Comprehensive Obesity Treatment Research Articles

6851 Rapidly Increasing Use of Anti-Obesity Medications among Veterans in the Veterans Health Administration (VA)

Abstract Disclosure: V. Vimalananda: None. S. Qian: None. R. Bolton: None. A. Hung: None. V. Smith: None. M. Maciejewski: None. Introduction: Obesity is a prevalent and costly chronic disease that compromises quality of life; increases risks of cardiometabolic disease, osteoarthritis, and several cancers; and accounts for 28% of U.S. health care costs. Anti-obesity medications (AOMs) may fill the treatment gap given the low uptake of bariatric surgery and limited effectiveness of behavioral interventions, and are guideline-recommended as part of a comprehensive obesity treatment plan. The landscape for obesity treatment has changed with introduction of the highly effective and in-demand glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1 + GIP receptor agonists (GIP/GLP-1 RAs). Given limited knowledge of use patterns, we describe use of AOMs among patients receiving care in the Veterans Health Administration (VA), which is the largest integrated health system in the United States. Methods: In a retrospective cohort study of VA patients from 7/1/2021-6/30/2023, we examined data from the VHA Corporate Data Warehouse separately for patients on AOMs without and with diagnosed diabetes, since the newer AOMs can be used at lower doses for the diabetes indication. Results: There were 31,106 patients without diabetes and at least one AOM prescription in the two year study period, who were 60% male and 62% White. AOM prescriptions from Year 1 to Year 2 among this group increased 215%. Overall, prescriptions were: semaglutide 34%, liraglutide 18%, orlistat 18%, phentermine/topiramate 14%, bupropion/naltrexone 12%, phentermine 4% and tirzepatide 0.03%. Prescribers were physicians 60%, LIPs 25%, and pharmacists 13%. There were 188,017 patients with diagnosed diabetes and at least one AOM prescription, and they were 92% male and 67% white. AOM prescriptions from Year 1 to Year 2 among this group increased 14% and were primarily (87%) for semaglutide. Prescribers were physicians 63%, licensed independent practitioners (LIPs) 23%, and pharmacists 10%. Conclusions AOM use is increasing in VA across all AOM classes, particularly among patients without diabetes, indicating growing interest in medical treatment of obesity. As AOM use spreads, real-world evidence on weight loss and clinical outcomes is needed among patients like those in VA who tend to be older and less healthy than the highly selected patients included in randomized clinical trials. Data is especially needed to guide practice among patients with obesity and without diabetes, given the dramatic increase in use among that group over the past 2 years. Presentation: 6/1/2024

Biochemical indices of blood in women suffering from anovulatory infertility during xenical treatment

Summary. Obesity is a common problem among women of childbearing age. It is known that obesity negatively affects various types of metabolism, many organs and organ systems, and in particular, a woman's fertility. Thus, obese women of childbearing age may experience menstrual irregularities, endometrial pathology, and infertility. The aim of the study – to determine changes in serum biochemical parameters in women with Xenical-induced anovulatory infertility. Materials and Methods. We surveyed 82 obese women who complained of no pregnancy for 2 years or more in the presence of regular sex without the use of contraceptives. Patients were divided into two equal groups: group 1 included 42 women, group 2 – 40 women. Comprehensive treatment of obesity in patients of group 1 was supplemented with the drug Xenical. A laboratory study was performed at the beginning of the experiment, after 3 and 6 months: blood lipid spectrum, ALT, AST, CRP, TSH, adiponectin, insulin, and OGTT. Results. Follow-up of patients in the first stage of the study was carried out for 6 months. Six months later, body weight in patients of group 1 decreased on average to (80.5±0.9) kg, in patients of group 2 – to (94.4±1.1) kg. In group 1, 36 patients became pregnant, in group 2 – 19. During the screening phase of the laboratory study in the experimental and control groups, elevated levels of cholesterol, LDL cholesterol, triglycerides, and decreased levels of HDL cholesterol and adiponectin. After 6 months, differences in the dynamics of lipid metabolism were recorded. Thus, cholesterol in the main group decreased by -0.35 [-0.75; 0.05] mol/l, and the control only -0.05 [-0.15; 0.25] mol/l (p = 0.027). There was a statistically significant difference between the groups in the reduction of atherogenic LDL. In six months of the study, all women who took Xenical showed normalization of cholesterol levels, decreased CRP, and increased adiponectin levels. Conclusions. Xenical is effective in the fight against obesity, improves laboratory blood tests, has a particularly positive effect on lipid metabolism, which resulted in the possibility of pregnancy in most patients who took this drug

