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Obesity

Updated : April 23, 2024





Background

Obesity is a condition characterized by an excessive and abnormal accumulation of body fat, which can lead to several health problems, such as cardiovascular disease, hyperlipidemia, hypertension, and diabetes mellitus. This condition has become a significant public health epidemic and has worsened over the past years.

The causes of obesity are complex and multifactorial, and it is the second most common preventable cause of death after smoking. The body mass index (BMI) is the commonly used method to classify obesity, which is calculated as body weight in kilograms differed by height in meters squared.

However, the BMI may not be as accurate for Asians, and older adults as a normal BMI may not always reveal underlying excess fat. Hence, other methods, such as assessing skin thickness in specific areas of the body, may be used to estimate obesity. Another method to assess fat mass is the DEXA scan, a dual-energy radiographic absorptiometry scan.

Epidemiology

Obesity is a significant issue in the United States, with almost one-third of adults and 17% of adolescents considered obese, according to 2012 data from the CDC. One out of every five adolescents, one out of every six elementary school-age children, and one out of 12 preschool-age children are also classified as obese.

Certain ethnic groups, particularly African Americans, experience higher rates of obesity than Caucasians and Hispanics. The prevalence of obesity also varies by region, with southern states having the highest rates.

However, obesity is not limited to the United States, as it is a growing concern worldwide, affecting around 500 million adults globally, with the numbers increasing at an alarming rate. Obesity poses significant health risks and increases the likelihood of developing diabetes, heart disease, and stroke.

Anatomy

Pathophysiology

Obesity has been linked to numerous health conditions, including cardiovascular disease, diabetes, and various cancers. Studies have shown that genetics, specifically the FTO gene, plays a significant role in obesity. Leptin, a hormone that regulates food intake and body weight, is often resistant in those with obesity, and adipose tissue can cause systemic inflammation, leading to insulin resistance and higher triglyceride levels.

The accumulation of fatty acids in the heart muscle can cause left ventricular dysfunction, and obesity can impact the renin-angiotensin system, leading to higher blood pressure. Visceral obesity, where fat accumulates around internal organs, increases the risk of cardiovascular disease. Some individuals with a BMI over 30 kg/m2 are metabolically healthy, meaning they do not exhibit insulin resistance or dyslipidemia. Adipocytes, or fat-storing cells, produce prothrombotic and inflammatory substances, including adipokines, which can increase the risk of stroke.

Obesity can cause macrophages to invade adipose tissue and produce adipokines, leading to chronic inflammation and altered lipid and glucose metabolism, which further increases the risk of cardiometabolic problems. Adiponectin, a hormone produced by adipocytes, has anti-inflammatory and insulin-sensitizing properties. Lower levels of adiponectin in circulation are associated with visceral obesity.

Etiology

Obesity results from an imbalance between energy intake and energy expenditure. This imbalance leads to excessive weight gain and is influenced by various factors, including cultural, genetic, and societal factors. Evidence suggests that genetics play a significant role in obesity, with multiple genes associated with adiposity and weight gain.

Other factors that contribute to obesity include a sedentary lifestyle, sleep disturbances, endocrine disorders, medications, and overconsumption of carbohydrates and high-sugar foods. In addition, a decrease in energy metabolism can also contribute to weight gain. Several syndromes are associated with obesity, including Prader-Willi syndrome and MC4R syndromes.

Prader-Willi syndrome is a rare genetic disorder resulting in constant hunger and a slower metabolism. MC4R syndrome is caused by mutations in the MC4R gene, which can result in a reduced ability to control appetite and a slower metabolism. Other less common syndromes associated with obesity include Bardet-Beidl syndrome, fragile X syndrome, Alstrom syndrome, and Wilson Turner congenital leptin deficiency.

Genetics

Prognostic Factors

Obesity is a primary health concern due to its significant morbidity and mortality rates. People classified as obese have a higher risk of experiencing adverse cardiac events and stroke. In addition, the quality of life is often poor for individuals with obesity. Several factors can contribute to the worsening of morbidity in obese patients, including the age at which obesity first develops.

