789289057738).
5. De Lorenzo A, Gratteri S, Gualtieri P, Cammarano A, Bertucci P, Di Renzo L. Why primary obesity is a disease? J Transl Med. 2019 May 22;17(1):169. doi: 10.1186/s12967-019-1919-y.
6. Nadolsky K, Addison B, Agarwal M, Almandoz JP, Bird MD, DeGeeter, et al. American Association of Clinical Endocrinology Consensus Statement: Addressing Stigma and Bias in the Diagnosis and Management of Patients with Obesity/Adiposity-Based Chronic Disease and Assessing Bias and Stigmatization as Determinants of Disease Severity. Endocr Pract. 2023 Jun;29(6):417-427. doi: 10.1016/j.eprac.2023.03.272.
7. Spahlholz J, Baer N, König HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination - a systematic review and meta-analysis of observational studies. Obes Rev. 2016 Jan;17(1):43-55. doi: 10.1111/obr.12343.
8. Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J Adv Nurs. 2018;74(5):1030-42.doi: 10.1111/jan.13511.
9. Sharma AM, Campbell-Scherer DL. Redefining obesity: Beyond the numbers. Obesity. 2017;25(4):660-661. doi: 10.1002/oby.21801.
10. Rueda-Clausen CF, Poddar M, Lear SA, Poirier P, Sharma AM. Canadian Adult Obesity Clinical Practice Guidelines: Assessment of People Living with Obesity. (https://obesitycanada.ca/guidelines/assessment).
11. Radna grupa za izradu vodiča dobre kliničke prakse „Lečenje gojaznosti“. Šumarac M, Polovina S, urednici. Nacionalni vodič dobre kliničke prakse: lečenje gojaznosti. Ministarstvo zdravlja Republike Srbije, 2022.(https://www.zdravlje.gov.rs/view_file.php?file_id=2406&cache=sr).
12. Durrer Schutz D, Busetto L, Dicker D, Farpour-Lambert N, Pryke R, Toplak H, et al. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts. 2019;12(1):40-66. doi: 10.1159/000496183.
13. Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020 Aug 4;192(31):E875-891. doi: 10.1503/cmaj.191707.
14. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Toplak H; Obesity Management Task Force of the European Association for the Study of Obesity. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8(6):402-424. doi: 10.1159/000442721.
15. Brown J, Clarke C, Johnson Stoklossa C, Sievenpiper J. Canadian Adult Obesity Clinical Practice Guidelines: Medical Nutrition Therapy in Obesity Management. (https://obesitycanada.ca/guidelines/nutrition).
16. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, Ball GD, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014 Sep 3;312(9):923-933. doi: 10.1001/jama.2014.10397.
17. Daly P, Pace T, Berg J, Menon U, Szalacha LA. A mindful eating intervention: A theory-guided randomized anti-obesity feasibility study with adolescent Latino females. Complement Ther Med. 2016 Oct;28:22-28. doi: 10.1016/j.ctim.2016.07.006.
18. Warren JM, Smith N, Ashwell M. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutr Res Rev. 2017 Dec;30(2):272-283. doi: 10.1017/S0954422417000154.
19. Jakicic JM, Rogers RJ, Davis KK, Collins KA. Role of Physical Activity and Exercise in Treating Patients with Overweight and Obesity. Clin Chem. 2018 Jan;64(1):99-107. doi: 10.1373/clinchem.2017.272443.
20. Boulé NG, Prud’homme D. Canadian Adult Obesity Clinical Practice Guidelines: Physical Activity in Obesity Management. (https://obesitycanada.ca/guidelines/physicalactivity).
21. Petridou A, Siopi A, Mougios V. Exercise in the management of obesity. Metabolism. 2019 Mar;92:163-169. doi: 10.1016/j.metabol.2018.10.009.
22. Vallis TM, Macklin D, Russell-Mayhew S. Canadian Adult Obesity Clinical Practice Guidelines: Effective Psychological and Behavioural Interventions in Obesity Management. (https://obesitycanada.ca/guidelines/behavioural).
