In the United States, Centers for Disease Control and Prevention (CDC) estimates that approximately 70% of adults and 33% of children and adolsescents are overwight or obese. Individuals with a body mass index (BMI) of over 30 kg/m2 are considered obese and individulas with a BMI between 25 and 29.9 kg/m2 are considered overweight.
Obesity is linked to more than 60 chronic diseases and overweight individuals are at higher risk for hypertension, stroke, coronary heart disease, type 2 diabetes and premature death.
Obesity costs Americans $147 billion each year. People who are obese pay more out of pocket than people who are not. The key to any weight loss treatment plan is to first understand underlying causes of weight gain. Select drugs such as antipsychotics (olanzapine, quetiapine), diabetes medications (insulin, sulfonylureas) and medical conditions like hypothyroidism can cause weight gain.
Treatment principles of weight loss are centered around caloric deficit and increased energy expenditure in order for the body to use fat as an energy source. The American College of Endocrinology (AACE) recommends various lifestyle measures in their obesity guidelines.
The guideline recommends eating plans with reduced calorie creating a daily deficit of 500 to 700 kcal. These include meditarian, low-carb, low-fat, high protein and vegetarian diets. Individuals should follow a caloric deficit diet that meets their personal and cultural preferences.
The guideline also recommends 150 minutes of physical activity and additional resistance training every week. Physical activities should be performed on three to five separate days per week. Behavior interventions such as goal setting, stress management, self-monitoring (food intake, exercise) and use of social support is highly encouraged.
Weight loss medications are recommended when lifestyle measures such as diet, physical activity and behavioral changes fail in helping to achieve adequate weight loss. Weight loss medications work by increasing satiety (feeling full) or decreasing appetite. Prescription medications are not appropriate for all patients and a thorough physician consultation is required prior to starting any treatment plan.
Weight loss medications without proper lifestyle modifications are not effective and won’t help with weight loss. Over the counter (OTC) supplements are generally ineffective and not recommended. Some of the most commonly prescribed weight loss drugs include Phentermine, Naltrexone and GLP-1 receptor agonists such as Saxenda and Victoza.
Bariatric surgery is recommended for adults with BMI of greater than 40 kg/m2 or BMI of greater than 35 kg/m2 with an obesity related condition.