Management of obesity
|Part of a series on|
|Human body weight|
Management of obesity can include lifestyle changes, medications, or surgery. The main treatment for obesity consists of weight loss via dieting and physical exercise. Diet programs can produce weight loss over the short term and long-term, although combining with exercise and counseling provide greater results. Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child. The National Institutes of Health recommend a weight loss goal of 5% to 10% of the person's current weight over six months.
One medication, orlistat, is current widely available and approved for long term use. Weight loss is modest to important, with an average of 2.9 kg (6.4 lb) at 1 to 4 years, but there is little information on how these drugs affect longer-term complications of obesity. Its use is associated with high rates of gastrointestinal side effects.
The most effective treatment for obesity is bariatric surgery. Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.
A 2007 review concluded that certain subgroups such as those with type 2 diabetes and women show long term benefits in all cause mortality, while outcomes for men do not seem to be improved with weight loss. A subsequent study found benefits in mortality from intentional weight loss in those who have severe obesity.
(diet, physical activity,
|Pharmacotherapy||Not appropriate||With co-morbidities||Yes||Yes||Yes|
|Surgery||Not appropriate||Not appropriate||With co-morbidities||Yes|
Diets to promote weight loss are generally divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie. Several diets are effective. A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilograms (4.4–8.8 lb) weight loss in all studies. At two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized. High protein diets do not appear to make any difference. A diet high in simple sugars such as those in soft drinks increases weight. There is evidence that dieting alone is efficient for weight loss and improving health for obese individuals.
With use, muscles consume energy derived from both fat and glycogen. Due to the large size of leg muscles, walking, running, and cycling are the most effective means of exercise to reduce body fat. Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel. To maintain health, the American Heart Association recommends a minimum of 30 minutes of moderate exercise at least 5 days a week.
The Cochrane Collaboration found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1 kilogram weight loss over dieting alone. A 1.5 kilograms (3.3 pounds) loss was observed with a greater degree of exercise. Even though exercise as carried out in the general population has only modest effects, a dose response curve is found, and very intense exercise can lead to substantial weight loss. During 20 weeks of basic military training with no dietary restriction, obese military recruits lost 12.5 kg (28 lb). High levels of physical activity seem to be necessary to maintain weight loss. A pedometer appears useful for motivation. Over an average of 18-weeks of use physical activity increased by 27% resulting in a 0.38 decreased in BMI.
Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population. The city of Bogota, Colombia for example blocks off 113 kilometers (70 mi) of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.
In an effort to combat the issue, a primary school in Australia instituted a standing classroom in 2013.
There is evidence that exercise alone is not sufficient to produce meaningful weight loss, but combining dieting and exercise provide the greatest health benefits and weight loss on the long term.
Weight loss programs
Weight loss programs involve lifestyle changes including diet modifications, physical activity and behavior therapy. This may involve eating smaller meals, cutting down on certain types of food, and making a conscious effort to exercise more. These programs also enable people to connect with a group of others who are attempting to lose weight, in the hopes that participants will form mutually motivating and encouraging relationships. Since 2013, the United States guidelines recommend to treat obesity as a disease and actively treat obese people for weight loss.
A number of popular programs exist, including Weight Watchers, Overeaters Anonymous, and Jenny Craig. These appear to provide modest weight loss (2.9 kg; 6.4 lb) over dieting on one's own (0.2 kg; 0.44 lb) over a two-year period, similarly to non-commercial diets. Internet-based programs appear to be ineffective. The Chinese government has introduced a number of "fat farms" where obese children go for reinforced exercise, and has passed a law which requires students to exercise or play sports for an hour a day at school (see Obesity in China).
In a structured setting with a trained therapist, these interventions produce an average weight loss of up to 8 kg in 6 months to 1 year, and 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later. There is a gradual weight regain after the first year of about 1 to 2 kg per year, but on the long-term this still results in a weight loss.
Comprehensive diet programs, providing counseling, targets for calorie intake and exercise, may be more efficient than dieting without guidance ("self-help"), although the evidence is very limited. Following comprehensive lifestyle modifications, the average maintained weight loss is more than 3 kg (6.6 lb) or 3% of total body mass, and could be sustained for five years, and up to 20% of the individuals maintain a weight loss of at least 10% (average of 33 kg). There is some evidence that fast weight loss produce greater long-term weight loss than gradual weight loss. Moderate on-site comprehensive lifestyle changes produce a greater weight loss than usual care, of 2 to 4 kg on average in 6 to 12 months. High-intensity comprehensive programs usually yield more weight loss than moderate or low-intensity, with about 35% to 60% of overweight individuals maintaining more than 5 kg weight loss after 2 years.
