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Abstract
Obesity is now recognized as a critical target for public health intervention in many parts of the world, affecting virtually all age and socio-economic groups within both developed and developing countries. This study's objective is to provide an overview of the full range of methods and models available for weight loss, including some methods used by overweight and obese people without medical supervision. Many diverse approaches for achieving weight loss and weight maintenance have been evaluated. According to some evidence-based guidelines, in order to achieve the best treatment outcomes, it is recommended that a combination of dietary therapy with low-calorie diet, increased physical activity, and behavioral therapy be incorporated. Advances in treatment and innovative policy initiatives focusing on prevention could reverse the global problem of obesity and overweight. The most effective forms of treatment require collaboration among health care providers in primary care settings, including nurses, dietitians, psychologists, physicians, and psychiatrists. Effective strategies for weight loss require management strategies that combine dietary therapy and physical activity by using behavioral interventions. Thus, in the near future, the Korean government must develop evidence-based (clinical or community) guidelines for obesity management. Also, due to the lack of high quality primary studies on obesity management in Korea, future randomized clinical or community trials are recommended in this area.
Figures and Tables
 | Figure 2Relationship of body mass index (BMI) to risk (mortality). The curvilinear plot is based on data adapted from the American Cancer Society study. As BMI increases the excess risk rises. A healthy or good body weight range is between 19 and 27 kg/m2 (From Bray GA. Am J Clin Nutr 1992;55:488S-494S, with permission from American Society for Nutrition) [14].
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 | Figure 3Burden of disease, preventability, and research and translation gaps (From Ockene JK, et al. Am J Prev Med 2007;32:244-252, with permission from Elsevier) [15].
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 | Figure 4Treatment algorithm for the assessment of patients with overweight and obesity. BMI, body mass index; F, females; Hx, history; M, males (From NHLBI Obesity Education Initiative. Practical guide to the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda [MD]: National Institute of Health; 2000) [13].
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 | Figure 5The triple-tier pathway for weight management (From Maryon-Davis A. Proc Nutr Soc 2005;64:97-103, with permission from Cambridge University Press) [16].
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 | Figure 6Summary flow chart on the prevention and therapy of obesity in Germany. BMI, body mass index. a)Healthy lifestyle means living according to the recommendations of the best practice program. b)Referral to specialist (diabetologist with focus on obesity, surgeon), if necessary (From Gandjour A, et al. Int J Qual Health Care 2001;13:325-332, with permission from Afschin Grandjour) [12].
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 | Figure 7Mean weight loss in 4 treatment groups of Wadden trial (From Wadden TA, et al. N Engl J Med 2005;353:2111-2120, with permission from Massachusetts Medical Society) [25].
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Table 1
Assessment of overweight and obese patients
From NHLBI Obesity Education Initiative. Practical guide to the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda (MD): National Institute of Health; 2000 [13].
Table 2
Classification of overweight and obesity by body mass index (BMI), waist circumference, and associated disease risk
a)Disease risk for type 2 diabetes mellitus, hypertension, and cardiovascular disease.
b)Increased waist circumference can also be a marker for increased risk even in persons of normal weight.
From World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253 [7].
Table 3
Relative risk of health problems associated with obesity
NIDDM, non-insulin-dependent diabetes mellitus; CHD, coronary heart disease.
From World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253 [7].
Table 4
Recommendations relevant to reducing obesity from Guide to Community Preventive Services through March 2006
From Centers for Disease Control and Prevention. Guide to community preventive services. Atlanta (GA): Centers for Disease Control and Prevention (US); 2005 [10].
Table 5
Progressive therapeutic modalities for obesity
From Dickerson VM. Obstet Gynecol Surv 2001;56:650-663, with permission from Wolters Kluwer Health [23]
Table 6
Response to behavior therapy for obesity with extended contact (weekly or biweekly sessions >6 months)
Bw, biweekly; D, diet; E, exercise; WF, weight-focused; EF, exercise-focused; H, home-based exercise; G, group-based exercise; Lb, long-bout exercise; Sb, short-bout exercise; SbE, short-bout exercise with home equipment. a)Included short-term use of a low-calorie liquid diet. b)Included use of low-calorie or balanced-deficit diet. IOMC, Institute of Medicine Criterion for successful long-term loss (≥5% body weight lost and maintained for>1 year). *,c)Means with differing superscripts indicate significant between-group differences (p<0.05) (From Lang A, et al. Eur J Cardiovasc Nurs 2006;5:102-114, with permission from Elsevier) [24].
Table 7
Efficacy and safety of weight loss medications
a)Data obtained from only one trial.
b)Data obtained from the Diabetes Prevention Program Trial; individuals with impaired fasting glucose were treated with drug.
From Aronne LJ, et al. Am J Med 2009;122(4 Suppl 1):S24-S32, with permission from Elsevier [26]
Table 8
Centers for Disease Control and Prevention evidence-based recommendations for promoting physical activity
From Wolf AM, et al. Am J Med 2009;122(4 Suppl 1):S19-S23, with permission from Elsevier [11]
Table 9
Characteristics of weight loss diets
NCEP, National Cholesterol Education Program; CV, cardiovascular; LCD, low-calorie diet; VLCD, very-low-calorie diet.
From Strychar I. CMAJ 2006;174:56-63, with permission from Canadian Medical Association [28].
Table 10
Key characteristics and primary result of included studies
*denotes significant vs. control
AHA, American Heart Association; BMI, body mass index; HELP, Healthy Eating and Lifestyle Program; LCD, low-calorie diet: VLCD, very low-calorie diet.
From Osei-Assibey G, et al. Obes Rev 2010;11:769-776, with permission from John Wiley and Sons [34]
Acknowledgement
This work was supported by the National Research of Korea Grant funded by the Korean Government (NRF-2010-413-B00024).
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