From the Guidelines
To achieve weight loss, a comprehensive approach combining diet, physical activity, and behavioral therapy is recommended, aiming for a sustained weight loss of 5% or more, as this has been shown to produce clinically meaningful health benefits, including improvements in glycemic control, blood pressure, and lipids, as well as reduced risk of diabetes and cardiovascular disease 1.
Key Recommendations
- Dietary changes: Prescribe a calorie-restricted diet with a 500-750 kcal/day energy deficit, and consider individualized dietary approaches based on patient preferences and nutritional needs 1.
- Physical activity: Recommend regular physical activity, such as 200-300 min/week, to support weight loss and overall health 1.
- Behavioral therapy: Provide high-frequency counseling (at least 16 sessions in 6 months) and focus on behavioral strategies to achieve and maintain weight loss 1.
- Monitoring and evaluation: Regularly monitor weight loss progress, and evaluate systemic, structural, and socioeconomic factors that may impact dietary patterns and food choices 1.
Considerations
- Patient-centered approach: Use a patient-centered communication style, and consider individual preferences, motivation, and life circumstances when recommending weight loss interventions 1.
- Weight loss goals: Aim for a gradual reduction of 1-2% of body weight per week, and consider long-term weight-maintenance programs to support sustained weight loss 1.
- Comorbidities: Consider the presence of comorbid conditions, such as heart failure or unexplained weight change, when evaluating and managing weight loss 1.
From the Research
Weight Loss Strategies
- Lifestyle modifications, including a reduced-calorie diet and increased physical activity, are considered first-line therapy for patients with overweight or obesity 2
- Behavioral strategies, such as motivational interviewing and cognitive behavior therapy, can facilitate adherence to weight loss interventions 2, 3
- A comprehensive approach, including reduced dietary intake, regular physical activity, and behavioral strategies, is warranted for successful weight loss and maintenance 4
Pharmacotherapy for Weight Loss
- Anti-obesity medications, such as orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide, can result in significant weight loss and improved cardiometabolism when used in combination with lifestyle interventions 5
- Newer medications, such as semaglutide, have shown promise for greater weight loss efficacy and may be more widely adopted by healthcare providers 6
- Pharmacotherapy should be tailored to individual patients based on their chronic conditions, comorbidities, and preferences 5, 6
Effective Weight Loss Interventions
- Intensive lifestyle interventions, consisting of a reduced-calorie diet, increased physical activity, and behavior therapy, can result in significant weight loss and improvements in health and quality of life 3
- A minimum of 6 months of high-intensity, comprehensive lifestyle intervention is recommended, followed by a 1-year weight loss maintenance program 3
- Physical activity, such as at least 150-300 minutes/week of moderate-intensity aerobic activity, is an essential component of effective weight loss interventions 2, 3