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

P39 Evaluación de los resultados del tratamiento integral de la obesidad en pacientes de la Clínica Privada Vélez Sarsfield

Introducción: la cirugía bariátrica produce una pérdida de peso sostenida a largo plazo y reduce la comorbilidad y mortalidad en pacientes con obesidad severa. La evaluación de la pérdida ponderal debe realizarse con las herramientas adecuadas desarrolladas: porcentaje de IMC perdido (PIMCP), porcentaje de exceso de IMC perdido (PEIMCP) y el IMC final (IMCF) esperable a los tres años de la cirugía.Objetivos: 1) evaluar la pérdida ponderal en los pacientes sometidos al tratamiento integral de la obesidad en la CPVS durante el período de agosto de 2012 a agosto de 2019; 2) determinar asociación entre los factores demográficos, comorbilidades y reducción de peso logrado; 3) determinar asociación entre el mantenimiento de la actividad física y plan alimentario, y resultado a largo plazo; 4) determinar factores de riesgo para reganancia de peso.Materiales y métodos: estudio observacional, longitudinal y analítico. Tipo de muestreo: consecutivo.Se analizó la historia clínica electrónica de los pacientes, posteriormente se realizó una entrevista telefónica y se obtuvieron las variables en la actualidad. Procedimiento quirúrgico: gastrectomía vertical en manga. El análisis estadístico: Infostat.

Physical activity as one of the elements of a comprehensive obesity treatment

Obesity is nowadays a disease of civilization contributing to the increase in mortality worldwide, especially in developing and developed countries. There is a need to take action to normalise the weight of as many people as possible, bearing in mind disadvantageous to the health and the life, effects of exaggerated increasing the amount of the fatty tissue. In this connection, the need to shape patterns of pro-healthy behaviour should be particularly emphasised. The implementation of appropriate physical activity should be one of the basic elements of a comprehensive obesity treatment. Taking into account a wide range of exercises, it is important to choose the right activity for a given person, taking into account their abilities and performance, as well as indications and contraindications to a specific form of training. A key role in the weight reduction process is played by the determination to continue the recommendations made in a long-term and systematic manner. If attempts of the non-invasive treatment turn out to be ineffective, sick persons with the obesity can be qualified for the bariatric surgery. Implementing the physical activity in the period before and post-operative is bringing the sequence of beneficial changes in the body of the patient. It often improves the well-being of patients as well as results in the faster convalescence and lowering the risk of complications. Both the non-invasive and surgical treatment of obesity should be complemented by the introduction of appropriate physical activity.

Experience of using sibutramine in combination with microcrystalline cellulose in clinical practice

For many years, interest in the issue of obesity has not faded, as obesity is now one of the most common pathologies in the world that directly affects quality of life and lifespan. Even a slight weight loss (5-10% of baseline values) in obese patients is known to improve metabolism and reduce the risk of a range of comorbidities. The article reflects the importance of comprehensive treatment of obesity, presents positive experience of using Reduxin (sibutramine in combination with microcrystalline cellulose) to reduce body weight and risk factors for cardiovascular disease in a specific clinical example in a patient with exogenous-constitutional obesity and eating disorders. The case of obesity in a young man of 24 years old is presented, when other components of the metabolic syndrome (except for arterial hypertension) were not formed. Thus, following the results of 24-week complex treatment, clinically significant reduction of body weight (by 21.7% of initial values) was observed in the patient. The data of psychological researches have shown that the patient has no increase of anxiety and depression level during treatment, but at the same time the indicators of quality of life according to the results of health questionnaire testing have improved. This clinical case corresponds to the results of the PrimaVera program and demonstrates that weight loss during sibutramine therapy in combination with microcrystalline cellulose has a positive impact on the overall health and emotional status of patients and leads to improved quality of life. Therefore, successful treatment of obesity and the maintenance of other outcomes are key to preventing cardiovascular disease.

Ожирение у детей: роль и возможности двигательной активности в комплексном лечении

The article presents an analytical review of scientific research on physical activity of overweight and obese children and adolescents. Obese children have low physical activity levels, decreased exercise tolerance, low adherence to active lifestyles. Worldwide and Russian studies showed that the effectiveness of losing weight and achieving the optimal body weight is higher when various kinds of physical exercises are included in comprehensive obesity treatment programmes. The most significant results for losing weight and increasing exercise tolerance are obtained in patients who are more highly motivated for moderate or high physical activity during 60-minute exercises not less than 3 times a week. Key words: children, adolescents, obesity, physical activity

Patient Characteristics Associated with Receipt of Prescription Weight-Management Medications Among Veterans Participating in MOVE!

