What are the strategies for effective weight management?

From the Guidelines

Weight management should prioritize a comprehensive lifestyle intervention program that includes diet modification, increased physical activity, and behavior modification, as recommended by the most recent study 1.

Key Components of Weight Management

• Diet: An individualized dietary intervention that reduces overall calorie intake by at least 500 kcal/day, with sufficient protein, vitamins, and minerals, is recommended for initial weight loss and maintenance in adults 1.
• Physical Activity: Clinicians should encourage adults with overweight or obesity to devote 30–60 min per day to moderate-intensity aerobic exercise, at least 5 days per week (≥150 min per week) 1.
• Behavior Modification: Behavioral strategies such as self-monitoring, goal setting, stimulus control, cognitive restructuring, problem solving, relapse prevention, stress management, contingency management, and social support can significantly enhance weight management efforts 1.

Importance of Regular Monitoring

• Clinicians should evaluate the effectiveness of lifestyle changes within 3 months, and depending on treatment targets, intensive lifestyle therapy, pharmacotherapy, or surgical referral may be considered for individuals showing minimal weight loss at this time 1.
• Regular physical activity is crucial for maintaining weight loss and reducing the risk of chronic diseases such as diabetes, heart disease, and certain types of cancer 1.

Medications and Surgical Referral

• For those struggling with significant obesity, medications like phentermine, orlistat, liraglutide (Saxenda), or semaglutide (Wegovy) may be prescribed by healthcare providers, typically for BMIs over 30 or over 27 with weight-related conditions 1.
• Surgical referral may be considered for individuals with a BMI of 40 or higher, or those with a BMI of 35 or higher with significant weight-related health issues 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 Purpose Weight loss aid The answer to weight management is weight loss using orlistat (PO) in overweight adults, 18 years and older, as a weight loss aid when used with a reduced-calorie and low-fat diet 2 2.

• Key points:
  • Overweight adults: 18 years and older
  • Used with: reduced-calorie and low-fat diet
  • Purpose: weight loss aid

From the Research

Weight Management Strategies

• Lifestyle modifications are considered first-line therapy for patients with overweight or obesity, and the most effective weight loss intervention includes a moderately reduced-calorie diet, increased physical activity, and behavior strategies to facilitate adherence 3.
• The goal of weight loss should be a modest weight loss of 5% to 10% that can be maintained long term, and adults should engage in at least 150 to 300 min/week of moderate-intensity or 75 to 150 min/week of vigorous-intensity aerobic physical activity 3.
• Effective behavior strategies for weight management include motivational interviewing, cognitive behavior therapy, removal of environmental trigger foods, self-distraction to help with cravings and boredom eating, and planning ahead 3.

Intensive Lifestyle Interventions

• Intensive lifestyle interventions for weight loss typically consist of a reduced-calorie diet, increased physical activity, and behavior therapy, and can result in approximately 8 kg (approximately 8% of initial weight) of weight loss in persons with obesity 4.
• To prevent weight regain, a 1-year weight loss maintenance program with at least monthly counseling with a trained interventionist is recommended 4.
• Lifestyle interventions can be delivered in-person, or through community- and commercial-based programs, as well as by telephone, Internet, and smartphone platforms, although in-person interventions tend to produce larger weight losses 4.

Pharmacological Interventions

• Orlistat and liraglutide are two drugs that have been shown to be effective in promoting weight loss in patients with overweight or obesity, with liraglutide resulting in significantly greater weight loss than orlistat in one study 5.
• Liraglutide has also been shown to improve several obesity-associated metabolic and cardiovascular risk factors, including fasting plasma glucose, systolic blood pressure, and low-density lipoprotein-cholesterol 5.

Bariatric Surgery

• Bariatric surgery is a highly effective treatment for severe obesity and its related diseases, such as type 2 diabetes, hypertension, and sleep apnea, and can result in substantial improvements in weight loss and type 2 diabetes outcomes compared to nonsurgical interventions 6.
• The two most common bariatric procedures, sleeve gastrectomy and gastric bypass, have similar effects on weight loss and diabetes outcomes, although emerging evidence suggests that sleeve gastrectomy may be associated with fewer reoperations and gastric bypass may lead to more durable weight loss and glycemic control 6.