Management of obesity/ja: Difference between revisions

[[File:ObesityMed2008.JPG|thumb|alt=肥満症の治療に使われる2種類の薬の段ボール包装。オルリスタットはゼニカルの商品名で、ロシュのブランド名が入った白いパッケージに入っている。シブトラミンは下の写真で、商品名メリディアである。オルリスタットは、英国ではAlliとしても販売されている。アボット・ラボラトリーズのロゴのAはパッケージの下半分にある。|right|[[Orlistat/ja|オルリスタット]]（ゼニカル）は肥満症の治療薬として最も一般的に使用されている薬であり、[[sibutramine/ja|シブトラミン]]（メリディア）は心血管系の副作用により発売中止となった薬である。]]

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 14.7kg. Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.

In 2016 the FDA approved an [[aspiration therapy]] device that siphons food from the stomach to the outside and decreases caloric intake.

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== Health policy ==

Obesity is a complex public health and policy problem because of its prevalence, costs, and health effects. As such, managing it requires changes in the wider societal context and effort by communities, local authorities, and governments. Public health efforts seek to understand and correct the [[Obesity and the environment|environmental factors]] responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct [[Junk food|junk]] [[food marketing]] to children, The World Health Organization recommends the taxing of sugary drinks. When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.

[[Mass media]] campaigns seem to have limited effectiveness in changing behaviors that influence obesity. At the same time they can increase knowledge and awareness regarding physical activity and diet, which might lead to changes in the long term. Campaigns might also be able to reduce the amount of time spent [[Sedentary lifestyle|sitting or lying down]] and positively affect the intention to be active physically. [[Nutrition facts label|Nutritional labelling]] with energy information on menus might be able to help reducing energy intake while dining in restaurants.

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== Clinical protocols ==

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.

In a clinical practice guideline by the [[American College of Physicians]], the following five recommendations are made:

# 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 [[Adverse effect (medicine)|side-effects]] and the unavailability of long-term safety and efficacy data.

# Drug therapy may consist of [[sibutramine]], [[orlistat]], [[phentermine]], [[diethylpropion]], [[fluoxetine]], and [[bupropion]]. 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. A survey of primary care physicians in the United States found that although clinical guidelines do not consider overweight to be a risk factor that increases mortality, physicians often report believing that being overweight increases all-cause mortality.

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.