Abstract
The prevalence of obesity has risen substantially during the past 25 years in the United States and most developed countries, with a related increase in type 2 diabetes mellitus.1,2 Almost one third of the adult US population is considered to be obese (body mass index [BMI] ≥30), and 1 in 20 is extremely obese (BMI ≥40).3 Nearly 17% of children and adolescents are overweight in the United States.3 Obesity is associated with increased risk for type 2 diabetes mellitus, coronary heart disease (CHD), hypertension, obstructive sleep apnea, and cancer, higher overall mortality rate,4–6 and decreased longevity.7,8 Extreme obesity can truncate life expectancy in young adults by 5 to 20 years.8 Accordingly, the expected benefits of weight reduction for obese individuals are profound. Weight loss of 5% to 10% generally lessens many health risks, including cardiovascular risks, although such improvements are most notably demonstrable in studies specifically conducted in high-risk populations, and the benefits are presumed to be greater when healthier weight is maintained for long periods.9,10 In overweight and obese individuals, weight loss achieved with most interventions over 1 to 2 years generally leads to improvements in blood pressure (BP), glycemic measures, and triglycerides (TGs). Improvements in total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) have been reported in studies using dietary interventions combined with exercise. When weight loss is achieved primarily via pharmacological interventions, these benefits have not occurred quite so consistently.11 Reduced caloric intake and increased physical activity are generally accepted as the foundations of any approach directed at weight reduction, but these lifestyle interventions do not appear to provide long-lasting success for obese individuals wishing to lose weight. About half of the weight lost with the help of lifestyle interventions is regained at 1 year; after …
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