Management of obesity

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Obesity management may include lifestyle changes, medications, or surgery. The primary treatment for obesity consists of diet and physical exercise. Diet programs can produce weight loss in the short term, but maintaining weight loss is often difficult and often requires exercise and a low-calorie diet as a permanent part of a person's lifestyle. The success rate of long-term weight loss treatment with low lifestyle changes, ranging from 2 to 20%. Changes in diet and lifestyle are effective in limiting excessive weight gain in pregnancy and improving outcomes for mothers and children. The National Institutes of Health recommends a weight loss goal of 5% to 10% of a person's current weight for six months.

One drug, orlistat, is currently widely available and approved for long-term use. Weight loss but simple with an average of 2.9 kg (6.4 pounds) in 1 to 4 years and there is little information about how these drugs affect long-term obesity complications. Its use is associated with high rates of gastrointestinal side effects.

The most effective treatment for obesity is bariatric surgery. Surgery for severe obesity is associated with long-term weight loss and overall mortality reduction. One study found weight loss between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% decrease in all causes of death when compared to standard weight loss measures.

The 2007 review concluded that certain subgroups such as those suffering from type 2 diabetes and women showed long-term benefits in all causes of death, while results for men did not seem to improve with weight loss. A further study found the mortality benefit of intentional weight loss in those with severe obesity.

Video Management of obesity

Diet

Diet for weight gain is generally divided into four categories: low fat, low carbohydrate, low calorie, and very low calories. A meta-analysis of six randomized controlled trials found no difference between the three main diet types (low-calorie, low-carbohydrate, and low-fat), with a weight loss of 2-4 kilograms (4.4-8.8 pounds) in all studies. In the two years these three methods resulted in the same weight loss regardless of the emphasized macronutrients. High-protein diets do not seem to make a difference. A simple high-sugar diet such as soft drinks increases weight.

A low-calorie diet provides 200-800 kcal/day, maintaining protein intake but limiting calories from fat and carbohydrates. They make the body starve and produce an average weekly weight loss of 1.5-2.5 kilograms (3.3-5.5 pounds). This diet is not recommended for general use because they are associated with adverse side effects such as loss of lean muscle mass, increased gout risk, and electrolyte imbalances. People who try this diet should be closely monitored by a doctor to prevent complications.

In different meta studies, low-carb diets show a more effective method for losing weight, than any other diet. Can the above article be updated to reflect that. source: Bueno, N. B. (2013). Diet ketogenik very low carbohydrate v. Low-fat diet for long-term weight loss: A meta-analysis of randomized controlled trials. The British Journal of Nutrition, 1178-1187.

Also many more recent studies have been conducted to show that the consumption of artificial sweeteners, refined carbohydrates and trans fats is a cause of the rapid weight gain we have seen in recent decades as they create insulin resistance. Therefore, the only way to lose weight and maintain weight in the long run is to eliminate these factors from your diet. Caloric restriction has not been proven as an effective method for long-term weight loss.

Source: Robert Lustig, M. (Director). (2009). Sugar The Bitter Truth [Motion Picture]. Taubes, G. (2002, 7 7). What if it was all a big lie?. New York Time.

Maps Management of obesity

Exercise

By using, muscles consume energy derived from fat and glycogen. Because of 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 brisk walking, there is a shift to greater fat usage as a fuel. To maintain health, the American Heart Association recommends at least 30 minutes of moderate exercise at least 5 days a week.

Cochrane Collaboration found that exercise alone causes limited weight loss. In combination with diet, however, it results in weight loss of 1 kilogram more than diet alone. The loss of 1.5 kilograms (3.3 pounds) was observed with higher exercise levels. Although exercise as done in the general population has only a modest effect, the dose response curve is found, and very intense exercise can lead to considerable weight loss. During 20 weeks of basic military training without dietary restrictions, fat military recruits lost 12.5 kg (28 pounds). A high level of physical activity seems necessary to maintain weight loss. Pedometers seem to be useful for motivation. Over an 18-week average of physical activity use increased by 27% resulting in a 0.38 decrease in BMI.

