Lifestyle and Pharmacological Approaches to Weight Loss: Efficacy and Safety

Context: Obesity results from a prolonged small positive energy balance, and its treatment needs to reverse this imbalance. Evidence Acquisition: Citations retrieved from PubMed and The Handbook of Obesity 2008 were selected to illustrate the points. Evidence Synthesis: Many different diets have been tried to treat obesity, and weight loss occurs with all of them. There is currently no evidence that clearly supports a superiority of one macro-nutrient composition for diets used for weight loss. The principal effect seems to be the degree of adherence to the prescribed calorie reduction. Lifestyle strategies to modify eating behavior can be used in individual counseling sessions or in groups, both of which are important in helping patients modify their patterns of eating. Physical activity is particularly important in helping patients maintain a weight loss once achieved and is less valuable for weight loss itself. Food intake is controlled through many different mechanisms, but only a few drugs have been developed that tap these mechanisms. Orlistat, which blocks intestinal lipase, is one; sibutramine, a serotonin-norepinephrine reuptake inhibitor, is a second. Surgical approaches provide the most dramatic weight loss and have been demonstrated to reduce long-term mortality and reduce the incidence of diabetes. Conclusions: Weight loss can be achieved by many methods, but the surgical procedures appear to be the most durable. (J Clin Endocrinol Metab 93: S81-S88, 2008)