Lorcaserin has been found to be effective in the treatment of obesity with a weight loss of 5.8 kg at one year as opposed to 2.2 kg with placebo and it is approved by the Food and Drug Administration for use in the treatment of obesity. Side effects may include serotonin syndrome.
Rimonabant (Acomplia), another drug, had been withdrawn from the market. It worked via a specific blockade of the endocannabinoid system. It has been developed from the knowledge that cannabis smokers often experience hunger, which is often referred to as "the munchies". It had been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to safety concerns. European Medicines Agency in October 2008 recommended the suspension of the sale of rimonabant as the risk seem to be greater than the benefits. Sibutramine (Meridia), which acts in the brain to inhibit deactivation of the neurotransmitters, thereby decreasing appetite was withdrawn from the UK market in January 2010 and United States and Canadian markets in October 2010 due to cardiovascular concerns.
Weight loss with these drugs is modest. Over the longer term, average weight loss on orlistat is 2.9 kg (6.4 lb), sibutramine is 4.2 kg (9.3 lb) and rimonabant is 4.7 kg (10 lb). Orlistat and rimonabant lead to a reduced incidence of diabetes, and all three drugs have some effect on cholesterol. However, there is little information on how these drugs affect the longer-term complications or outcomes of obesity. In 2010 it was found that sibutramine increases the risk of heart attacks and strokes in people with a history of cardiovascular disease.
There are a number of less commonly used medications. Some are only approved for short term use, others are used off-label, and still others are used illegally. Most are appetite suppressants that act on one or more neurotransmitters. Racemic amphetamine, phendimetrazine, diethylpropion, and phentermine are approved by the FDA for short term use, while bupropion, topiramate, and zonisamide are sometimes used off-label. Recombinant human leptin is very effective in those with obesity due to congenital complete leptin deficiency via decreasing energy intake and possibly increases energy expenditure. This condition is, however, rare and this treatment is not effective for inducing weight loss in the majority of people with obesity. It is being investigated to determine whether or not it helps with weight loss maintenance.
The usefulness of certain drugs depends upon the comorbidities present. Metformin is preferred in overweight diabetics, as it may lead to mild weight loss in comparison to sulfonylureas or insulin. The thiazolidinediones, on the other hand, may cause weight gain, but decrease central obesity. Diabetics also achieve modest weight loss with fluoxetine, orlistat and sibutramine over 12–57 weeks. Preliminary evidence has however found higher number of cardiovascular events in people taking sibutramine verses control (11.4% vs. 10.0%). The long-term health benefits of these treatments remain unclear.
Fenfluramine and dexfenfluramine were withdrawn from the market in 1997, while ephedrine (found in the traditional Chinese herbal medicine má huáng made from the Ephedra sinica) was removed from the market in 2004.
Though hypothesized that supplementation of vitamin D may be an effective treatment for obesity, studies do not support this. There is also no strong evidence to recommend herbal medicines for weight loss.
Bariatric surgery ("weight loss surgery") is the use of surgical intervention in the treatment of obesity. As every operation may have complications, surgery is only recommended for severely obese people (BMI > 40) who have failed to lose weight following dietary modification and pharmacological treatment. Weight loss surgery relies on various principles: the two most common approaches are reducing the volume of the stomach (e.g. by adjustable gastric banding and vertical banded gastroplasty), which produces an earlier sense of satiation, and reducing the length of bowel that comes into contact with food (e.g. by gastric bypass surgery or endoscopic duodenal-jejunal bypass surgery), which directly reduces absorption. Band surgery is reversible, while bowel shortening operations are not. Some procedures can be performed laparoscopically. Complications from weight loss surgery are frequent.
Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures. A marked decrease in the risk of diabetes mellitus, cardiovascular disease and cancer has also been found after bariatric surgery. Marked weight loss occurs during the first few months after surgery, and the loss is sustained in the long term. In one study there was an unexplained increase in deaths from accidents and suicide, but this did not outweigh the benefit in terms of disease prevention. When the two main techniques are compared, gastric bypass procedures are found to lead to 30% more weight loss than banding procedures one year after surgery. For obese individuals with non-alcoholic fatty liver disease (NAFLD), bariatric surgery improves or cures the liver.
A preoperative diet such as low-calorie diets or very-low-calorie diet, is usually recommended to reduce liver volume by 16-20%, and preoperative weight loss is the only factor associated with postoperative weight loss. Preoperative weight loss can reduce operative time and hospital stay. although there is insufficient evidence whether preoperative weight loss may be beneficial to reduce long-term morbidity or complications. Weight loss and decreases in liver size may be independent from the amount of calorie restriction.
