Lifestyle and pharmacological approaches to weight loss: efficacy and safety.
ABSTRACT Obesity results from a prolonged small positive energy balance, and its treatment needs to reverse this imbalance.
Citations retrieved from PubMed and The Handbook of Obesity 2008 were selected to illustrate the points.
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 macronutrient 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.
Weight loss can be achieved by many methods, but the surgical procedures appear to be the most durable.
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ABSTRACT: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age. Its clinical expression is diverse, including metabolic, behavioral, and reproductive effects, with many affected by obesity and decreased quality of life. Women with PCOS who have undergone surgically induced weight loss have reported tremendous benefit, not only with weight loss, but also improvement of hyperandrogenism and menstrual cyclicity. In a rat model of PCOS achieved via chronic administration of dihydrotestosterone (DHT) exposure, we investigated the ability of bariatric surgery, specifically vertical sleeve gastrectomy (VSG), to ameliorate the metabolic, behavioral, and reproductive abnormalities invoked by this PCOS model. We found that DHT treatment combined with exposure to a high-fat diet resulted in increased body weight and body fat, impaired fasting glucose, hirsutism, anxiety, and irregular cycles. VSG resulted in reduced food intake, body weight, and adiposity with improved fasting glucose and triglycerides. VSG induced lower basal corticosterone levels and attenuated stress responsivity. Once the DHT levels decreased to normal, regular estrous cyclicity was also restored. VSG, therefore, improved PCOS manifestations in a comprehensive manner and may represent a potential therapeutic approach for specific aspects of PCOS.Obesity Surgery 01/2014; · 3.74 Impact Factor
Article: The management of obesity[Show abstract] [Hide abstract]
ABSTRACT: The prevalence and incidence of obesity is rising as current ways of managing obesity are proving to be ineffective. The preferred approach is to induce an energy deficit by decreasing energy intake through a low calorie diet and increasing energy expenditure through exercise. In order to provoke body weight loss the changes in lifestyle that this approach involves have to be sustained and while some individuals have the motivation to do this the vast majority of the population has not. Very low calorie diets are ineffective as the body adapts to them by lowering energy expenditure and altering the macronutrient composition of low calorie diets has no additional effect. The anti-obesity drugs orlistat, sibutramine and rimonabant can provoke body weight loss but all suffer from side effects. However, the explosion in our understanding of the factors that regulate energy intake is likely to lead to the development of more effective drugs with fewer side effects. Bariatric or weight reducing surgery is highly effective at provoking body weight loss but there are obvious barriers to its widespread use.Lipid Technology 07/2009; 21(7).
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ABSTRACT: Obesity treatment based on lifestyle modifications is characterized by a high proportion of treatment failures. The study of predictors of success could be useful for a better definition of therapeutic needs in individual patients. Few studies have attempted a comprehensive assessment of psychological factors related with treatment response. Aim of the study is the identification of psychological and psychopathological features associated with a good treatment response in patients referring for obesity.Journal of endocrinological investigation 07/2014; 37(12). · 1.65 Impact Factor