Weight-management medications (WMM) are recommended for the treatment of obesity. This study examined characteristics associated with initial receipt of WMM among eligible veterans in the first year following enrollment in the Veterans Health Administration (VHA) MOVE! behavioral weight-management program. We conducted a retrospective cohort study of VHA patients with obesity or overweight and obesity-related comorbidities who enrolled in MOVE! from October 2013 to September 2016 (N = 153,939). Multivariable logistic regression models estimated predictors of having a filled prescription for WMM and for orlistat. A total of 1.1% of these veterans received WMM. The most common WMM included orlistat (70.4%), phentermine/topiramate (11.2%), and bupropion/naltrexone (9.7%). Female sex, higher BMI, obstructive sleep apnea, osteoarthritis, depression, lower back pain, and alcohol abuse were associated with greater odds of use of WMM, whereas age over 65 years, Hispanic ethnicity, and required co-payments were associated with lower odds. Among patients receiving WMM, older age, black race, female sex, higher BMI, cardiovascular disease, lower back pain, and congestive heart failure were associated with use of orlistat versus any other WMM. Of patients engaged in MOVE! in the VHA, 1.1% received WMM. WMM are underutilized among veterans. Additional research is needed to understand barriers to incorporating WMM into comprehensive obesity treatment plans.

Emotional intelligence, emotion regulation and affectivity in adults seeking treatment for obesity

Obesity has become an increasingly widespread endemic with social implications; however, the relationship between higher body mass index (BMI) and psychological functioning is still not fully understood. This study examined the differences in affect-related psychological variables among BMI classes. A total of 134 adults seeking treatment for obesity and 124 controls completed a set of questionnaires to assess: trait emotional intelligence, emotion regulation strategies, anxiety, depression, binge eating behaviors and happiness. Correlations and multivariate analysis of variance were run per each study variable controlling for BMI class (normal weight, overweight, or obesity class I, II, III). Individuals with obesity class III were characterized by reduced trait emotional intelligence and happiness, and a higher tendency to use emotion suppression compared to normal weight individuals. All individuals with obesity also showed higher levels of depression and binge eating behaviors compared to both normal weight and overweight adults. Depression and emotion suppression were the most relevant discriminant factors across BMI classes, while trait emotional intelligence resulted as an important psychological factor clustering individual differences between obese and non-obese individuals. These results suggest that more attention to the affective domain of psychological functioning is needed for proper and comprehensive treatment of obesity.

Physiotherapy in the comprehensive treatment of obesity

Abstract Background: World Health Organization considers obesity as the most serious health condition in the world today. This concerns not only adults but also children and young people. Obesity is the leading cause of increased morbidity, disabilities, mortality rates and deteriorated quality of life in society. Higher death risk due to cardiovascular diseases and certain cancerous conditions are also attributable to obesity. Some 40% adults in the world today are overweight and 13% are obese. These tendencies have also been observed in Poland. Specific components of comprehensive slimming treatments include dietary treatment, nutrition education, habits modification, increased level of physical activity, pharmacological treatment and surgical interventions. The basis in obesity treatment is to induce a negative energy balance. This status is typically achieved through dietary measures and increased energy expenditure. Helping prepare adequate individual therapeutic programs is a key to success in slimming of the obese patients. Mass reduction programs are prepared individually based on FITT formula, which takes into consideration four aspects of physical activity: frequency, intensity, time and type of physical activity. The role of physiotherapists in this process is essential. Individual therapeutic programs help adjust all the aspects of training to the health status of the obese patients, with respect to coexisting diseases.

Pediatric Health Care Provider Perceptions of Weight Loss Surgery in Adolescents

This study explored pediatric health care providers' obesity treatment practices and perceptions about adolescent weight loss surgery (WLS). Surveys were e-mailed to pediatric listservs. After descriptive analyses, correlations, chi-squares, and one-way analyses of variance compared responses by provider characteristics. Surveys were completed by 109 providers. Almost half do not routinely measure body mass index. Providers typically counsel patients about lifestyle change, with limited perceived benefit; <10% have ever referred patients for WLS, citing cost (20%), risk (49%), or "not indicated in pediatrics" (17%) as reasons. However, when presented with patient scenarios of different ages and comorbidities, likeliness to refer for WLS increased substantially. Surgeons, younger providers and those with fewer years of experience were more likely to refer for WLS (P < .05). Despite expert consensus recommendations supporting WLS as part of a comprehensive obesity treatment plan, significant pediatric provider resistance to refer obese adolescents remains. Improved referral and management practices are needed.