Research has shown that individuals who become obese at a younger age are at a greater risk of developing serious health conditions later in life. The amount of central adiposity, or fat stored around the abdomen, is also a significant factor in obesity-related morbidity. The severity of obesity is another factor that contributes to morbidity.

Individuals with severe obesity, defined as a body mass index (BMI) greater than 40, are at a much higher risk of developing health complications than those with a lower BMI. Gender also plays a role in obesity-related morbidity. Research has shown that men tend to have more visceral fat, linked to a higher risk of developing metabolic disorders and cardiovascular disease.

In contrast, women tend to have more subcutaneous fat, less strongly associated with these conditions. Finally, race has a role in obesity-related morbidity. Research has shown that certain racial and ethnic groups, such as Black, Hispanic, and Native American populations, are more likely to be obese and to experience health complications related to obesity compared to White populations.

Clinical History

Children and Adolescents: 

Clinical Presentation: 

  • Excessive weight gain and body mass index (BMI) for age. 
  • Delayed motor development. 
  • Behavioral issues related to body image and self-esteem. 
  • Early signs of metabolic syndrome, such as elevated blood pressure and insulin resistance. 

Associated Comorbidities or Activities: 

  • Sedentary lifestyle, excessive screen time, and poor dietary habits are common contributors. 

Acuity of Presentation: 

  • Chronic condition with long-term health implications. 

Adults: 

Clinical Presentation: 

  • Central obesity (excess abdominal fat). 
  • Metabolic syndrome: Hypertension, dyslipidemia, insulin resistance. 
  • A higher chance of cardiovascular conditions, such as stroke and coronary artery disease. 
  • Joint problems, especially in weight-bearing areas. 

Associated Comorbidities or Activities: 

  • Poor eating and inactivity are two unhealthy lifestyle variables that are frequently linked to obesity.Increased risk of sleep apnea, depression, and certain cancers. 

Acuity of Presentation: 

  • Gradual onset of symptoms with a progressive impact on overall health.Elderly: Clinical Presentation: 
    • Decreased mobility and physical function. 
    • Exacerbation of age-related chronic conditions. 
    • Increased risk of falls and fractures. 
    • Higher surgical and medical procedure risks. 

    Associated Comorbidities or Activities: 

    • Obesity can worsen existing cardiovascular issues and contribute to frailty. 
    • Reduced muscle mass and increased adiposity. 

    Acuity of Presentation: 

    • Long-term impact on health, potentially worsening age-related conditions. 

Physical Examination

  • Body Mass Index (BMI): It is a commonly used screening tool to assess whether an individual is underweight, average weight, overweight, or obese.  
  • Waist Circumference: Central or abdominal obesity is a significant risk factor for various health conditions. Measuring waist circumference helps determine the distribution of body fat. 
  • Body Fat Percentage: While not commonly measured during routine examinations, body fat percentage provides a more accurate representation of a person’s body composition than BMI. Specialized tools, such as bioelectrical impedance devices or dual-energy X-ray absorptiometry (DEXA) scans, may be used. 
  • Blood Pressure: Obesity is often associated with hypertension (high blood pressure). Regular blood pressure monitoring helps assess cardiovascular risk. 
  • Heart and Lung Examination: Obesity can impact the cardiovascular and respiratory systems. Assessing the heart rate, rhythm, and lung sounds can provide insights into an individual’s overall cardiovascular and respiratory health. 
  • Joint Examination: Obesity can cause joint difficulties, especially in the hips and knees. A thorough examination of joints helps identify any signs of osteoarthritis or other musculoskeletal issues. 
  • Skin Examination: Obesity may be associated with skin conditions, such as acanthosis nigricans (dark, velvety patches of skin) and skin infections due to skin folds. Examining the skin can reveal potential complications. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