Ileojejunal bypass, in which the digestive tract is rerouted to bypass the small intestine, was an experimental surgery designed as a remedy for morbid obesity.
The effects of liposuction on obesity are less well determined. Some small studies show benefits while others show none. A treatment involving the placement of an intragastric balloon via gastroscopy has shown promise. One type of balloon led to a weight loss of 5.7 BMI units over 6 months or 14.7 kg (32 lb). Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.
An implantable nerve simulator which improves the feeling of fullness was approved by the FDA in 2015.
Much of the Western world has created clinical practice guidelines in an attempt to address rising rates of obesity. Australia, Canada, the European Union, and the United States have all published statements since 2004.
- People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
- If these goals are not achieved, pharmacotherapy can be offered. The person needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
- Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. For more severe cases of obesity, stronger drugs such as amphetamine and methamphetamine may be used on a selective basis. Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide.
- In people with a BMI over 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The person needs to be aware of the potential complications.
- Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.
A clinical practice guideline by the US Preventive Services Task Force (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a healthy diet in unselected people in primary care settings, but that intensive behavioral dietary counseling is recommended in those with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.
Canada developed and published evidence-based practice guidelines in 2006. The guidelines attempt to address the prevention and management of obesity at both the individual and population levels in both children and adults. The European Union published clinical practice guidelines in 2008 in an effort to address the rising rates of obesity in Europe. Australia came out with practice guidelines in 2004.
Temporary, controllable gastric pseudo-bezoars (swallowable, swellable foreign bodies in the stomach meant to reduce gastric volume from inside the organ) are being tested. Treatment with naltrexone plus bupropion in a phase three trial resulted in a weight lose of 5–6% versus 1% for a placebo.
- US Department of Health and Human Services. (2017). "2015–2020 Dietary Guidelines for Americans - health.gov". health.gov. Skyhorse Publishing Inc. Retrieved 30 September 2019.
- Arnett, Donna K.; Blumenthal, Roger S.; Albert, Michelle A.; Buroker, Andrew B.; Goldberger, Zachary D.; Hahn, Ellen J.; Himmelfarb, Cheryl D.; Khera, Amit; Lloyd-Jones, Donald; McEvoy, J. William; Michos, Erin D.; Miedema, Michael D.; Muñoz, Daniel; Smith, Sidney C.; Virani, Salim S.; Williams, Kim A.; Yeboah, Joseph; Ziaeian, Boback (17 March 2019). "2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease". Circulation. 140 (11): e596–e646. doi:10.1161/CIR.0000000000000678. PMID 30879355.
- Jensen, MD; Ryan, DH; Apovian, CM; Ard, JD; Comuzzie, AG; Donato, KA; Hu, FB; Hubbard, VS; Jakicic, JM; Kushner, RF; Loria, CM; Millen, BE; Nonas, CA; Pi-Sunyer, FX; Stevens, J; Stevens, VJ; Wadden, TA; Wolfe, BM; Yanovski, SZ; Jordan, HS; Kendall, KA; Lux, LJ; Mentor-Marcel, R; Morgan, LC; Trisolini, MG; Wnek, J; Anderson, JL; Halperin, JL; Albert, NM; Bozkurt, B; Brindis, RG; Curtis, LH; DeMets, D; Hochman, JS; Kovacs, RJ; Ohman, EM; Pressler, SJ; Sellke, FW; Shen, WK; Smith SC, Jr; Tomaselli, GF; American College of Cardiology/American Heart Association Task Force on Practice, Guidelines.; Obesity, Society. (24 June 2014). "2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society". Circulation. 129 (25 Suppl 2): S102-38. doi:10.1161/01.cir.0000437739.71477.ee. PMC 5819889. PMID 24222017. Lay summary.
- Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E; Douketis; Morrison; Hramiak; Sharma; Ur; Obesity Canada Clinical Practice Guidelines Expert Panel (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]". CMAJ. 176 (8): S1–13. doi:10.1503/cmaj.061409. PMC 1839777. PMID 17420481.CS1 maint: multiple names: authors list (link)
- Thom, G; Lean, M (May 2017). "Is There an Optimal Diet for Weight Management and Metabolic Health?" (PDF). Gastroenterology (Review). 152 (7): 1739–1751. doi:10.1053/j.gastro.2017.01.056. PMID 28214525.
- Wing, Rena R; Phelan, Suzanne (1 July 2005). "Science-Based Solutions to Obesity: What are the Roles of Academia, Government, Industry, and Health Care? Proceedings of a symposium, Boston, Massachusetts, USA, 10–11 March 2004 and Anaheim, California, USA, 2 October 2004". Am. J. Clin. Nutr. 82 (1 Suppl): 207S–273S. doi:10.1093/ajcn/82.1.222S. PMID 16002825.