Obesity Policy Streams, the Economy, and a Call for Nursing Leadership

Obesity policy has received increasing prominence on the national agenda. Constricting national and state economies, however, threaten the public's perception and support of obesity as a national agenda item. Inversely related to the declining United States (U.S.) economy, obesity rates have continued to climb over the past decade. Economic detractors and incremental healthcare reform underscore the importance of nurses as policy leaders. Informing the policy process while educating the public regarding comprehensive treatment of obesity and related conditions is increasingly important in meeting current and future healthcare needs in a manner that reverses the physical and economic burden of obesity. The public health model is an effective model for addressing, treating, and mitigating the effects of chronic health conditions through primary and secondary management. Nurses are uniquely positioned to impact obesity through primary prevention, secondary prevention, and tertiary disease management. Nursing leadership in the obesity policy streams can mitigate the human and economic impact of obesity and related conditions.

Comparative Efficiency and Safety of Pharmacological Approaches to the Management of Obesity

Obesity and overweight are reaching global epidemic proportions affecting more than 1.1 billion individuals worldwide. Excess weight is associated with an increased mortality, chronic morbidity (including type 2 diabetes, arterial hypertension, cardiovascular diseases, and certain cancers), decreased quality of life, and considerable health care costs (1). Antiobesity drugs work through different mechanisms either in the central nervous system (CNS) or in the peripheral tissues. These mechanisms include: 1 ) suppression of food intake in the CNS, 2 ) decreased gut absorption of nutrients, and 3 ) increased energy expenditure or oxidation of nutrients. The efficacy of antiobesity drugs should be evaluated by their ability to reduce fat stores (preferentially visceral adipose tissue), maintain weight loss, diminish obesity-related health risks, and thus decrease morbidity and mortality, and improve quality of life. An ideal antiobesity drug should be administered orally, devoid of major side effects, and distributed at affordable price. Treatment with antiobesity drugs can be considered in obese patients who failed to achieve a sufficient weight loss to a program of lifestyle change, diet, and physical activity. However, the drug treatment of obesity should be an integral part of the comprehensive obesity treatment program that includes diet, exercise, and cognitive behavioral intervention (2,3). Treatment of obesity should be individually tailored taking into account the degree and character of obesity, age, sex, and the presence of comorbidities (4). Drugs used for the treatment of obesity in the past were associated with serious side effects (psycho-stimulatory, depression, addiction, cardio-excitatory effects, pulmonary hypertension, and valve disease). Antiobesity agents that possess cardio-excitatory and psycho-stimulatory effects (e.g., phentermine, ephedrine, and caffeine mixture) have still been available for the short-term use in some countries (<3 months). Currently, only two drugs, sibutramine and orlistat, are prescribed for long-term administration. The most important trial evaluating the long-term efficacy of …

Clinical and psychological correlates of health-related quality of life in obese patients

BackgroundHealth-related quality of life (HRQL) is poor in obese subjects and is a relevant outcome in intervention studies. We aimed to determine factors associated with poor HRQL in obese patients seeking weight loss in medical units, outside specific research projects.MethodsHRQL, together with a number of demographic and clinical parameters, was studied with generic (SF-36, PGWB) and disease-specific (ORWELL-97) questionnaires in an unselected sample of 1,886 (1,494 women; 392 men) obese (BMI > 30 kg/m2) patients aged 20-65 years attending 25 medical units scattered throughout Italy. The clinics provide weight loss treatment using different programs. General psychopathology (SCL-90 questionnaire), the presence of binge eating (Binge Eating scale), previous weight cycling and somatic comorbidity (Charlson's index) were also determined. Scores on SF-36 and PGWB were compared with Italian population norms, and their association with putative determinants of HRQL after adjustment for confounders was assessed through logistic regression analysis.ResultsHRQL scores were significantly lower in women than in men. A greater impairment of quality of life was observed in relation to increasing BMI class, concurrent psychopathology, associated somatic diseases, binge eating, and weight cycling. In multivariate analysis, psychopathology (presence of previously-diagnosed mental disorders and/or elevated scores on SCL-90) was associated with lower HRQL scores on both psychosocial and somatic domains; somatic diseases and higher BMI, after adjustment for confounders, were associated with impairment of physical domains, while binge eating and weight cycling appeared to affect psychosocial domains only.ConclusionsPsychopathological disturbances are the most relevant factors associated with poor HRQL in obese patients, affecting not only psychosocial, but also physical domains, largely independent of the severity of obesity. Psychological/psychiatric interventions are essential for a comprehensive treatment of obesity, and to improve treatment outcome and to reduce the burden of disease.