Signs that encourage the use of ladders and community campaigns have proven effective in increasing exercise in the population. The city of Bogota, Colombia, for example, blocks 113 kilometers (70 mi) of roads every Sunday and on holidays to make it easier for residents to exercise. This pedestrian zone is part of an effort to combat chronic diseases, including obesity.

In an effort to combat this problem, Australian elementary schools run classrooms by 2013.

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Weight loss program

Weight loss programs often promote lifestyle changes and dietary modifications. This may involve eating small meals, reducing certain types of foods, and making conscious attempts to exercise more. These programs also allow people to connect with a group of other people who are trying to lose weight, in the hope that the participants will shape the motivation and encourage mutually beneficial relationships.

A number of popular programs exist, including Weight Watchers, Overeaters Anonymous, and Jenny Craig. This appears to provide a modest weight loss (2.9 kg, 6.4 pounds) during self-diet (0.2 kg, 0.44 pounds) over a two-year period. Internet-based programs do not seem to be effective. The Chinese government has introduced a number of "fat fields" where obese children go for strengthened training, and have passed laws requiring students to exercise or play sports for an hour a day at school (see Obesity in China).

In a structured setting, 67% of people who lose more than 10% of their body mass are retained or continue to lose weight a year later. The average weight loss maintained over 3 kg (6.6 pounds) or 3% of the total body mass can be maintained for five years.

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Drug

Some anti-obesity drugs 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 weight loss of 5.8 kg in one year compared with 2.2 kg with placebo and approved by the Food and Drug Administration for use in the treatment of obesity. Side effects may include serotonin syndrome.

The phentermine/topiramate (Qsymia) combination drug is approved by the FDA in addition to low-calorie diet and exercise for chronic weight management.

Rimonabant (Acomplia), another drug, has been withdrawn from the market. It works through a specific blockade of the endocannabinoid system. It has been developed from the knowledge that marijuana smokers often experience hunger, often referred to as "snacks". It has been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to security concerns. The European Medicines Agency in October 2008 recommended the suspension of rimonabant sales because the risk appeared to outweigh the benefits. Sibutramine (Meridia), which acts in the brain to inhibit the deactivation of neurotransmitters, thus reducing appetite withdrawn from the UK market in January 2010 and the US and Canadian markets in October 2010 due to cardiovascular concerns.

Weight loss with these drugs is simple. In the long run, the average weight loss in orlistat is 2.9 kg (6.4 pounds), sibutramine is 4.2 kg (9.3 lb) and rimonabant is 4.7 kg (10 pounds). Orlistat and rimonabant cause a reduced incidence of diabetes, and all three drugs have an effect on cholesterol. However, there is little information about how these drugs affect long-term complications or outcomes of obesity. In 2010 it was found that sibutramine increases the risk of heart attack and stroke in people with a history of cardiovascular disease.

There are a number of drugs that are rarely used. Some are only approved for short-term use, others are used off-label, and others are used illegally. Most appetite suppressants act on one or more neurotransmitters. Rasemic amphetamine, phendimetrazine, diethylpropion, and phentermine are approved by the FDA for short-term use, while bupropion, topiramate, and zonisamide are sometimes used off-label. Recombinant human leptin is highly effective in those with obesity because of complete congenital leptin deficiency through decreased energy intake and may increase energy expenditure. This condition, however, is rare and this treatment is not effective for weight loss in the majority of people with obesity. This is being investigated to determine whether or not it helps with weight maintenance.

The usefulness of certain drugs depends on the existing comorbidities. Metformin is preferred in overweight diabetics, as it can lead to mild weight loss compared with sulfonylureas or insulin. Thiazolidinediones, on the other hand, can cause weight gain, but decrease central obesity. Diabetics also achieve simple weight loss with fluoxetine, orlistat and sibutramine for 12-57 weeks. However, preliminary evidence found higher rates of cardiovascular events in people using sibutramine verse control (11.4% vs. 10.0%). The long-term health benefits of this treatment remain unclear.