- Anderson JW, Konz EC, Frederich RC, Wood CL; Konz; Frederich; Wood (1 November 2001). "Long-term weight-loss maintenance: A meta-analysis of US studies". Am. J. Clin. Nutr. (Meta-analysis). 74 (5): 579–84. doi:10.1093/ajcn/74.5.579. PMID 11684524.CS1 maint: multiple names: authors list (link)
- Thangaratinam, S; Rogozinska, E; Jolly, K; Glinkowski, S; Roseboom, T; Tomlinson, JW; Kunz, R; Mol, BW; Coomarasamy, A; Khan, KS (May 16, 2012). "Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence". BMJ (Clinical Research Ed.). 344: e2088. doi:10.1136/bmj.e2088. PMC 3355191. PMID 22596383.
- "How Are Overweight and Obesity Treated?". NHLBI. Retrieved 29 September 2016.
- Rucker D, Padwal R, Li SK, Curioni C, Lau DC; Padwal; Li; Curioni; Lau (2007). "Long term pharmacotherapy for obesity and overweight: Updated meta-analysis". BMJ. 335 (7631): 1194–99. doi:10.1136/bmj.39385.413113.25. PMC 2128668. PMID 18006966.CS1 maint: multiple names: authors list (link)
- Colquitt, JL; Pickett, K; Loveman, E; Frampton, GK (Aug 8, 2014). "Surgery for weight loss in adults". The Cochrane Database of Systematic Reviews. 8 (8): CD003641. doi:10.1002/14651858.CD003641.pub4. PMID 25105982.
- Sjöström L, Narbro K, Sjöström CD, et al. (August 2007). "Effects of bariatric surgery on mortality in Swedish obese subjects". N. Engl. J. Med. 357 (8): 741–52. doi:10.1056/NEJMoa066254. PMID 17715408.
- Poobalan AS, Aucott LS, Smith WC, Avenell A, Jung R, Broom J; Aucott; Smith; Avenell; Jung; Broom (November 2007). "Long-term weight loss effects on all cause mortality in overweight/obese populations". Obes Rev. 8 (6): 503–13. doi:10.1111/j.1467-789X.2007.00393.x. PMID 17949355.CS1 maint: multiple names: authors list (link)
- Peeters A, O'Brien PE, Laurie C, et al. (December 2007). "Substantial intentional weight loss and mortality in the severely obese". Ann. Surg. 246 (6): 1028–33. doi:10.1097/SLA.0b013e31814a6929. PMID 18043106.
- Matarese, Laura E.; Pories, Walter J. (December 2014). "Adult weight loss diets: metabolic effects and outcomes". Nutrition in Clinical Practice (Review). 29 (6): 759–767. doi:10.1177/0884533614550251. ISSN 1941-2452. PMID 25293593.
- Initiative, NHLBI Obesity Education (2000). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (National guidelines). National Institutes of Health, National Heart, Lung, and Blood Institute, NHLBI Obesity Education Initiative, North American Association for the Study of Obesity.
- Strychar I (January 2006). "Diet in the management of weight loss". CMAJ. 174 (1): 56–63. doi:10.1503/cmaj.045037. PMC 1319349. PMID 16389240.
- Sacks FM, Bray GA, Carey VJ, et al. (February 2009). "Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates". N. Engl. J. Med. 360 (9): 859–73. doi:10.1056/NEJMoa0804748. PMC 2763382. PMID 19246357.
- Schwingshackl, L; Hoffmann, G (Apr 15, 2013). "Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis". Nutrition Journal. 12: 48. doi:10.1186/1475-2891-12-48. PMC 3636027. PMID 23587198.
- Te Morenga, L; Mallard, S; Mann, J (Jan 15, 2012). "Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies". BMJ (Clinical Research Ed.). 346: e7492. doi:10.1136/bmj.e7492. PMID 23321486.
- "Obesity: maintaining a healthy weight and preventing excess weight gain". pathways.nice.org.uk.
- Gwinup G (1987). "Weight loss without dietary restriction: Efficacy of different forms of aerobic exercise". Am J Sports Med. 15 (3): 275–9. doi:10.1177/036354658701500317. PMID 3618879.
