Management of Obesity

Marvin   A.   Kirschner

Abstract

Obesity is rapidly becoming a worldwide epidemic with serious consequences of life-shortening morbidity. This paper explores current modalities available for the control of overweight and obesity. Most overweight and obese persons setting out to lose weight envision achieving ideal body weight, a generally unrealistic goal. Studies collated in the National Heart & Lung Institute Monograph (1998) strongly suggest that a loss of 10% of body weight results in significant improvement of hypertension, dyslipidemia, diabetes, and cardiovascular risk factors, and is a far more achievable goal for weight control. Fad diets and commercial weight loss programs are widely used by the general population seeking weight loss. Metaanalyses show that these diets can result in 2-8% loss of weight after 1 year, although many of theses studies suffer from lack of adequate controls, and thus may over-estimate the weight losses. In the few studies comparing results from commercial programs to proper control groups, weight loss of 2-4% have been achieved. As for pharmacologic agents to aid in weight loss, the sympathomimetic drugs are FDA- approved for only 12 weeks of use. There are presently 2 drugs approved for long term weight loss; sibutramine (an SSRI and sympathomimetic reuptake inhibitor), and orlistat (an intestinal lipase inhibitor). Carefully controlled studies have shown that both drugs caused 3-5% weight loss after 1 year of continued use. With both drugs, the weight loss can be significantly enhanced (as much as 100%) with lifestyle changes involving exercise and behavior modification. A new highly anticipated drug which acts to inhibit endogenous cannabinod receptors, (Rimonabant) has shown 5-7% weight loss after 1 year, but its approval has been suspended by the FDA as of this writing. As for major weight loss programs, very low calorie diets (VLCD) were popular in the 1980-90s. This strenuous approach of consuming only protein-rich supplements resulted in 20-25% weight loss after 1 year, however on returning to normal food, there were high rates of weight regain. Surgical approaches to weight loss are reserved for patients with Type III Obesity and are becoming more widely used, yielding the greatest degree of weight loss and long-term maintenance.

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