Management of obesity: Difference between revisions

Line 58:

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 ~~{{convert|~~1.~~5|kg|lb|abbr=off}}~~ 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 relationship|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 ~~{{convert|~~12.~~5|kg|lb|abbr=on}}~~. 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 decrease in BMI.

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 1.5kg 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 relationship|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 12.5kg. 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 decrease 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 ~~{{convert|113|km|mi|sp=us}}~~ of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These [[pedestrian zone]]s are part of an effort to combat chronic diseases, including obesity.

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 113km of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These [[pedestrian zone]]s 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.

Line 69:

Weight loss programs involve lifestyle changes including diet modifications, physical activity and behavior therapy. This may involve eating [[portion size|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 treating obesity as a disease and actively treat obese people for weight loss.

A number of popular programs exist including [[WW International|Weight Watchers]], [[Overeaters Anonymous]] and [[Jenny Craig, Inc.|Jenny Craig]]. These appear to provide modest weight loss (~~{{convert|~~2.~~9|kg|lb|abbr=on|disp=semicolon}}~~) over dieting on one's own (~~{{convert|~~0.~~2|kg|lb|abbr=on|disp=semicolon}}~~) over a two-year period, similarly to non-commercial diets. As of 2005, there was insufficient scientific evidence to determine whether Internet-based programs produce effective weight loss.

A number of popular programs exist including [[WW International|Weight Watchers]], [[Overeaters Anonymous]] and [[Jenny Craig, Inc.|Jenny Craig]]. These appear to provide modest weight loss (2.9kg) over dieting on one's own (0.2kg) over a two-year period, similarly to non-commercial diets. As of 2005, there was insufficient scientific evidence to determine whether Internet-based programs produce effective weight loss.

The [[Government of the People's Republic of China|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]]).

Line 76:

Attending group meetings for [[Weight loss|weight reduction]] programmes rather than receiving one-on-one support may increase the likelihood that obese people will lose weight. Those who participated in groups had more treatment time and were more likely to lose enough weight to improve their health. Study authors suggested that one explanation for the difference is that group participants spent more time with the clinician (or whoever delivered the programme) than those receiving one-on-one support.

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 ~~{{convert|3|kg|lb|abbr=on}}~~ 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.

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 3kg 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.

The [[National Institute for Health and Care Excellence|NICE]] devised a set of essential criteria to be met by commercial weight management organizations to be approved.

Line 90:

* Semaglutide (Wegovy) is currently approved by the FDA for long-term use, being associated with a 6-12% loss in body weight compared to placebo.

* The [[combination drug]] [[phentermine/topiramate]] (Qsymia) is approved by the FDA as an addition to a reduced-calorie diet and exercise for chronic [[weight management]].

* Orlistat reduces intestinal fat absorption by inhibiting pancreatic [[lipase]]. Over the longer term, average weight loss on orlistat is ~~{{convert|~~2.~~9|kg|lb|abbr=on}}~~. It leads to a reduced incidence of diabetes, and has some effect on [[cholesterol]]. However, there is little information on how it affects the longer-term complications or outcomes of obesity.

* Orlistat reduces intestinal fat absorption by inhibiting pancreatic [[lipase]]. Over the longer term, average weight loss on orlistat is 2.9kg. It leads to a reduced incidence of diabetes, and has some effect on [[cholesterol]]. However, there is little information on how it affects the longer-term complications or outcomes of obesity.

* [[Racemic amphetamine]], [[phendimetrazine]], [[diethylpropion]], and [[phentermine]] are approved by the FDA for short term use.

Line 114:

[[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 ~~{{convert|~~14.~~7|kg|lb|abbr=on}}~~. Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.

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.

An implantable nerve simulator which improves the feeling of fullness was approved by the FDA in 2015.