  • Cushing’s Syndrome: This endocrine disorder results from chronic exposure to excess cortisol, either due to adrenal gland abnormalities or exogenous steroid use. Symptoms include central obesity, thinning of extremities, stretch marks, hypertension, and glucose intolerance. 
  • Hypothyroidism: A condition characterized by decreased thyroid hormone production, which can lead to weight gain, cold intolerance, constipation,fatigue, dry skin, and hair loss. 
  • Polycystic Ovary Syndrome (PCOS): It is a hormonal disorder common among women of reproductive age. Symptoms include weight gain, irregular periods, hirsutism (excessive hair growth), acne, and infertility. 
  • Prader-Willi Syndrome: A genetic disorder characterized by excessive eating (hyperphagia), intellectual disability, short stature, and incomplete sexual development. Individuals with Prader-Willi syndrome often have severe obesity if food intake is not controlled. 
  • Genetic Obesity Syndromes: Rare genetic disorders such as Bardet-Biedl syndrome, leptin receptor deficiency, or melanocortin-4 receptor deficiency can cause severe early-onset obesity. 
  • Depression and Emotional Eating: Psychological problems, such as sadness and anxiety, can contribute to overeating and obesity. Emotional eating behaviors could mask underlying emotional problems that require therapeutic intervention. 
  • Medication-Induced Weight Gain: Certain medications, such as antipsychotics, antidepressants, corticosteroids, and anticonvulsants, can lead to weight gain as a side effect. 
  • Insulinoma: A rare pancreatic tumor that secretes excess insulin, leading to hypoglycemia. Overeating in response to hypoglycemic episodes can result in weight gain. 
  • Sleep Apnea: Obstructive sleep apnea can alter sleep patterns and cause excessive daytime drowsiness, that can lead to weight gain via hormone imbalance. 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Lifestyle Modifications: 

  • Dietary Changes: Encouraging a balanced diet that is low in calories and high in nutrient density. Portion control, reducing intake of high-calorie foods and sugary beverages, and increasing consumption of fruits, vegetables, lean proteins, and whole grains. 
  • Physical Activity: Promoting regular physical activity, including aerobic exercises (e.g., walking, swimming, cycling) and strength training to improve muscle mass and metabolic rate. Aim for at least 150 minutes of moderate-intensity exercise per week. 
  • Behavioral Therapy: Providing education and support for behavior change, including goal setting, self-monitoring, stimulus control, and coping strategies for managing emotional eating and cravings. 
  • Stress Management: Mindfulness and relaxation exercises may help prevent emotional eating and improve adherence to lifestyle changes. 

Pharmacotherapy: 

  • Weight Loss Medications: Prescription medications may be considered for individuals with a BMI of 30 or above (or BMI of 27 or above with obesity-related comorbidities) who have not achieved sufficient weight loss through lifestyle modifications alone. These drugs inhibit appetite, reduce fat absorption, and increase satiety. Examples include orlistat, phentermine/topiramate, liraglutide, and bupropion/naltrexone. 
  • Adjunctive Therapies: Some medications approved for other purposes, such as certain antidepressants or anticonvulsants, may also lead to weight loss as a side effect and can be considered in select cases. 

Bariatric Surgery: 

  • Indications: Bariatric surgery is considered for individuals with severe obesity (BMI ≥ 40) or those with a BMI ≥ 35 with obesity-related comorbidities who have not achieved weight loss with nonsurgical methods. 
  • Types of Procedures: Frequently performed bariatric procedures encompass adjustable gastric banding, sleeve gastrectomy, gastric bypass, and biliopancreatic redirection with duodenal switch. These procedures work by reducing stomach capacity, altering digestion, and influencing gut hormones involved in appetite regulation. 

Multidisciplinary Approach: 

  • Medical Supervision: Regular follow-up with healthcare providers, including physicians, dietitians, psychologists, and exercise specialists, is essential for ongoing monitoring, adjustment of treatment plans, and support. 
  • Long-Term Maintenance: Emphasizing the importance of continued adherence to lifestyle modifications, behavior changes, and follow-up care to prevent weight regain and sustain improvements in health outcomes over the long term. 

