Evidence Statement: Weight loss produced by lifestyle modifications reduces blood pressure in overweight nonhypertensive individuals. Evidence Category A.

aerobic activity.

Evidence Statement: Increased aerobic activity to increase cardiorespiratory fitness reduces blood pressure independent of weight loss. Evidence Category A.

high blood pressure.

RECOMMENDATION: Weight loss is recommended to lower elevated blood pressure in overweight and obese persons with high blood pressure. Evidence Category A.

HDL-cholesterol

Evidence Statement: Weight loss produced by lifestyle modifications reduces serum triglycerides and increases HDL-cholesterol, and generally produces some reductions in serum total cholesterol, and LDL cholesterol. Evidence Category A.

blood lipids.

Evidence Statement: Weight loss produced by weight loss medications and adjuvant lifestyle modifications produces no consistent change in blood lipids. Evidence Category B.

abdominal fat

Evidence Statement: Limited evidence suggests that decreases in abdominal fat correlate with improvements in the lipid profile of overweight individuals, although these improvements have not been shown to be independent of weight loss. Evidence Category C.

cardiorespiratory fitness

Evidence Statement: Increased aerobic activity to increase cardiorespiratory fitness favorably affects blood lipids, particularly if accompanied by weight loss. Evidence Category A.

total cholesterol

RECOMMENDATION: Weight loss is recommended to lower elevated levels of total cholesterol, LDL-cholesterol and triglycerides and to raise low levels of HDL cholesterol in overweight and obese persons with dyslipidemia. Evidence Category A.

overweight nonhypertensive individuals.

Evidence Statement: Weight loss produced by lifestyle modifications reduces blood pressure in overweight nonhypertensive individuals. Evidence Category A.

blood glucose

Evidence Statement: Weight loss produced by lifestyle modifications, reduces blood glucose levels in overweight and obese persons without type 2 diabetes, and reduces blood glucose levels and HbA1c in some patients with type 2 diabetes. Evidence Category A.

type 2 diabetes

Evidence Statement: Weight loss produced by weight loss medications has not been shown to be any better than weight loss through lifestyle modification for improving blood glucose levels in overweight or obese persons both with and without type 2 diabetes. Evidence Category B.

overweight nonhypertensive individuals.

Evidence Statement: Decreases in abdominal fat improve glucose tolerance in overweight individuals with impaired glucose tolerance, although this has not been shown to be independent of weight loss. Evidence Category C.

blood pressure

Evidence Statement: Weight loss produced by lifestyle modifications reduces blood pressure in overweight nonhypertensive individuals. Evidence Category A.

elevated blood glucose

RECOMMENDATION: Weight loss is recommended to lower elevated blood glucose levels in overweight and obese persons with type 2 diabetes. Evidence Category A.

improves glucose tolerance

Evidence Statement: Increased cardiorespiratory fitness improves glucose tolerance in overweight individuals, but no evidence shows this relationship to be independent of weight loss. Evidence Category C.

lifestyle modifications

Evidence Statement: Weight loss produced by most weight loss medications (except for sibutramine) and adjuvant lifestyle modifications is accompanied by reductions in blood pressure. Evidence Category B. .

Goals for Weight Loss and Management

Reduce body weight

Maintain a lower body weight over the long term

Prevent further weight gain .

what expert tell about obesity

WHAT TREATMENTS ARE EFFECTIVE?

Low Calorie Diet

Evidence Statement: LCDs can reduce total body weight by an average of 8 percent over 3 to 12 months. Evidence Category A.

decrease in abdominal fat

Evidence Statement: LCDs resulting in weight loss effect a decrease in abdominal fat. Evidence Category A.

increasing physical activity

Evidence Statement: No improvement in cardiorespiratory fitness as measured by VO2 max appears to occur in overweight or obese adults who lose weight on LCDs without increasing physical activity. Evidence Category B.

