“Genetic variation can influence weight loss, as can the biological response to different diets. There is an important genetic component associated with the extent to which individuals engage in physical activity. By age 18 to 20, genetic factors account for almost all (85 %) of the differences in participation in sports.”
Exercise vs. Diet
“Studies on obesity have evaluated exercise as a sole treatment. However, the effects from diet are significantly greater than those from exercise, but increasing physical activity may have important benefits on improving BP and cardiometabolic risk factors. It is also clear that food is more than calories and that dietary choices and diet quality play a role in long-term weight change.”
“Behavioral modifications and/or lifestyle interventions are an important part of weight-loss programs. Studies that are the gold standard say that the interventions are notable for the frequency of contact, the emphasis on individualizing therapy, and the long-term emphasis on maintaining weight loss.”
The built environment is often a barrier to healthy behaviors. Examples of this built environment include neighborhood walkability, access to healthy food options, social engagements that promote high calorie foods and beverages, ads and billboards etc. Navigating this built environment when trying to lose weight is an integral part of the intervention.
Diets with many different macronutrient compositions can result in short-term weight loss. However, weight loss reaches a plateau within the first 3 to 6 months. After that, weight is regained and often returns to baseline by 1 to 2 years.
Maintenance of long-term weight loss is strongly influenced by the ability to adhere to the dietary program. Behavioral support can significantly improve outcomes. There are variations among individuals in the response to each diet, which are larger than the difference in mean weight loss between comparison diets. It is important to consider genetic differences regarding dietary response to weight loss, as personalized dietary regimens improve the efficacy of long-term weight-loss regimens.
Best practices for medications approved for weight management
The American Heart Association/American College of Cardiology/The Obesity Society “guideline for the management of overweight and obesity in adults” and the Endocrine Society clinical practice guideline on obesity pharmaco-therapy both agree that clinicians may consider prescribing weight-reducing drug therapies for patients who:
(1) struggle to achieve weight goals,
(2) meet label indications (BMI >30 kg/m2 or BMI 27 kg/m2 with comorbidity), and
(3) need to lose weight for health reasons (such as osteoarthritis, prediabetes, fatty liver or other conditions).
Furthermore, the American Association of Clinical Endocrinologists/American College of Endocrinology “comprehensive clinical practice guidelines for medical care of patients with obesity” indicate that clinicians may consider pharmacotherapy as a first-line treatment of weight reduction if patients present with one or more severe comorbidities and would benefit from weight loss of >10%. Those guidelines do not require that patients fail lifestyle therapy before clinicians prescribe medications.
What is the current status of clinical adoption of medications for chronic weight management?
According to the Awareness, Care and Treatment in Obesity Management study, there are a number of misconceptions regarding obesity shared by providers and patients alike, specifically that obesity is not a disease, that patients have the primary responsibility for their problem and for its treatment, that prevention is more important than treatment, and that the risks of treatment should be low.
At present, the FDA has approved nine agents (five for long-term use and four for short-term use)
Dietary supplements, herbal products, over-the-counter products, and other treatments with unproven efficacy and unknown safety have helped undercut the credibility of legitimate weight-management practices by allowing the promotion of agents that are often unsafe, in-effective, and have unproven health claims.
These agents are regulated by the U.S. Federal Trade Commission but not by the FDA, and thus they do not undergo the rigorous testing and review exercised by the FDA when it approves pharmaceutical preparations for patients who are overweight or obese. Many respondents thought that dietary supplements are safer than prescription drugs, and many overestimated the degree of regulatory screening of these products. Evidence to support the effectiveness for weight loss or the safety of these preparations is usually nonexistent. Moreover, variability in the composition of these products adds an additional uncertainty to their use.