Prevention and Public Health Initiatives: 

  • Community Interventions: Implementing policies and programs at the community level to promote healthy eating, physical activity, and obesity prevention across populations. 
  • Health Education: Increasing awareness about the risks of obesity, the benefits of healthy lifestyles, and available resources for weight management through public health campaigns, school-based programs, and workplace wellness initiatives. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of a non-pharmacological approach for treating Obesity

Dietary Interventions:

  • Caloric Restriction: Encourage individuals to consume fewer calories than they expend, promoting a gradual and sustainable weight loss.
  • Balanced Diet: Encourage the balanced diet rich in nutrient-dense foods such vegetables, whole grains, fruits, lean meats, and healthy fats.
  • Portion Control: Educate individuals on appropriate portion sizes to avoid overeating.

Physical Activity:

  • Regular Exercise: Encourage regular physical activity, including both aerobic exercises (e.g., walking, jogging, cycling) and strength training, tailored to individual abilities and preferences.
  • Incremental Changes: Gradually increase physical activity levels to avoid overwhelming individuals and improve adherence.

Behavioral Therapy:

  • Goal Setting: Help individuals set realistic and achievable weight loss goals, focusing on both short-term and long-term objectives.
  • Self-Monitoring: Encourage the tracking of food intake, physical activity, and emotional triggers for eating to raise awareness and facilitate behavior change.
  • Cognitive-Behavioral Therapy (CBT): Address psychological factors influencing eating behavior, such as emotional eating and unhealthy coping mechanisms.
  • Stimulus Control: Assist individuals in managing their environment to reduce cues that trigger unhealthy eating habits.

Lifestyle Education and Support:

  • Nutritional Education: Provide information about healthy eating, reading food labels, and making informed food choices.
  • Meal Planning: Teach skills in meal planning and preparation to promote healthier food choices and portion control.
  • Social Support: Encourage individuals to seek support from friends, family, or support groups to enhance motivation and accountability.

Stress Management:

  • Mindfulness and Relaxation Techniques: Stress management and emotional eating prevention strategies include mindfulness practices, meditation, and relaxation exercises.
  • Behavioral Stress Reduction: Address lifestyle factors contributing to stress, such as lack of sleep, and promote healthy coping mechanisms.

Sleep Hygiene:

  • Adequate Sleep: Encourage appropriate sleep habits, as inadequate sleep has been related to weight increase and obesity. Encourage a consistent sleep schedule and good sleep hygiene practices.

Environmental Modifications:

  • Healthy Food Availability: Encourage the creation of conditions that make healthy food selections more accessible and available, particularly in communities, workplaces, and schools.
  • Physical Activity Promotion: Encourage the creation of environments that support physical activity, such as accessible parks, sidewalks, and recreational spaces.

Role of Gastrointestinal agents in the treatment of Obesity

Gastrointestinal (GI) agents play a significant role in the treatment of obesity by targeting various mechanisms involved in appetite regulation, nutrient absorption, and metabolism. 

  • Orlistat: This lipase inhibitor lowers total caloric intake by preventing the intestines from absorbing dietary lipids. It has been demonstrated to produce moderate weight reduction when combined with a low-calorie diet. It can result in higher weight loss than diet alone. Side effects including gastrointestinal symptoms such as oily spotting, flatulence, and fecal incontinence. It can also impair the absorption of fat-soluble vitamins, necessitating supplementation. 
  • Phentermine/Topiramate: Phentermine is a sympathomimetic amine that suppresses appetite, while topiramate is an antiepileptic drug that enhances satiety and may affect taste perception. When taken in conjunction with lifestyle changes, the combination of phentermine and topiramate has been proven to result in considerable weight reduction compared to placebo. 

Common side effects include insomnia, dry mouth, paresthesia, and constipation. There are also concerns about potential cardiovascular and cognitive adverse effects. 