Very Low Calorie Diet

Evidence Statement: VLCDs produce greater initial weight loss than LCDs. However, the long-term (> 1 year) weight loss is not different from that of the LCD. Evidence Category A.

lower fat diets

Evidence Statement: Although lower fat diets without targeted caloric reduction help promote weight loss by producing a reduced caloric intake, lower-fat diets coupled with total caloric reduction produce greater weight loss than lower fat diets alone. Evidence Category A.

Lower fat diets

Evidence Statement: Lower fat diets produce weight loss primarily by decreasing caloric intake. Evidence Category B.

Reducing fat as part of an LCD

RECOMMENDATION: LCDs are recommended for weight loss in overweight and obese persons. Evidence Category A. Reducing fat as part of an LCD is a practical way to reduce calories. Evidence Category A.

Physical activity

Evidence Statement: Physical activity, i.e., aerobic exercise, in overweight and obese adults results in modest weight loss independent of the effect of caloric reduction through diet. Evidence Category A..

Physical activity

Evidence Statement: Physical activity in overweight and obese adults modestly reduces abdominal fat. Evidence Category B.

Physical activity in overweight

Evidence Statement: Physical activity in overweight and obese adults increases cardiorespiratory fitness independent of weight loss. Evidence Category A.

Physical activity ...

RECOMMENDATION: Physical activity is recommended as part of a comprehensive weight loss therapy and weight maintenance program because it: (1) modestly contributes to weight loss in overweight and obese adults (Evidence Category A)

Physical activity

(2) may decrease abdominal fat (Evidence Category B), (3) increases cardiorespiratory fitness (Evidence Category A), and (4) may help with maintenance of weight loss (Evidence Category C).

The combination of a reduced calorie diet and increased physical activity

Evidence Statement: The combination of a reduced calorie diet and increased physical activity produces greater weight loss than diet alone or physical activity alone. Evidence Category A.

The combination of a reduced calorie diet and increased physical activity

Evidence Statement: The combination of a reduced calorie diet and increased physical activity produces greater reductions in abdominal fat than either diet alone or physical activity alone, although it has not been shown to be independent of weight loss. Evidence Category B..

A combination of a reduced calorie diet and increased physical activity

Evidence Statement: A combination of a reduced calorie diet and increased physical activity improves cardiorespiratory fitness as measured by VO2 max when compared to diet alone. Evidence Category A.

The combination of a reduced calorie diet and increased physical activity

RECOMMENDATION: The combination of a reduced calorie diet and increased physical activity is recommended, since it produces weight loss, decreases abdominal fat, and increases cardiorespiratory fitness. Evidence Category A.

Behavior therapy

Evidence Statement: Behavior therapy, when used in combination with other weight loss approaches, provides additional benefits in assisting patients to lose weight short term (1 year). Evidence Category B

3 to 5 years

No additional benefits are found at 3 to 5 years in the absence of continued intervention. Evidence Category B.

multimodal strategies

Evidence Statement: No one behavior therapy appeared superior to any other in its effect on weight loss; rather, multimodal strategies appeared to work best and those interventions with the greatest intensity appeared to be associated with the greatest weight loss. Evidence Category A.

Long-term follow-up

Evidence Statement: Long-term follow-up of patients undergoing behavior therapy shows a return to baseline weight in the great majority of subjects in the absence of continued behavioral intervention. Evidence Category B.

weight maintenance

RECOMMENDATION: Behavior therapy is a useful adjunct when incorporated into treatment for weight loss and weight maintenance. Evidence Category B.

setting expectations

RECOMMENDATION: The possibility that a standard approach to weight loss will work differently in diverse patient populations must be considered when setting expectations about treatment outcomes. Evidence Category B.

Pharmacotherapy

Evidence Statement: Pharmacotherapy, which has generally been studied along with lifestyle modification including diet and physical activity, using dexfenfluramine, sibutramine, orlistat, or phentermine/fenfluramine, results in weight loss in obese adults when used for 6 months to 1 ear. Evidence Category B.

comprehensive weight loss program

RECOMMENDATION: Weight loss drugs may only be used as part of a comprehensive weight loss program including diet and physical activity for patients with a BMI of ≥30 with no concomitant obesity related risk factors or diseases, or for patients with a BMI of ≥27 with concomitant obesity related risk factors or diseases. Evidence Category B.

