Combined Approaches to Treatment

Worldwide prevalence rates of obesity and overweight are rising, and safe and effective treatment strategies are urgently needed. Obesity has been recognized as a preventable and treatable disease, and there is a growing evidence base showing the efficacy of various clinical strategies for its management. Given the overwhelming research focus on this disease, it is likely that the coming years will bring more treatment options, raising the chance that patients will have meaningful and sustained weight loss.

Obesity is a multifactorial problem. According to the National Institutes of Health (NIH), the main focus of an obesity intervention should be on health improvement instead of body weight reduction. People who are overweight or obese have increased risk for more than 30 other diseases such as heart disease, cancer, breathing problems, and diabetes. For the millions of obese and overweight, the ideal model of obesity treatment is a comprehensive intervention including dietary, activity-related, behavioral, pharmacological, and/or surgical components that is geared toward individual needs.

Not all treatments will work for everyone. When a diet, exercise, or drug plan does not produce expected results, either the individual is blamed for noncompliance, or the treatment is deemed ineffective. Most people can be helped to manage their weight, and healthcare providers must avoid stigmatizing and blaming patients for their obesity. It is important that practitioners understand that patients do not come equipped with appropriate compliance skills, and that the practitioner must assist in teaching the underlying information and attendant skills. The more obese the patient, the more important it is to understand that the weight loss may be outside the control of the patient and the lifestyle modifications without more serious intervention such as bariatric surgery.

For the average weight-loss patient, however, dietary-focused weight-management programs can be successful when combined with appropriate activity, behavioral and lifestyle modification, and education and skill training. These programs are generally utilized for patients with body mass indexes (BMIs) under 30, and with no comorbidities. The key behavior combination for success of these weight-managed programs is reduced energy intake, reduced (but not eliminated) dietary fat and carbohydrate intake, increased physical activity, and nutrition and health education relative to the patient's personal situation.

Activity-related weight-loss programs alone do little to cause short-term weight loss. The ineffectiveness of moderate exercise by itself is not surprising considering 1 lb. of body fat contains about 3,600 calories. Combined with appropriate additional interventions such as dietary, behavioral, and lifestyle modifications, physical activity contributes to avoiding weight gain, maintenance of weight loss, and contributes to the overall health of people at any weight.

Weight-loss medications (pharmacological interventions) are currently recommended for use only as an adjunct to diet, exercise, and behavior modification. Little is known about the benefits of combining behavioral and pharmacological therapies, or about the mechanisms that would make these combined approaches more effective than using either approach alone. Weight-loss medications must be prescribed in combination with, rather than in lieu of, lifestyle modification. Researchers found that best results were obtained when medications were combined with an intensive, group program of lifestyle modification.

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