Management and Interventions

Key Points

• An initial goal of a 5% to 10% reduction in weight is reasonable.

• A process-oriented target (lifestyle) may be more beneficial for some than a target weight.

• A weight reduction rate of 1 to 2 pounds weekly is achievable if intake is reduced by 500 to 1000 kcal daily.

• Caloric restriction alone is not as effective as combining it with an exercise program.

• A low-energy-dense diet composed of generous quantities of vegetables and fruits promotes health and facilitates weight management.

Although long-term treatment of obesity has generally had disappointing results, some individuals have lost and maintained significant amounts of weight. Weight loss programs have typically shown modest benefit, with variable results depending on the method, but most weight is eventually regained in 4 to 5 years. An exception is bariatric surgery, although its use is restricted to a small subset of the extremely obese population. Primary prevention strategies using many interventions at the individual and population levels are needed to limit the growing epidemic of obesity. Early intervention should start in childhood, and because excessive weight gain can occur at any age, strategies should be continued through adulthood. Family physicians should calculate BMI for all patients at least yearly to monitor for a developing weight disorder, with further screening for comorbidities if overweight is found.

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