  • Liraglutide: It is a glucagon-like peptide-1 (GLP-1) receptor agonist that reduces appetite, delays gastric emptying, and promotes satiety. Liraglutide has demonstrated significant weight loss efficacy in clinical trials when used alongside diet and exercise. It is authorized for the long-term treatment of weight in people who are overweight or obese and have at least one comorbidity linked to weight. Common side effects include vomiting, diarrhea, nausea, constipation, and hypoglycemia, particularly in individuals with type 2 diabetes. 
  • Naltrexone/Bupropion: It is an antagonist of the opioid receptor, whereas bupropion is an inhibitor of the absorption of dopamine and norepinephrine. The combination is thought to modulate brain pathways involved in appetite and reward. Naltrexone/bupropion combination therapy has been shown to produce modest weight loss compared to placebo when used in conjunction with lifestyle modifications. Common side effects include constipation, headache, nausea, dizziness, and insomnia. There are also concerns about the potential for increased blood pressure and seizures. 
  • Bile Acid Sequestrants: When bile acid sequestrants attach to bile acids in the colon, they prevent the absorption of fat and increase the outflow of bile acids. While primarily used for lipid management, bile acid sequestrants may also have modest effects on weight loss by reducing fat absorption. Side effects include constipation, bloating, and flatulence. They may also interfere with the absorption of fat-soluble vitamins. 

Role of CNS Stimulants, Anorexiants in the treatment of Obesity

Central Nervous System (CNS) stimulants and anorexiants are a class of medications used in the treatment of obesity to help suppress appetite and promote weight loss. These drugs affect neurotransmitters in the brain, influencing the perception of hunger and satiety. 

  • Phentermine: The brain’s release of norepinephrine is stimulated by this sympathomimetic amine. It primarily acts as an appetite suppressant by influencing the central nervous system. In order to aid in weight reduction, phentermine is frequently taken briefly as a temporary adjuvant to lifestyle therapies like diet and exercise. Common side effects include insomnia, dry mouth, increased heart rate, and elevated blood pressure.  
  • Diethylpropion: It is another sympathomimetic amine that works similarly to phentermine, affecting neurotransmitters in the brain to reduce appetite. Diethylpropion is used short-term to assist with weight loss in individuals with obesity when other measures have not been successful. Side effects may include dizziness, insomnia and increased heart rate. Long-term safety is a concern, and use is typically limited. 
  • Phentermine/Topiramate: This combination involves the appetite suppressant phentermine and the antiepileptic drug topiramate. It increases feelings of fullness and decreases hunger by acting on several different brain circuits. 
  • Naltrexone/Bupropion: This combination includes an opioid receptor antagonist (naltrexone) and an antidepressant (bupropion). It affects the brain’s reward system and appetite control. 

Role of Glucagonlike Peptide-1 Agonists in the treatment of Obesity

A family of drugs known as glucagon-like peptide-1 agonists was first created to treat type 2 diabetes. It is an incretin hormone produced in the small intestine in response to food intake. GLP-1 agonists enhance the effects of endogenous GLP-1 by binding to its receptors, leading to increased insulin secretion, reduced glucagon release, slowed gastric emptying, and enhanced feelings of fullness.

  • Liraglutide: Originally developed for diabetes management (under the brand name Victoza), liraglutide was later approved for obesity treatment. One subcutaneous injection of Saxenda is given each day. Clinical trials have shown that liraglutide is associated with significant weight loss when used as part of a comprehensive obesity management plan. Common side effects include vomiting, diarrhea,nausea, and constipation. It may also increase the risk of pancreatitis.
  • Semaglutide: Semaglutide, another GLP-1 agonist initially developed for diabetes (under the brand name Ozempic), has received approval for the treatment of obesity. Wegovy is injected subcutaneously once every seven days. Clinical trials have demonstrated substantial weight loss with semaglutide treatment for obesity. Common side effects are similar to liraglutide, including gastrointestinal symptoms, and there is a potential risk of pancreatitis.

