Overweight and obesity management methods

Management of obesity is a complex process, demanding lifestyle changes which may include: behavioral weight loss management programs, increased physical activity, pharmacotherapy, and in the case of morbid obesity – even surgical intervention.

Dietary management

Dietary modulation is the most essential part of the process of weight reduction. Dietary strategies include limitation of calorie intake, lifestyle and eating habits changes and expanding one's knowledge of the principles of healthy nutrition.

Replacing one or two meals a day with VLCD formulas may become an important component of a well-balanced diet, while still sustaining the body mass.

To this end, we recommend low-calorie diets which, because of their food energy consumption, can be distinguished into:

1. very low energy diets [VLCD, very low-calorie diet]
up to 800 kcal/day for men and women

2. low energy diets [LCD, low-calorie diet]:
a. 800-1200 kcal/day for women
b. 800-1400 kcal/day for men

3. moderate energy deficit [HBD, hot belly diet]
a. over 1200 kcal/day for women
b. over 1400 kcal/day for men

Physical activity

Bearing in mind that the main cause of obesity is excess energy intake in relation to its expenditure, it is imperative that during a body mass reduction programme one's physical activity is increased. The intensity of exercise should be adjusted to one's individual needs.

People with no previous history of physical activity can start off by walking to work, to a shopping centre, or by giving up driving. At first, we recommend 30-minute training, two to three times a week. With time and as your fitness improves, the intensity and frequency of exercise can be increased. Most effective are aerobic exercises of moderate intensity, i.e. those that fall within 50 to 70 percent of your maximum heart rate (HR).

Examples of moderate intensity exercises:

That's all it takes.

Physical activity, in addition to helping you lose weight, has other important benefits as well. By increasing your heart's ejection fraction and the volume of blood circulating in the body, it also improves proper functioning of your circulatory system.

It increases the vital capacity (VC) of lungs, more oxygen is injected into the bloodstream, while an increase in the number of mitochondria leads to better skeletal muscle oxidation.

Physical activity is also the best way to combat mental fatigue and improve your state of mind, which in turn are of great assistance in the weight loss process.

Pharmacological management

The use of pharmacotherapy is recommended in individuals with body mass index (BMI) ≥ 30 kg/m2, or in individuals with BMI ≥ 27 kg/m2 and an increased risk of cardiovascular diseases, type 2 diabetes or a family history of genetic disorders.

Pharmacotherapy can be implemented in individuals who after eight weeks of using a low-calorie diet lost less than 2 kg of body weight.

Drugs such as thyroid hormones, ephedrine or sympathomimetics, which were used in the past, were banned because of the many undesirable side effects such as addictiveness, liver damage or the risk of primary pulmonary hypertension or heart valve disorders. 

Sibutramine, a serotonin and norepinephrine reuptake inhibitor, was used until recently as an effective appetite suppressant. However, in 2010 the European Medicines Agency (EMA) withdrew the drug from the market because of an increased risk of heart attacks and strokes in patients with a history of cardiovascular disease.

The only obesity treatment drug that is currently approved by EMA for sale without prescription is orlistat. Its primary function is preventing the absorption of fats from the human diet by acting as a lipase inhibitor, thereby reducing caloric intake.

When used in conjunction with an appropriate diet, orlistat – in addition to the weight loss – can also moderately reduce global cholesterol and low-density lipoprotein (LDL) levels, increase high-density lipoprotein (HDL) levels, reduce systolic and diastolic blood pressure and improve insulin resistance.

Orlistat's undesirable side effects include steatorrhoea which, in conjunction with flatulence and soiling, can be quite discomforting. Of concern is also the fact that absorption of fat-soluble vitamins (A, D, E and K) and other highly lipophilic nutrients may also be inhibited by the use of orlistat. And then there's also the problem of orlistat overuse by people suffering from eating disorders.

Surgical intervention

Bariatric surgery is currently the most effective method of treatment of morbid obesity.

Bariatric surgery is recommended for people aged 18 to 60 with morbid (grade III) obesity (BMI ≥ 40kg / m2), or for people with grade II obesity (BMI 35-39kg / m2) and at least one serious coexisting medical condition who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy).

Under some circumstances, people with type 2 diabetes and BMI ≥ 30 kg/m2 should also be eligible for surgery. 

Classification of bariatric surgical procedures:

Rapid weight loss after obesity surgery can contribute to nutritional derangements due to deficiencies of vitamins, proteins and micronutrients, and these need to be continuously replenished.

Post-operative plastic and reconstructive surgery may also be required.

Worldwide clinical studies show consistently that the most effective weapon in the war with excessive weight is a low-energy nutrient-rich diet.

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