23. Jacob A, Moullec G, Lavoie K, Laurin C, Cowan T, Tisshaw C. Impact of cognitive-behavioral interventions on weight loss and psychological outcomes : A meta-analysis. Heal Psychol. 2018;37(5):417-432. doi: 10.1037/hea0000576.
24. Dalle Grave R, Sartirana M, Calugi S. Personalized cognitive-behavioural therapy for obesity (CBT-OB): theory, strategies and procedures. Biopsychosoc Med. 2020 Mar 9;14:5. doi: 10.1186/s13030-020-00177-9. doi: 10.1186/s13030-020-00177-9.
25. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011; Sep;12((9)):709-723. doi: 10.1111/j.1467-789X.2011.00892.x.
26. Chakhtoura M, Haber R, Ghezzawi M, Rhayem C, Tcheroyan R, Mantzoros CS. Pharmacotherapy of obesity: an update on the available medications and drugs under investigation. EClinicalMedicine. 2023 Mar 20;58:101882. doi: 10.1016/j.eclinm.2023.101882.
27. Pedersen SD, Manjoo P, Wharton S. Canadian Adult Obesity Clinical Practice Guidelines: Pharmacotherapy for Obesity Management. (https://obesitycanada.ca/guidelines/pharmacotherapy).
28. Moon S, Chung HS, Kim YJ. Efficacy and Safety of the New Appetite Suppressant, Liraglutide: A Meta-Analysis of Randomized Controlled Trials. Endocrinology and Metabolism. 2021;36(3):647-660. doi: 10.3803/EnM.2020.934.
29. Rubino D, Abrahamsson N, Davies M. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425. doi: 10.1001/jama.2021.3224.
30. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. doi: 10.1056/NEJMoa2206038.
31. Smith SR, Fujioka K, Gupta AK, Billes SK, Burns C, Kim D, Dunayevich E, Greenway FL. Combination therapy with naltrexone and bupropion for obesity reduces total and visceral adiposity. Diabetes Obes Metab. 2013 Sep;15(9):863-6. doi: 10.1111/dom.12095.
32. Langlois MF, Freedhoff Y, Morin MP. Canadian Adult Obesity Clinical Practice Guidelines: Commercial Products and Programs in Obesity Management. (https://obesitycanada.ca/guidelines/commercialproducts).
33. Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015 Oct 15;373(16):1531-1540. doi: 10.1056/NEJMsa1504267.
34. Biertho L, Hong D, Gagner M. Canadian Adult Obesity Clinical Practice Guidelines: Bariatric Surgery: Surgical Options and Outcomes. (https://obesitycanada.ca/guidelines/surgeryoptions).
35. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Review. JAMA. 2020 Sep 1;324(9):879-887. doi: 10.1001/jama.2020.12567.
36. Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring). 2020 Apr;28(4):O1-O58. doi: 10.1002/oby.22719.
37. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017 May;13(5):7277-41. doi: 10.1016/j.soard.2016.12.018.
38. Uredba o Nacionalnom programu za prevenciju gojaznosti kod dece i odraslih. "Sl. glasnik RS", br. 9/2018. (https://www.zdravlje.gov.rs/view_file.php?file_id=2040&cache=sr).
39. Flowers R, Blackshaw J, Van Dijk M, Reid L, WGLL Thematic Group on Healthy Weight (All Age), Public Health England. What Good Healthy Weight for all ages Looks Like. 2019.(https://www.adph.org.uk/wp-content/uploads/2019/07/What-Good-Healthy-Weight-Looks-Like.pdf).
40. Public Health England. Whole systems approach to obesity: A guide to support local approaches to promoting a healthy weight. 2019.(https://assets.publishing.service.gov.uk/media/5d396e7140f0b604de59fde9/Whole_systems_approach_to_obesity_guide.pdf).