Role of Glucagonlike Peptide-1 Agonists in the treatment of Obesity

A family of drugs known as glucagon-like peptide-1 agonists was first created to treat type 2 diabetes. It is an incretin hormone produced in the small intestine in response to food intake. GLP-1 agonists enhance the effects of endogenous GLP-1 by binding to its receptors, leading to increased insulin secretion, reduced glucagon release, slowed gastric emptying, and enhanced feelings of fullness. 

  • Liraglutide: Originally developed for diabetes management (under the brand name Victoza), liraglutide was later approved for obesity treatment. One subcutaneous injection of Saxenda is given each day. Clinical trials have shown that liraglutide is associated with significant weight loss when used as part of a comprehensive obesity management plan. Common side effects include vomiting, diarrhea,nausea, and constipation. It may also increase the risk of pancreatitis. 
  • Semaglutide: Semaglutide, another GLP-1 agonist initially developed for diabetes (under the brand name Ozempic), has received approval for the treatment of obesity. Wegovy is injected subcutaneously once every seven days. Clinical trials have demonstrated substantial weight loss with semaglutide treatment for obesity. Common side effects are similar to liraglutide, including gastrointestinal symptoms, and there is a potential risk of pancreatitis.

Role of Antidepressants, Dopamine reuptake inhibitors; opioid antagonists in the treatment of obesity

These substances may enhance energy expenditure and decrease appetite by activating pro-opiomelanocortin (POMC) neurons. 

  • Bupropion: Activates dopaminergic neurons in the brain, which may decrease hunger and increase energy expenditure by stimulating pro-opiomelanocortin (POMC) neurons. 
  • Naltrexone: Prevents feedback inhibition of POMC neurons by blocking opioid receptors on them, hence boosting POMC activity. 

Combination may modulate activity in the brain’s dopamine reward pathway, which aids in controlling food cravings and binge eating tendencies. 

Role of Melanocortin Agonists in the treatment paradigm of Obesity

Melanocortin agonists are a class of medications that target the melanocortin system, specifically the melanocortin-4 receptor (MC4R), which plays an important role in regulating energy homeostasis and appetite. These drugs are being explored for their potential role in the treatment of obesity.  

  • Setmelanotide: These medications have the potential to suppress appetite. Setmelanotide, a synthetic version of melanocortin-4 receptor agonist, has also been investigated for treating rare genetic conditions like pro-opiomelanocortin, or POMC deficiencies leptin levels receptors (LEPR) deficiencies and Bardet-Biedl syndrome that are linked to severe obesity. 
  • Bremelanotide: Bremelanotide, which was first created as a therapy for sexual dysfunction, has been studied for its possible involvement in weight control and shows melanocortin agonist action. 

Use of Intervention with a procedure in treating Obesity

  • Gastric Bypass Surgery: During this procedure, the stomach is divided to produce a tiny pouch. The top section the the small intestine and a piece of the stomach are then bypassed to attach to this pouch by a reconfiguration the the small intestine. limits food intake and modifies the absorption of nutrients. It causes considerable weight reduction and benefits in diabetes of type 2, hypertension, and hyperlipidemia. It also has both restricting and malabsorptive effects. 
  • Sleeve Gastrectomy: It involves slicing off a sizable section of the stomach to leave the stomach shaped like a banana. Restricts food intake by reducing stomach capacity and leads to hormonal changes that contribute to weight loss. Significant weight loss with potential improvements in obesity-related comorbidities. It is a restrictive procedure without intestinal rerouting. 
  • Adjustable Gastric Banding: During this process, the top portion of the stomach is wrapped with an inflatable band to form a little pouch. Limits food intake by creating a smaller stomach pouch. Gastric banding that can be adjusted is a strictly restricted technique. It is less common today due to the availability of more effective alternatives. 
  • Biliopancreatic Diversion with Duodenal Switch: It involves a sleeve gastrectomy to create a smaller stomach, followed by rerouting the small intestine to limit the absorption of nutrients. Combines restrictive and malabsorptive elements for significant weight loss and metabolic improvements. Effective for substantial weight loss and resolution of obesity-related conditions but is associated with a higher risk of nutritional deficiencies. 
  • Gastric Balloon: A gastric balloon is temporarily placed in the stomach through endoscopic means and inflated to create a feeling of fullness. Temporarily reduces stomach capacity and induces a feeling of satiety. A less invasive option for temporary weight loss. Balloons are typically removed after six months. 
  • Endoscopic Procedures: Various endoscopic procedures, such as endoscopic sleeve gastroplasty (ESG), are being developed to provide less invasive alternatives to traditional bariatric surgeries. These procedures aim to reduce stomach capacity and induce weight loss through endoscopic techniques. 