Surgical interventions

Evidence Statement: Surgical interventions in adults with a BMI ≥ 40 or a BMI ≥ 35 with comorbid conditions result in substantial weight loss. Evidence Category B.

BMI ≥40 or ≥35 with comorbid conditions

RECOMMENDATION: Surgical intervention is an option for carefully selected patients with clinically severe obesity (a BMI ≥40 or ≥35 with comorbid conditions) when less invasive methods of weight loss have failed and the patient is at high risk for obesity-associated morbidity and mortality. Evidence Category B.

what expert tell about obesity

TREATMENT GUIDELINES

Measures of body fat

Evidence Statement: Measures of body fat give reasonably equivalent values for following overweight or obese patients during treatment. Evidence Category D.

BMI to assess overweight

RECOMMENDATION: Practitioners should use the BMI to assess overweight and obesity. Body weight alone can be used to follow weight loss and to determine efficacy of therapy. Evidence Category C.

Waist circumference

Evidence Statement: Waist circumference is the most practical anthropometric measurement for assessing a patient’s abdominal fat content before and during weight loss treatment. Computed tomography and magnetic resonance imaging are both more accurate but are impractical for routine clinical use. Evidence Category C.

assess abdominal fat content

RECOMMENDATION: The waist circumference should be used to assess abdominal fat content. Evidence Category C.

classify overweight

RECOMMENDATION: The BMI should be used to classify overweight and obesity and to estimate relative risk for disease compared to normal weight. Evidence Category C

BMI cut points

Evidence Statement: The same BMI cut points can be used to classify the level of overweight and obesity for adult men and adult nonpregnant women, and generally for all racial/ethnic groups. Evidence Category C.

Sex specific cutoffs

Evidence Statement: Sex specific cutoffs for waist circumference can be used to identify increased risk associated with abdominal fat in adults with a BMI in the range of 25 to 34.9 kg/m2. An increase in waist circumference may also be associated with increased risk in persons of normal weight. Evidence Category C.

Waist circumference cutpoints

Waist circumference cutpoints can generally be applied to all adult ethnic or racial groups. On the other hand, if a patient is very short (under 5 feet) or has a BMI above the 25 to 34.9 kg/m2range, waist cutpoints used for the general population may not be applicable. Evidence Category D.

identify increased disease risk

RECOMMENDATION: For adult patients with a BMI of 25 to 34.9 kg/m2, sex specific waist circumference cutoffs should be used in conjunction with BMI to identify increased disease risk. Evidence Category C.

Patient motivation

Evidence Statement: Patient motivation is a key component for success in a weight loss program. Evidence Category D.

well designed programs

Evidence Statement: Overweight and obese patients in well designed programs can achieve a weight loss of as much as 10 percent of baseline weight, a weight loss that can be maintained for a sustained period of time (1 year or longer). Evidence Category A.

motivation to enter weight loss therapy

RECOMMENDATION: Practitioners need to assess the patient’s motivation to enter weight loss therapy; assess the readiness of the patient to implement the plan; and then take appropriate steps to motivate the patient for treatment. Evidence Category D.

The initial goal of weight loss therapy

RECOMMENDATION: The initial goal of weight loss therapy should be to reduce body weight by approximately 10 percent from baseline. With success, further weight loss can be attempted, if indicated through further assessment. Evidence Category A.

rate of 1 to 2 lb/week

Evidence Statement: Weight loss at the rate of 1 to 2 lb/week (calorie deficit of 500 to 1,000 kcal/day) commonly occurs for up to 6 months, at which point weight loss begins to plateau unless a more restrictive regimen is implemented. Evidence Category B.

a period of 6 months

RECOMMENDATION: Weight loss should be about 1 to 2 lb/week for a period of 6 months with the subsequent strategy based on the amount of weight lost. Evidence Category B.