A prospective trial for laparoscopic adjustable gastric banding in morbidly obese adolescents: an interim report of weight loss, metabolic and quality of life outcomes

Background and Materials and Methods The outcome of patients completing 12 months of follow-up in a prospective longitudinal trial of the safety/efficacy of laparoscopic adjustable gastric banding (LAGB) for morbidly obese adolescents aged 14 to 17 years using a Food and Drug Administration Institutional Device Exemption for the use of the LAPBAND was analyzed. Baseline and outcome data were abstracted from a prospective database. Results Baseline (mean ± SD) body mass index was 50 ± 10 kg/m 2, and excess weight was 178 ± 53 lb in 20 patients. Comorbidities included hypertension (45%), dyslipidemia (80%), insulin resistance (90%), metabolic syndrome (95%), and biopsy-proven nonalcoholic steatohepatitis (88%). At mean (SD) follow-up of 26 (9) months, % excess weight loss was 34% ± 22% (n = 20) and 41% ± 27% (n = 12), and the metabolic syndrome was resolved in 63% and 82% of the patients at 12 and 18 months, respectively. Hypertension normalized in all patients, along with improvement in lipid abnormalities and quality of life scores ( P < .05). At 12 months, of the 5 patients with less than 20% excess weight loss, dyslipidemia and metabolic syndrome were resolved in 2 patients. Conclusion At intermediate follow-up of a LAGB-based obesity treatment program, weight loss led to resolution or improvement of major obesity-related comorbidities in most patients, supporting the efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program and its long-term evaluation.

Comprehensive treatment of obesity and its prevention

Obesity is associated to chronic metabolic entities affecting the quality of life and life expectancy. An early treatment, if efficient, can overcome most of the problems. The normalisation of body composition, of energy reserves and their distribution, as well as the minimisation of weight dependent metabolic upsets and the establishment of therapeutic priorities, according to the repercussions of obesity, are important factors for the treatment of this disease. Prevention is important and its basis is teaching and the setting in healthy life style with modification of the food habits and the incorporation of physical work into everyday activities. Diet therapy, physical activity, pharmacotherapy, surgery education and psychology are the forms proposed for the treatment and prevention of obesity.

P4. The Short Term Outcome of the First 10 Morbidly Obese Adolescent Patients in the FDA-Approved Trial for Laparoscopic Adjustable Gastric Banding

Department of Pathology, University of Illinois at ChicagoABSTRACTBackground: We received the LAP-BAND InvestigationalDevice Exemption (IDE) from the US Food and DrugAdministration in December 2004 to conduct a prospectivelongitudinal trial examining the safety and efficacy oflaparoscopic adjustable gastric banding (LAGB) in morbidlyobese adolescents ages 14 to 17 years.Objectives: To report the short-term results of LAGB in the first10 adolescents with complete 9 months of follow-up.Patients and Methods: Baseline characteristics and outcomedata were analyzed in 10 patients enrolled between March 2005and February 2006.Results: All of the patients were girls. Their mean body massindex ( 2SD) was 50 13 kg/m , and excess weight was 17179 pounds. Comorbidities included depression (3 patients), sleepapnea (3), hypertension (6), dyslipidemia (7), insulin resistance(9),metabolicsyndrome(9),andsteatohepatitis(in4of5patientswith liver biopsy). Operative time was 45 9 minutes, anddischarges were within 23 hours of surgery. Band-relatedcomplications were as follows: 2 dehydration, 1 pouchdilation, and 1 port revision. All of the patients lost weight,with a 9-month excess weight loss of 30% 16% (range 14%–57%). Hypertension and the metabolic syndrome were resolvedin100%ofpatients(P¼0.04)and80%ofthepatients(P¼0.01),respectively, along with significant improvement in the PediatricQualityofLifeandBeckDepressionInventoryscoresandatrendtoward improvement in high-density lipoprotein cholesterolabnormalities (P¼0.08).Conclusions: Atshort-termfollow-up,weightlossoccurredwithminimal complications, leading to early resolution of majorobesity-related comorbidities. Continued evaluation of thelong-term safety and efficacy of LAGB as a surgical adjunct toa comprehensive obesity treatment program is warranted. JPGN45:465–473, 2007. Key Words: Laparoscopic adjustablegastric banding—LAP-BAND—Adolescent obesity—Bariatricsurgery—Comorbidities—Health-related quality of life.