- Sahlin K, Sallstedt EK, Bishop D, Tonkonogi M (2008). "Turning down lipid oxidation during heavy exercise—what is the mechanism?". J. Physiol. Pharmacol. 59 (Suppl 7): 19–30. PMID 19258655.CS1 maint: multiple names: authors list (link)
- Haskell WL, Lee IM, Pate RR; et al. (August 2007). "Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association". Circulation. 116 (9): 1081–93. doi:10.1161/CIRCULATIONAHA.107.185649. PMID 17671237.CS1 maint: multiple names: authors list (link)
- Shaw K, Gennat H, O'Rourke P, Del Mar C; Gennat; O'Rourke; Del Mar (2006). "Exercise for overweight or obesity". Cochrane Database of Systematic Reviews (4): CD003817. doi:10.1002/14651858.CD003817.pub3. PMID 17054187.CS1 maint: multiple names: authors list (link)
- Lee L, Kumar S, Leong LC; Kumar; Leong (February 1994). "The impact of five-month basic military training on the body weight and body fat of 197 moderately to severely obese Singaporean males aged 17 to 19 years". Int. J. Obes. Relat. Metab. Disord. 18 (2): 105–9. PMID 8148923.CS1 maint: multiple names: authors list (link)
- Bessesen DH (June 2008). "Update on obesity". J. Clin. Endocrinol. Metab. 93 (6): 2027–34. doi:10.1210/jc.2008-0520. PMID 18539769.
- Bravata DM, Smith-Spangler C, Sundaram V, et al. (November 2007). "Using pedometers to increase physical activity and improve health: a systematic review". JAMA: The Journal of the American Medical Association. 298 (19): 2296–304. doi:10.1001/jama.298.19.2296. PMID 18029834.
- Kahn EB, Ramsey LT, Brownson RC, et al. (May 2002). "The effectiveness of interventions to increase physical activity. A systematic review". Am J Prev Med. 22 (4 Suppl): 73–107. doi:10.1016/S0749-3797(02)00434-8. PMID 11985936.
- "www.paho.org". Pan American Health Organization. Retrieved January 10, 2009.
- "World's first standing classroom launched in Australia - The Times of India". The Times Of India.
- Baron M (November 2004). "Commercial weight-loss programs". Health Care Food Nutr Focus. 21 (11): 8–9. PMID 15559885.
- Heshka S, Anderson JW, Atkinson RL, et al. (April 2003). "Weight loss with self-help compared with a structured commercial program: a randomized trial". JAMA. 289 (14): 1792–8. doi:10.1001/jama.289.14.1792. PMID 12684357.
- Atallah, R.; Filion, K. B.; Wakil, S. M.; Genest, J.; Joseph, L.; Poirier, P.; Rinfret, S.; Schiffrin, E. L.; Eisenberg, M. J. (11 November 2014). "Long-Term Effects of 4 Popular Diets on Weight Loss and Cardiovascular Risk Factors: A Systematic Review of Randomized Controlled Trials". Circulation: Cardiovascular Quality and Outcomes (Systematic review of RCTs). 7 (6): 815–827. doi:10.1161/CIRCOUTCOMES.113.000723. PMID 25387778.
- Vakil, RM; Doshi, RS; Mehta, AK; Chaudhry, ZW; Jacobs, DK; Lee, CJ; Bleich, SN; Clark, JM; Gudzune, KA (1 June 2016). "Direct comparisons of commercial weight-loss programs on weight, waist circumference, and blood pressure: a systematic review". BMC Public Health (Systematic review). 16: 460. doi:10.1186/s12889-016-3112-z. PMC 4888663. PMID 27246464.
- Gudzune, KA; Doshi, RS; Mehta, AK; Chaudhry, ZW; Jacobs, DK; Vakil, RM; Lee, CJ; Bleich, SN; Clark, JM (7 April 2015). "Efficacy of commercial weight-loss programs: an updated systematic review". Annals of Internal Medicine (Systematic review). 162 (7): 501–12. doi:10.7326/M14-2238. PMC 4446719. PMID 25844997.
- Tsai AG, Wadden TA; Wadden (January 2005). "Systematic review: an evaluation of major commercial weight loss programs in the United States". Annals of Internal Medicine. 142 (1): 56–66. doi:10.7326/0003-4819-142-1-200501040-00012. PMID 15630109.
- Hewitt, Duncan (May 23, 2000). "China battles obesity". BBC. Retrieved August 8, 2009.
- MacLeod, Calum (August 1, 2007). "Obesity of China's kids stuns officials". USA Today. Retrieved August 8, 2009.
- Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK; Galuska; Kettel Khan; Gillespie; Serdula (July 2007). "Weight regain in U.S. adults who experienced substantial weight loss, 1999–2002". Am J Prev Med. 33 (1): 34–40. doi:10.1016/j.amepre.2007.02.040. PMID 17572309.CS1 maint: multiple names: authors list (link)
- Kernan, Walter N.; Inzucchi, Silvio E.; Sawan, Carla; Macko, Richard F.; Furie, Karen L. (January 2013). "Obesity - A Stubbornly Obvious Target for Stroke Prevention". Stroke (Review). 44 (1): 278–286. doi:10.1161/STROKEAHA.111.639922. PMID 23111440.