@@ Line 58: / Line 58: @@
 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&nbsp;kilogram weight loss over dieting alone. A {{convert|1.5|kg|lb|abbr=off}} 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 relationship|dose response curve]] is found and very intense exercise can lead to substantial weight loss. During 20&nbsp;weeks of basic military training with no dietary restriction, obese military recruits lost {{convert|12.5|kg|lb|abbr=on}}.  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 decrease in BMI.
+The [[Cochrane Collaboration]] found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1&nbsp;kilogram weight loss over dieting alone. A 1.5kg 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 relationship|dose response curve]] is found and very intense exercise can lead to substantial weight loss. During 20&nbsp;weeks of basic military training with no dietary restriction, obese military recruits lost 12.5kg.  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 decrease 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 {{convert|113|km|mi|sp=us}} of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These [[pedestrian zone]]s are part of an effort to combat chronic diseases, including obesity.
+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 113km of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These [[pedestrian zone]]s 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.
@@ Line 69: / Line 69: @@
 Weight loss programs involve lifestyle changes including diet modifications, physical activity and behavior therapy. This may involve eating [[portion size|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 treating obesity as a disease and actively treat obese people for weight loss.
-A number of popular programs exist including [[WW International|Weight Watchers]], [[Overeaters Anonymous]] and [[Jenny Craig, Inc.|Jenny Craig]]. These appear to provide modest weight loss ({{convert|2.9|kg|lb|abbr=on|disp=semicolon}}) over dieting on one's own ({{convert|0.2|kg|lb|abbr=on|disp=semicolon}}) over a two-year period, similarly to non-commercial diets. As of 2005, there was insufficient scientific evidence to determine whether Internet-based programs produce effective weight loss.
+A number of popular programs exist including [[WW International|Weight Watchers]], [[Overeaters Anonymous]] and [[Jenny Craig, Inc.|Jenny Craig]]. These appear to provide modest weight loss (2.9kg) over dieting on one's own (0.2kg) over a two-year period, similarly to non-commercial diets. As of 2005, there was insufficient scientific evidence to determine whether Internet-based programs produce effective weight loss.
 The [[Government of the People's Republic of China|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]]).
@@ Line 76: / Line 76: @@
 Attending group meetings for [[Weight loss|weight reduction]] programmes rather than receiving one-on-one support may increase the likelihood that obese people will lose weight. Those who participated in groups had more treatment time and were more likely to lose enough weight to improve their health. Study authors suggested that one explanation for the difference is that group participants spent more time with the clinician (or whoever delivered the programme) than those receiving one-on-one support.
-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 {{convert|3|kg|lb|abbr=on}} 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&nbsp;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&nbsp;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&nbsp;kg weight loss after 2 years.
+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 3kg 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&nbsp;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&nbsp;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&nbsp;kg weight loss after 2 years.
 The [[National Institute for Health and Care Excellence|NICE]] devised a set of essential criteria to be met by commercial weight management organizations to be approved.
@@ Line 90: / Line 90: @@
 * Semaglutide (Wegovy) is currently approved by the FDA for long-term use, being associated with a 6-12% loss in body weight compared to placebo.
 * The [[combination drug]] [[phentermine/topiramate]] (Qsymia) is approved by the FDA as an addition to a reduced-calorie diet and exercise for chronic [[weight management]].
-* Orlistat reduces intestinal fat absorption by inhibiting pancreatic [[lipase]]. Over the longer term, average weight loss on orlistat is {{convert|2.9|kg|lb|abbr=on}}. It leads to a reduced incidence of diabetes, and has some effect on [[cholesterol]]. However, there is little information on how it affects the longer-term complications or outcomes of obesity.
+* Orlistat reduces intestinal fat absorption by inhibiting pancreatic [[lipase]]. Over the longer term, average weight loss on orlistat is 2.9kg. It leads to a reduced incidence of diabetes, and has some effect on [[cholesterol]]. However, there is little information on how it affects the longer-term complications or outcomes of obesity.
 * [[Racemic amphetamine]], [[phendimetrazine]], [[diethylpropion]], and [[phentermine]] are approved by the FDA for short term use.
@@ Line 114: / Line 114: @@
 [[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&nbsp;BMI units over 6&nbsp;months or {{convert|14.7|kg|lb|abbr=on}}. Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.
+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&nbsp;BMI units over 6&nbsp;months or 14.7kg. 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.