Fenfluramine and dexfenfluramine were withdrawn from the market in 1997, while ephedrine (found in traditional Chinese herbs mÃÆ'¡ huÃÆ'¡ng made from Ephedra sinica ) was removed from the market in the year 2004.

Although it is hypothesized that vitamin D supplementation may be an effective treatment for obesity, the study does not support this.

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Surgery

Bariatric surgery ("weight loss surgery") is the use of surgical interventions in obesity care. Because every surgery may be complicated, surgery is only recommended for very obese people (BMI & gt; 40) who fail to lose weight following dietary modification and pharmacological treatments. Surgical weight-loss surgery depends on a variety of principles: the two most common approaches are to reduce stomach volume (eg by adjustable hull and vertical banded gastroplasty), which produce previous satiety, and reduce intestinal lengths associated with food (eg by gastric bypass surgery or duodenal-jejunal endoscopic bypass surgery), which directly reduces absorption. Band operations are reversible, while bowel shortening operations do not. Some procedures can be done laparoscopically. Complications of weight loss surgery are common.

Surgery for severe obesity is associated with long-term weight loss and overall mortality reduction. One study found weight loss between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% decrease in all causes of death when compared to standard weight loss measures. Sharp declines in risk of diabetes mellitus, cardiovascular disease and cancer have also been found after bariatric surgery. Established weight loss occurs during the first few months after surgery, and the loss is sustained over the long term. In one study there was an increase in unexplained deaths from accidents and suicide, but this did not exceed the benefits of disease prevention. When the two main techniques were compared, gastric shortcut procedures were found to cause 30% more weight loss than the appeals procedure one year after surgery.

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

The effects of liposuction on obesity are poorly defined. Some small studies show benefits while others show nothing. Treatments involving intragastric balloon placement through gastroscopy have been promising. One type of balloon causes weight loss of 5.7 units of BMI over 6 months or 14.7 kg (32 pounds). Regaining lost weight is common after removal, however, and 4.2% of people are intolerant of the device.

An implant nerve simulator that boosts feeling full has been approved by the FDA by 2015.

In 2016 the FDA approves aspiration therapy devices that suck food from the stomach out and reduce caloric intake. In 2015 one experiment showed promising results.

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Clinical protocol

Much of the Western world has created clinical practice guidelines in an effort to cope with rising rates of obesity. Australia, Canada, the European Union and the United States have published all statements since 2004.

In the clinical practice guidelines by the American College of Physicians, the following five recommendations are made:

1. People with a BMI above 30 should be counseled about diet, exercise, and other relevant behavioral interventions, and set realistic goals for weight loss.
2. If this goal is not met, pharmacotherapy may be offered. The person needs to be informed of possible side effects and unavailability of long-term safety and efficacy data.
3. Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. For more severe cases of obesity, more potent drugs such as amphetamine and methamphetamine can be used selectively. Evidence is not enough 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, referrals for bariatric surgery may be indicated. The person needs to be aware of potential complications.
5. Those who require bariatric surgery should be referred to a high-volume referral center, as evidence suggests that surgeons who frequently perform this procedure have fewer complications.

A clinical practice guideline by the US Prevention Task Force (USPSTF) concluded that evidence is insufficient to recommend or challenge routine behavioral counseling to promote a healthy diet in people not selected in primary care settings, but intensive behavioral counseling is encouraged in those with hyperlipidemia and factor another known risk for chronic diseases associated with cardiovascular and diet. Intensive counseling may be provided by a primary care physician or by referral to another specialist, such as a nutritionist or dietitian.

Canada developed and published evidence-based practice guidelines in 2006. This guide seeks to address obesity prevention and management at both the individual and population levels in both children and adults. The EU published its clinical practice guidelines in 2008 in an effort to cope with rising obesity rates in Europe. Australia came out with a practice guide in 2004.

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Research

Meanwhile, controlled gastric pseudo-bezoars (swallowing, expanding foreign bodies intended to reduce stomach volume from within organs) are being tested. Treatment with naltrexone plus bupropion in a three-phase trial resulted in 5-6% weight loss versus 1% for placebo.

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References

Source of the article : Wikipedia