- Gudzune, KA; Doshi, RS; Mehta, AK; Chaudhry, ZW; Jacobs, DK; Vakil, RM; Lee, CJ; Bleich, SN; Clark, JM (April 7, 2015). "Efficacy of commercial weight-loss programs: an updated systematic review". Annals of Internal Medicine. 162 (7): 501–512. doi:10.7326/M14-2238. PMC 4446719. PMID 25844997.
- Allan, Karen (2018). "4.4 Group‐based interventions for weight loss in obesity.". In Hankey, Catherine (ed.). Advanced nutrition and dietetics in obesity. Wiley. pp. 164–168. ISBN 9780470670767.
- Avery, Amanda (2018). "4.7 Commercial weight management organisations for weight loss in obesity.". In Hankey, Catherine (ed.). Advanced nutrition and dietetics in obesity. Wiley. pp. 177–182. ISBN 9780470670767.
- "FDA approves Belviq to treat some overweight or obese adults". FDA. June 27, 2012. Retrieved 8 July 2012.
- "WIN – Publication – Prescription Medications for the Treatment of Obesity". National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. Archived from the original on January 13, 2009. Retrieved January 14, 2009.
- Astrup, A. (Jul 2010). "Drug management of obesity—efficacy versus safety". N Engl J Med. 363 (3): 288–90. doi:10.1056/NEJMe1004076. PMID 20647205.
- Bays, HE (March 2011). "Lorcaserin: drug profile and illustrative model of the regulatory challenges of weight-loss drug development". Expert Review of Cardiovascular Therapy. 9 (3): 265–77. doi:10.1586/erc.10.22. PMID 21438803.
- Healy, Melissa; For, / (June 27, 2012). "FDA approves lorcaserin, first weight-loss drug OK'd since 1999". Los Angeles Times.CS1 maint: numeric names: authors list (link)
- "FDA approves weight-management drug Qsymia". Food and Drug Administration. July 17, 2012.
- "Anti-obesity drug no magic bullet". Canadian Broadcasting Corporation. January 2, 2007. Retrieved 2008-09-19.
- "FDA Briefing Document NDA 21-888 Zimulti (rimonabant) Tablets, 20 mg Sanofi Aventis Advisory Committee" (PDF). Food and Drug Administration. June 13, 2007. Retrieved 2008-09-19.
- "www.emea.europa.eu" (PDF).
- "Abbott Laboratories Voluntarily Withdraws Weight-loss Drug Sibutramine (Meridia) from the Canadian Market - Health Canada Information Update 2010-10-08". 2012-10-23.
- "www.nice.org.uk" (PDF). Archived from the original (PDF) on 2010-11-06.
- "Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review".
- James WP, Caterson ID, Coutinho W, et al. (September 2010). "Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects" (PDF). N. Engl. J. Med. 363 (10): 905–17. doi:10.1056/NEJMoa1003114. hdl:2437/111825. PMID 20818901.
- Li Z, Maglione M, Tu W, et al. (April 2005). "Meta-analysis: pharmacologic treatment of obesity". Annals of Internal Medicine. 142 (7): 532–46. doi:10.7326/0003-4819-142-7-200504050-00012. PMID 15809465.
- "Evekeo Prescribing Information" (PDF). Arbor Pharmaceuticals LLC. April 2014. pp. 1–2. Retrieved 11 August 2015.
- Kelesidis T, Kelesidis I, Chou S, Mantzoros CS; Kelesidis; Chou; Mantzoros (January 2010). "Narrative review: the role of leptin in human physiology: emerging clinical applications". Annals of Internal Medicine. 152 (2): 93–100. doi:10.7326/0003-4819-152-2-201001190-00008. PMC 2829242. PMID 20083828.CS1 maint: multiple names: authors list (link)
- UK Prospective Diabetes Study (UKPDS) Group (1998). "Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34)". Lancet. 352 (9131): 854–65. doi:10.1016/S0140-6736(98)07037-8. PMID 9742977.
- Fonseca V (2003). "Effect of thiazolidinediones on body weight in patients with diabetes mellitus". Am. J. Med. 115 Suppl 8A (8): 42S–48S. doi:10.1016/j.amjmed.2003.09.005. PMID 14678865.
- "Early Communication about an Ongoing Safety Review ofÂ Meridia (sibutramine hydrochloride)". FDA. Retrieved Nov 23, 2009.
- Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J; Zhang; Avenell; Gregg; Schmid; Lau (2005). "Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus". Cochrane Database of Systematic Reviews (1): CD004096. doi:10.1002/14651858.CD004096.pub2. PMC 6718205. PMID 15674929.CS1 maint: multiple names: authors list (link)
- Rados C (2004). "Ephedra ban: no shortage of reasons". FDA Consum. 38 (2): 6–7. PMID 15101356.
- Pathak, K.; Soares, M. J.; Calton, E. K.; Zhao, Y.; Hallett, J. (2014-06-01). "Vitamin D supplementation and body weight status: a systematic review and meta-analysis of randomized controlled trials". Obesity Reviews. 15 (6): 528–537. doi:10.1111/obr.12162. ISSN 1467-789X. PMID 24528624.
- Maunder, Alison; Bessell, Erica; Lauche, Romy; Adams, Jon; Sainsbury, Amanda; Fuller, Nicholas R. (2020-01-27). "Effectiveness of herbal medicines for weight loss: A systematic review and meta-analysis of randomized controlled trials". Diabetes, Obesity & Metabolism. doi:10.1111/dom.13973. ISSN 1463-1326. PMID 31984610.
- Sullivan, S. (2015). "Endoscopic Treatment of Obesity". In Jonnalagadda, S.S. (ed.). Gastrointestinal Endoscopy: New Technologies and Changing Paradigms. Springer. pp. 61–82. ISBN 9781493920327. Retrieved 18 March 2016.
- Muñoz, R.; Escalona, A. (2015). "Chapter 51: Endoscopic Duodenal-Jejunal Bypass Sleeve Treatment for Obesity". In Agrawal, S. (ed.). Obesity, Bariatric and Metabolic Surgery: A Practical Guide. Springer. pp. 493–498. ISBN 9783319043432. Retrieved 18 March 2016.
- Encinosa WE, Bernard DM, Chen CC, Steiner CA; Bernard; Chen; Steiner (2006). "Healthcare utilization and outcomes after bariatric surgery". Medical Care. 44 (8): 706–12. doi:10.1097/01.mlr.0000220833.89050.ed. PMID 16862031.CS1 maint: multiple names: authors list (link)
- Sjöström L, Narbro K, Sjöström CD, et al. (2007). "Effects of bariatric surgery on mortality in Swedish obese subjects". N. Engl. J. Med. 357 (8): 741–52. doi:10.1056/NEJMoa066254. PMID 17715408.
- Adams TD, Gress RE, Smith SC, et al. (2007). "Long-term mortality after gastric bypass surgery". N. Engl. J. Med. 357 (8): 753–61. doi:10.1056/NEJMoa066603. PMID 17715409.
- Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD; Karliner; Walsh; Petersen; Feldman (October 2008). "Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures". Am. J. Med. 121 (10): 885–93. doi:10.1016/j.amjmed.2008.05.036. PMID 18823860.CS1 maint: multiple names: authors list (link)
- Chitturi, Shiv; Wong, Vincent Wai-Sun; Chan, Wah-Kheong; Wong, Grace Lai-Hung; Wong, Simon Kin-Hung; Sollano, Jose; Ni, Yen-Hsuan; Liu, Chun-Jen; Lin, Yu-Cheng; Lesmana, Laurentius Adrianto; Kim, Seung Up (2018-07-10). "The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 2: Management and special groups". Journal of Gastroenterology and Hepatology. 33 (1): 86–98. doi:10.1111/jgh.13856. ISSN 1440-1746. PMID 28692197.
- Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK (December 2008). "Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis". Clinical Gastroenterology and Hepatology. 6 (12): 1396–402. doi:10.1016/j.cgh.2008.08.012. PMID 18986848.
- Thorell, A; MacCormick, AD; Awad, S; Reynolds, N; Roulin, D; Demartines, N; Vignaud, M; Alvarez, A; Singh, PM; Lobo, DN (September 2016). "Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations". World Journal of Surgery (Professional society guidelines). 40 (9): 2065–83. doi:10.1007/s00268-016-3492-3. PMID 26943657.
- Holderbaum, M; Casagrande, DS; Sussenbach, S; Buss, C (February 2018). "Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review". Surgery for Obesity and Related Diseases (Systematic review). 14 (2): 237–244. doi:10.1016/j.soard.2017.09.531. PMID 29239795.
- Livhits, M; Mercado, C; Yermilov, I; Parikh, JA; Dutson, E; Mehran, A; Ko, CY; Gibbons, MM (2008). "Does weight loss immediately before bariatric surgery improve outcomes: a systematic review". Surgery for Obesity and Related Diseases. 5 (6): 713–21. doi:10.1016/j.soard.2009.08.014. PMID 19879814.
