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Treatment Modalities of Obesity

What fits whom?

Vojtch Hainer, MD, PHD¹, Hermann Toplak, MD, PHD² and Asimina Mitrakou, MD³

¹ Institute of Endocrinology, Prague, Czech Republic
² Department of Medicine, Diabetes and Metabolism, Medical University Graz, Graz, Austria
³ Department of Internal Medicine, Henry Dunant Hospital, Athens, Greece

Address correspondence and reprint requests to Dr. Vojtech Hainer, Institute of Endocrinology, Narodni 8, 116 94 Prague 1, Czech Republic. E-mail: vhainer{at}endo.cz

The prevalence of obesity is increasing in both developed and developing countries, with rates reaching 10–35% among adults in the Euro-American region. Obesity is associated with increased risks of cardiovascular diseases, type 2 diabetes, arthritis, and some type of cancers. Obesity significantly affects the quality of life and reduces the average life expectancy. The effective treatment of obesity should address both the medical and the social burden of this disease. Obesity needs to be treated within the health care system as any other complex disease, with empathy and without prejudice. Both health care providers and patients should know that the obesity treatment is a lifelong task. They should also set realistic goals before starting the treatment, whereas keeping in mind that even a modest weight loss of 5–15% significantly reduces obesity-related health risks. Essential treatment of obesity includes low-calorie low-fat diets, increased physical activity, and strategies contributing to the modification of lifestyle. Anti-obesity drugs facilitate weight loss and contribute to further amelioration of obesity-related health risks. A short-term weight loss, up to 6 months, is usually achieved easily. However, the long-term weight management is often associated with a lack of compliance, failures, and a high dropout rate. Regular physical activity, cognitive behavioral modification of lifestyle, and administration of anti-obesity drugs improve weight loss maintenance. Bariatric surgery is an effective strategy to treat severely obese patients. Bariatric surgery leads to a substantial improvement of comorbidities as well as to a reduction in overall mortality by 25–50% during the long-term follow-up. Obesity treatment should be individually tailored and the following factors should be taken into account: sex, the degree of obesity, individual health risks, psychobehavioral and metabolic characteristics, and the outcome of previous weight loss attempts. In the future, an evaluation of hormonal and genetic determinants of weight loss could also contribute to a better choice of individual therapy for a particular obese patient. A multilevel obesity management network of mutually collaborating facilities should be established to provide individually tailored treatment. Centers of excellence in obesity management represented by multidisciplinary teams should provide comprehensive programs for the treatment of obesity derived from evidence-based medicine.

Abbreviations: PYY, peptide YY • VLCD, very-low-calorie diet

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