We found a strong inverse association between obesity and mortality that is consistent with the results of several cohort studies and observational studies in other health care systems, with potential relevance for the treatment of obesity.
In a significant number of patient’s obesity is not addressed at the time of the initial diagnosis which leads often to weight gain, in most cases to a substantial degree. Pharmacological therapy for hypertension and overweight is sometimes used, but to a limited extent, and is less successful. Obesity itself is not addressed directly, except for bariatric surgery.
Obesity rates have increased among children, young adults, and the elderly. Obese individuals with body mass index (BMI) values above the current national definition of obesity in children and young adults are most likely to experience obesity-related disease. Therefore, the BMI used in epidemiological surveys should be adjusted for age, sex, puberty status, and geographic region.
Signs of obesity include lack of physical activity, low physical ability, weight gain, and loss of muscularity. The onset is typically at age 20, and is usually associated with weight problems. These people may be overweight, obese, or both.
There is a clear relationship among high rates of obesity, lack of physical activity and unhealthy eating habits, in which people fail to consume a full range of available foodstuffs because of lack of knowledge and skills. There is no one clear cause of obesity. The most salient factors, which act in an additive manner, are lack of physical activity and unhealthy lifestyle factors in which people have adopted eating high calorie junk food as a way of avoiding hunger.
Many of these side effects are related to weight loss: fatigue, loss of appetite, constipation, stomach upset, headaches, feeling faint or vertigo, dizziness, and dry lips. Other side effects are common and often go away with weight loss and may be related to the weight management program: abdominal pain, loss of blood, numbness or tingling of limbs, and swelling. A small number of people experience a few other side effects but can't necessarily attribute these to the weight management program and many have experienced side effects related to weight loss before or since being in a program. Some of the side effects of obesity treatment appear to be due to unhealthy behaviors, genetics, and/or lack of adherence to medication.
Although several of the studies reported no significant differences in adherence to treatments, patients receiving a combination of medications reported being better-treated than those on monotherapy. Thus patients should be advised that the addition of a medication to diet/drug regimen should increase the chance of weight loss in those with obesity.
Weight loss treatments using caloric restriction, sustained-release oral medications and exercise, and non-caloric medications, when compared with placebo, have been proven to be effective in treating obesity over a 6-month period in a randomized, double-blind, placebo-controlled study. Results from multiple randomized, controlled trials have shown that a weight fluctuation of at least 2 lb/week during weight loss therapy is associated with better long-term treatment outcomes than for those treated with a placebo. Because of the potential for both adverse events and lack of information about effectiveness on treating obesity, it is recommended that the use of some weight loss treatments be monitored carefully.
Although more research is needed to confirm or refute the results of this study, the treatment options might be improved using a variety of techniques and medications. The treatments that may be of the most help are those for reducing body fat and managing obesity in an overall healthy manner. Physicians and patients need to keep in mind that there is not one ideal treatment for obesity; each patient must individualize treatment based on factors such as the cause and effects of the disease. A multidisciplinary approach tailored to the patient is necessary, so that the whole person is treated, instead of only focusing on weight loss at a certain time. Physicians may be encouraged to use weight loss in their practice if the problem is not caused by a simple disorder such as obesity.
In this population, there was a significant improvement with weight maintenance in one area of the QALY. The other areas improved but did not reach statistical significance.
There have been several small pilot clinical trials involving treatment, but none have shown any conclusive efficacy. Further, none have lasted more than one year. In addition, most studies were uncontrolled, with one study of moderate sizes ( n = 382) being the only controlled study reported, but found no evidence of benefit or detrimental effects. A recently published uncontrolled trial of an intensive inpatient treatment programme ( n=75), however, did indicate some improvement in some parameters of obesity (body mass index and waist circumference) and in metabolic and endocrine disorders (glucose levels, insulin, leptin, and triglycerides). However, the data remain preliminary as of August 2008.