- Roman, M; Monaghan, A; Serraino, GF; Miller, D; Pathak, S; Lai, F; Zaccardi, F; Ghanchi, A; Khunti, K; Davies, MJ; Murphy, GJ (February 2019). "Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes". The British Journal of Surgery (Meta-analysis). 106 (3): 181–189. doi:10.1002/bjs.11001. hdl:2381/43636. PMID 30328098.
- Cassie, S; Menezes, C; Birch, DW; Shi, X; Karmali, S (2010). "Effect of preoperative weight loss in bariatric surgical patients: a systematic review". Surgery for Obesity and Related Diseases (Systematic review). 7 (6): 760–7, discussion 767. doi:10.1016/j.soard.2011.08.011. PMID 21978748.
- Giugliano G, Nicoletti G, Grella E, et al. (April 2004). "Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women". Br J Plast Surg. 57 (3): 190–4. doi:10.1016/j.bjps.2003.12.010. PMID 15006519.
- Klein S, Fontana L, Young VL, et al. (June 2004). "Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease". N. Engl. J. Med. 350 (25): 2549–57. doi:10.1056/NEJMoa033179. PMID 15201411.
- Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J; Martínez-Cervell; García-Alvarez; Sendra-Gutiérrez; González-Enríquez (July 2008). "Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis". Obes Surg. 18 (7): 841–6. doi:10.1007/s11695-007-9331-8. PMID 18459025.CS1 maint: multiple names: authors list (link)
- "FDA approves first-of-kind device to treat obesity". fda.gov. January 14, 2015. Retrieved 18 January 2015.
- FDA release. June 14, 2016
- Kumar, N (25 July 2015). "Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration". World Journal of Gastrointestinal Endoscopy. 7 (9): 847–59. doi:10.4253/wjge.v7.i9.847. PMC 4515419. PMID 26240686.
- "Obesity Guidelines Website". Australian Government Department of Health and Ageing. Retrieved Oct 25, 2009.
- Tsigosa Constantine; Hainer, Vojtech; Basdevant, Arnaud; Finer, Nick; Fried, Martin; Mathus-Vliegen, Elisabeth; Micic, Dragan; Maislos, Maximo; et al. (April 2008). "Management of Obesity in Adults: European Clinical Practice Guidelines". The European Journal of Obesity. 1 (2): 106–16. doi:10.1159/000126822. PMC 6452117. PMID 20054170.
- Snow V, Barry P, Fitterman N, Qaseem A, Weiss K; Barry; Fitterman; Qaseem; Weiss; Clinical Efficacy Assessment Subcommittee of the American College of Physicians (2005). "Pharmacologic and surgical management of obesity in primary care: A clinical practice guideline from the American College of Physicians". Annals of Internal Medicine. 142 (7): 525–31. doi:10.7326/0003-4819-142-7-200504050-00011. PMID 15809464.CS1 maint: multiple names: authors list (link) Fulltext.
- U.S. Preventive Services Task Force (June 2003). "Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale". Am Fam Physician. 67 (12): 2573–6. PMID 12825847. Archived from the original on 2014-02-24. Retrieved 2014-02-24.
- Pignone MP, Ammerman A, Fernandez L, et al. (2003). "Counseling to promote a healthy diet in adults: A summary of the evidence for the U.S. Preventive Services Task Force". American Journal of Preventive Medicine. 24 (1): 75–92. doi:10.1016/S0749-3797(02)00580-9. PMID 12554027.
- Mintchev MP, Deneva MG, Aminkov BI, Fattouche M, Yadid-Pecht O, Bray RC; Deneva; Aminkov; Fattouche; Yadid-Pecht; Bray (1 February 2010). "Pilot study of temporary controllable gastric pseudobezoars for dynamic non-invasive gastric volume reduction". Physiol. Meas. 31 (2): 131–44. Bibcode:2010PhyM...31..131M. doi:10.1088/0967-3334/31/2/001. PMID 20009188.CS1 maint: multiple names: authors list (link)
- Greenway, Frank L.; Fujioka, Ken; Plodkowski, Raymond A.; Mudaliar, Sunder; Guttadauria, Maria; Erickson, Janelle; Kim, Dennis D.; Dunayevich, Eduardo; COR-I Study Group (2010). "Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial : The Lancet". The Lancet. 376 (9741): 595–605. doi:10.1016/S0140-6736(10)60888-4. PMID 20673995.
- Media related to Management of obesity at Wikimedia Commons
https://www.weightloseclinic.com/ weight loss clinic