From the Guidelines
Management of obesity in young women should prioritize a comprehensive approach that combines lifestyle modifications, behavioral therapy, and sometimes medications or surgery, taking into account the complex interplay of biological, psychological, and social determinants of health, as highlighted in the most recent study 1.
Key Components of Obesity Management
- Lifestyle modifications:
- A balanced diet with a moderate caloric deficit of 500-1000 calories daily, emphasizing whole foods, lean proteins, fruits, vegetables, and whole grains while limiting processed foods and sugary beverages.
- Regular physical activity, including 150-300 minutes of moderate-intensity exercise weekly, combining aerobic activities with strength training 2-3 times weekly.
- Behavioral strategies:
- Self-monitoring,
- Stress management,
- Adequate sleep (7-9 hours nightly).
Considerations for Medications and Surgery
- For those with BMI ≥30 or ≥27 with obesity-related conditions, FDA-approved medications may be considered, including orlistat, phentermine-topiramate, naltrexone-bupropion, liraglutide, or semaglutide, as discussed in 1.
- Bariatric surgery may be appropriate for women with BMI ≥40 or ≥35 with comorbidities who haven't achieved sufficient weight loss through other methods.
Special Considerations
- Reproductive health: weight loss can improve fertility and reduce pregnancy complications, as noted in 1 and 1.
- Conditions such as pregnancy, PCOS, and menopause require special considerations, with a focus on healthy weight maintenance, moderate physical activity, and tailored dietary interventions during pregnancy, and lifestyle interventions, including dietary modifications and exercise, for women with PCOS, as outlined in 1.
Monitoring and Follow-Up
- Regular monitoring of weight, metabolic parameters, and potential nutritional deficiencies is crucial, with a focus on addressing the complex physiological and psychological factors contributing to obesity in young women, as emphasized in 1.
From the FDA Drug Label
Use for weight loss in overweight adults, 18 years and older, when used along with a reduced-calorie and low-fat diet Directions read the enclosed brochure for other important information diet and exercise are the starting points for any weight loss program. The management of obesity in young women may involve the use of orlistat (PO), but only for those who are 18 years and older and overweight.
- The recommended approach is to start with diet and exercise before adding orlistat.
- Orlistat should be used in conjunction with a reduced-calorie, low-fat diet and exercise program.
- It is essential to consult with a doctor before starting any exercise program or using orlistat 2 2.
From the Research
Management of Obesity in Young Women
- The management of obesity in young women involves a comprehensive approach that includes lifestyle modifications, behavioral therapy, and potentially pharmacotherapy or surgical interventions 3, 4.
- Lifestyle modifications are considered the first-line therapy for patients with overweight or obesity, and should include a moderately reduced-calorie diet, increased physical activity, and the use of behavior strategies to facilitate adherence 3.
- The goal of weight loss should be a modest 5% to 10% reduction in body weight that can be maintained long-term, rather than focusing on rapid weight loss 3, 5.
- Physical activity should be encouraged from childhood through young adulthood, with adults aiming for at least 150 to 300 minutes per week of moderate-intensity or 75 to 150 minutes per week of vigorous-intensity aerobic physical activity 3.
- Behavioral therapy, such as motivational interviewing and cognitive behavior therapy, can be effective in supporting weight loss and maintaining a healthy lifestyle 3.
- For young women who do not respond to lifestyle counseling, pharmacotherapy or surgical interventions may be considered, with options including medications such as orlistat, phentermine/topiramate, and liraglutide, as well as bariatric surgery or endoscopic surgery 4, 6, 7.
Pharmacotherapy Options
- There are currently several Food and Drug Administration-approved medications for the treatment of obesity, including orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, and semaglutide 6.
- Studies have shown that liraglutide can be an effective option for weight loss, with one study finding that it resulted in significantly greater weight loss compared to orlistat 7.
- New medications, such as semaglutide and tirzepatide, are also being investigated and may offer improved efficacy compared to current options 5.
Importance of Individualized Approach
- Obesity is a chronic disease that requires a continuous treatment model across the lifespan, and individualized treatment options may be necessary to maximize patient outcomes 5.
- While there is evidence to support the use of baseline and process predictors to inform treatment decisions, the effect sizes associated with these predictors are small, and more research is needed to determine the best approach for individualizing treatment 5.