Use of phases in managing Obesity

Assessment and Evaluation: 

  • This initial phase involves a comprehensive assessment of the individual’s medical history, current health status, weight-related comorbidities, dietary habits, physical activity level, psychological factors, and readiness for change. 
  • Healthcare providers may perform physical examinations, laboratory tests, and assessments of eating behaviors and mental health. 

Goal Setting and Treatment Planning: 

  • Based on the assessment findings, healthcare providers work collaboratively with the individual to establish realistic and achievable goals for weight loss, lifestyle modifications, and overall health improvement. 
  • Treatment plans are individualized and may include dietary interventions, physical activity recommendations, behavioral therapy, and, in some cases, pharmacotherapy or surgical options. 

Lifestyle Modification Phase: 

  • The lifestyle modification phase focuses on implementing behavioral changes aimed at promoting healthy eating habits, increasing physical activity, and improving overall lifestyle behaviors. 
  • Dietary interventions may involve calorie restriction, portion control, meal planning, and education on nutrition and food choices. 
  • Physical activity recommendations typically include regular exercise, incorporating both aerobic activities and strength training, tailored to the individual’s abilities and preferences. 

Behavioral Therapy and Support: 

  • Behavioral therapy plays a critical role in addressing psychological factors, emotional eating, and unhealthy behaviors associated with obesity. 
  • To assist people recognize and change unhelpful attitudes, ideas, and behaviors connected to food and weight, practitioners may apply mindfulness practices, motivational interviewing, and cognitive-behavioral therapy (CBT). 
  • Support groups, counseling, and peer support networks provide additional encouragement, accountability, and social support during the weight loss journey. 

Monitoring and Adjustment: 

  • Regular monitoring and follow-up are essential throughout the treatment process to track progress, address challenges, and make necessary adjustments to the treatment plan. 
  • Healthcare providers monitor weight changes, dietary adherence, physical activity levels, and any emerging health issues to ensure the effectiveness and safety of interventions. 
  • Treatment plans may be modified as needed based on individual response, preferences, and evolving health needs. 

Maintenance and Relapse Prevention: 

  • Once weight loss goals are achieved, the focus shifts to long-term maintenance strategies aimed at sustaining healthy behaviors, preventing weight regain, and optimizing overall health and well-being. 
  • Maintenance strategies may include continued adherence to healthy eating habits, regular physical activity, ongoing behavioral support, and periodic follow-up with healthcare providers for monitoring and reinforcement. 
  • Strategies for relapse prevention, coping with setbacks, and managing stress are also emphasized to help individuals maintain their achievements and sustain long-term success.

Medication

 

amphetamine

Immediate-release:

5 - 10

mg

Orally 

every day

30 to 60 mins before meals (Do not exceed 30 mg/day)



setmelanotide 

2

mg

Subcutaneous (SC)

daily

2

weeks



Whenever it is tolerated, and further weight loss is needed
3 mg/day daily subcutaneous (SC) injection
Reduce to 1 mg subcutaneously (SC) daily if not tolerated; titrate to 2 mg subcutaneously (SC