Short‐term Outcome in the First 10 Morbidly Obese Adolescent Patients in the FDA‐approved Trial for Laparoscopic Adjustable Gastric Banding

We received the LAP-BAND Investigational Device Exemption (IDE) from the US Food and Drug Administration in December 2004 to conduct a prospective longitudinal trial examining the safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in morbidly obese adolescents ages 14 to 17 years. To report the short-term results of LAGB in the first 10 adolescents with complete 9 months of follow-up. Baseline characteristics and outcome data were analyzed in 10 patients enrolled between March 2005 and February 2006. All of the patients were girls. Their mean body mass index (+/-SD) was 50 +/- 13 kg/m, and excess weight was 171 +/- 79 pounds. Comorbidities included depression (3 patients), sleep apnea (3), hypertension (6), dyslipidemia (7), insulin resistance (9), metabolic syndrome (9), and steatohepatitis (in 4 of 5 patients with liver biopsy). Operative time was 45 +/- 9 minutes, and discharges were within 23 hours of surgery. Band-related complications were as follows: 2 dehydration, 1 pouch dilation, and 1 port revision. All of the patients lost weight, with a 9-month excess weight loss of 30% +/- 16% (range 14%-57%). Hypertension and the metabolic syndrome were resolved in 100% of patients (P = 0.04) and 80% of the patients (P = 0.01), respectively, along with significant improvement in the Pediatric Quality of Life and Beck Depression Inventory scores and a trend toward improvement in high-density lipoprotein cholesterol abnormalities (P = 0.08). At short-term follow-up, weight loss occurred with minimal complications, leading to early resolution of major obesity-related comorbidities. Continued evaluation of the long-term safety and efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program is warranted.

Current pharmacological approaches to the treatment of obesity.

Although comprehensive obesity treatment programmes were shown to induce weight loss and to improve risk factors and comorbidities, the weight reduction is moderate and most patients will rapidly regain weight. For these reasons, drugs have been developed or are in development to support and maintain weight loss. At present, two drugs are available for the adjunct treatment of obesity. Sibutramine is a centrally acting inhibitor of noradrenaline and serotonine reuptake, thereby decreasing caloric intake and increasing energy expenditure. Orlistat is a specific lipase inhibitor that impairs fat absorption, thereby reducing fat uptake. Both drugs have been found to be effective and safe in a number of clinical studies for up to two years. The current experience with these drugs raises questions related to the long-term efficacy with particular reference to cardiovascular end-points. In addition, other current and future pharmacological principles for weight reduction are discussed. There is no doubt that an evidence-based rational pharmacological treatment of obesity is still in an early stage.

The Role of Physical Activity in the Prevention and Management of Obesity

The United States is facing 2 major lifestyle-related epidemics that are intricately linked: an epidemic of obesity and an epidemic of inactivity. Multiple interactions exist between lack of physical activity and obesity. Increased physical activity lowers the risk of obesity, may favorably influence distribution of body weight, and confers a variety of health-related benefits even in the absence of weight loss. Physical activity is important for achieving proper energy balance, which is needed to prevent or reverse obesity. Not only is energy expended during physical activity, physical activity also has a positive effect on resting metabolic rate. Regular physical activity can improve body composition. Properly designed programs of physical activity may preserve or even increase lean muscle mass during weight loss. Physical activity has also been strongly associated with maintenance of weight loss. Physical activity that expends 1,500 to 2,000 kcal/week appears necessary to maintain weight loss. Numerous studies have shown that the combination of proper nutrition and regular physical activity is the most effective intervention for weight loss and maintenance of weight loss. Walking is the most convenient and logical way most obese persons can increase their physical activity. Physical activity plays multiple roles in the prevention and treatment of obesity. Dietitians and other health care workers who treat obese patients should understand the role physical activity plays in comprehensive obesity treatment as well as how to incorporate a physical activity prescription in treatment plans for obese clients. J Am Diet Assoc. 1998;98(suppl 2):S31–S38.