Management of obesity and overweight

Lean, M. E.J. (2019) Management of obesity and overweight. Medicine, 47(3), pp. 175-183. (doi: 10.1016/j.mpmed.2018.12.008)

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Modern weight management incorporates optimization of health and risk factors, irrespective of weight change, short-term weight loss and long-term prevention of weight gain/regain. Patients with excess body fat and elevated metabolic risks needing professional weight management can be identified by a large waist (>102 cm for men, >88 cm for women. A modest weight loss of 5–10 kg is achievable by many conventional dietary intervention methods, with multiple small benefits. However, this is usually insufficient to improve quality of life sufficiently for people to maintain their reduced weight. A target loss of 15 kg is now recommended for severe and medically complicated obesity, for example to obtain remission from type 2 diabetes mellitus. A structured programme addressing diet and physical activity and behavioural management, as used in the UK Counterweight Programme and the DiRECT trial for type 2 diabetes remission, is cost-effective in generating <15% weight loss for 20–30% of patients who attempt it. Used with good dietary support, most available anti-obesity drugs are generally safe, and usually double the weight loss and clinical benefits of diet and exercise. Newer glucagon-like peptide 1 (GLP-1) agonists, for example semaglutide, achieve mean weight losses of >10 kg. Bariatric surgery, improves multiple health risks and extends life expectancy for extreme obesity (body mass index >40 kg/m2), However a target of >15 kg loss, in line with patients’ wishes, is sufficient on medical grounds, and is becoming more achievable within primary care.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Lean, Professor Michael
Authors: Lean, M. E.J.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Medicine
ISSN (Online):1878-9390
Published Online:12 February 2019

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