Obesity Treatment Strategies

Open access


Obesity is a disease with severe health consequences and increased risk of mortality. The most commonly used criteria to assess the presence and the severity of obesity are body mass index, waist circumference, waist-to-height ratio and the presence of the health conditions caused or worsened by obesity. Worldwide obesity has more than doubled in the last 4 decades. Obesity is the second of the leading preventable causes of death worldwide (after smoking). Obesity has a plurifactorial pathogenesis. The central perturbation consists in the imbalance between calories intake and calories consumption (by inappropriate diet and sedentary lifestyle). Identification of all the ethiological factors is important for treatment and prophylaxis. Weight loss benefits are multiple and important: improvement in glicemic control and in plasma lipid levels, blood presure control, obstructiv sleep apneea reduction, improvement in management of daily activities and profesional performances, increase quality of life, reduction in mortality. Overweight or obese patient will complete a diagnostic and a treatment program. Treatment of obesity claims a targeted multidimensional therapy: weight and lifestyle management, diet, sustained physical activity in daily life, exercise, decrease life stressors, smoking cessation, drug therapy, bariatric surgery psichological, familial and social suport. Weight loss program must be carefully planned, adapted to the patient’s abilities and comorbidities and supervised by a nutritionist and a physiotherapist.

1. WHO - Obesity and overweight. Fact sheet Nr. 311, Updated March 2011.

2. Feller S, Boeing H, Tobias Pischon T. Body Mass Index, Waist Circumference, and the Risk of Type 2 Diabetes Mellitus. Dtsch Arztebl Int. 2010. 107(26):470–476.

3. vanDis I, Kromhout D, Geleijnse JM, Boer JM, Verschuren WM - BMI and WC predict both 10-year nonfatal and fatal cardiovascular disease risk: study conducted in 20,000 Dutch men and women aged 20-65 years. Eur J Cardiovasc Prev Rehabil, 2009, 16(6):729-734.

4. Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med, 2008, 359:2105–2120.

5. Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation. 2008;117:1658–1666.

6. American Heart Association febr. 2011 - Heart and stroke facts. Dallas; 2011.

7. U.S. Depart of Health and Human Services NIH 2009. Weight-control Information Network. Physical Activity Guidelines for Americans. Oct. 2008. Available at http://www.health.gov/paguidelines.

8. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance United States, Morbidity & Mortality Weekly Report, 2008;57:SS-4.

9. Ryan Donna, David M Kendall, John Blundell, Ken Fujioka. Strategies to Combat Obesity: The Role of Appetite. Regulation and Impulse Control Authors and Disclosures. 2011 January 28.

10. Bogle Vanessa. Haringey Obesity Strategy. 2007-2010.

11. Tsigosa C, H Vojtech, Basdevant A, Finer N, Fried M, Mathus-Vliegen Elisabeth et al. Management of Obesity in Adults: European Clinical Practice Guidelines. The European Journal of Obesity. 2008;1(2):106–116.

12. Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci. 2006;331(4):214–218.

13. Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet. 2010;375:1737-1748.

14. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16):1530–1538.

15. Barness LA, Opitz JM, Gilbert-Barness E. Obesity: genetic, molecular, and environmental aspects. Am J Med Genet. 2007;143A(24): 3016–3034.

16. Calle EE, Thun MJ, Petrelli JM, Rodriguez C. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341(15):1097–1105.

17. Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes (London). 2007;31(4):569–577.

18. Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, et al. Obesity in adulthood and its consequences for life expectancy: A life-table analysis. Ann Intern Med. 2003;138(1):24–32.

19. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–1096.

20. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009; 28(5):822-831.

21. Hammond RA. The economic impact of obesity in the US. Brookings Institute. Sept 2010.

22. Heber D. An Integrative View of Obesity. Am J Clin Nutr. 2010;9:280S-283S.

23. National Institutes of Health, The Practical Guide Identification, Evaluation and Treatment of Overweight and Obesity in Adults National Heart, Lung, and Blood Institute NIH Publication No. 00-4084 October U.S. Department of Health and Human Services, 2000.

24. Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197–1209.

25. Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ. Obesity and thrombosis. Eur J Vasc Endovasc Surg. 2007;33(2):223–233.

26. Lee SD, Ju G, Choi JA, Kim JW, Yoon IY. The association of oxidative stress with central obesity in obstructive sleep apnea. Sleep Breath. 2011 May 26.

27. James WP. The fundamental drivers of the obesity epidemic. Obes Rev. 2008;S1:6-13.

28. Katsuki A, Sumida Y, Gabazza EC, et al. Plasma levels of agouti-related protein are increased in obese men. J Clin Endocrinol Metab. 2001;86:1921.

29. Vassallo Josanne. Pathogenesis of obesity. Journal of the Malta College of Pharmacy Practice. 2007;12:19–22.

30. Farooqi IS, Jebb SA, Langmack G, et al. Effects of recombinant leptin therapy in a child with congenital leptin deficiency. N Engl J Med. 1999;341:879.

31. Bouchard C. Defining the genetic architecture of the predisposition to obesity: a challenging but not insurmountable task. Am J Clin Nutr. 2010;(91):5-6.

32. Heather A. Genetic Predisposition to Type 2 Diabetes Promotes Weight Gain. Garvan Institute of Medical Research http://www.eurekalert.org/pub_releases/2010-05/ra-wgw051010.php.

33. Gardner DS, Hosking J, Metcalf BS, Jeffery AN, Voss LD, Wilkin T.J. Contribution of early weight gain to childhood overweight and metabolic health: a longitudinal study (Early Bird 36). Pediatrics, 2009;123(1):e67-73.

34. Wang Gene-Jack, Nora D. Volkow, Joanna S. Fowler. The role of dopamine in motivation for food in humans: implications for obesity. Expert Opinion on Therapeutic Targets. 2002;6:601-609.

35. Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J, et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J. 2010;31:737-746.

36. Kokkoris P, Pi-Sunyer FX. Obesity and endocrine disease. Endocrinol Metab Clin North Am. 2003;32:895-914.

37. Dietary Guidelines for Americans - U.S. Government Printing. Dietary Guidelines. gov/2010;

38. National Institute for Health and Clinical Excellence (NICE), (2006 and 2009) - Obesity: The prevention, identification, assessment and management of overweight and obesity in adults and children. London: NICE. www.nice.org.uk/guidance/CG43;

39. Wing Rena R, Phelan Suzanne. Science-Based Solutions to Obesity. Am J Clin Nutr. 2005;82(1 Suppl):207S–273S.

40. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of Type 2 diabetes by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343-1350.

41. Wadden TA, Sternberg JA, Letizia KA, Stunkard AJ. Treatment of obesity by very low calorie diet, behaviour therapy and combination: a 5 year experience. Int J Obes. 1989;13S:39-46.

42. Dixon JB, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–323.

43. Freitas A, Sweeney JF. Bariatric Surgery. In: B. Banerjee. Nutritional Management of Digestive Disorders. Boca Raton, FL: CRC Press. 2010;327–342.

44. Shikora SA, Kim J, Tarnoff ME. Nutritional and gastrointestinal complications of bariatric surgery. Nutrition in Clinical Practice. 2007;22(1):29–40.

45. Sjostrom L, et al - Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–752.

46. Thaler JP, Cummings DE - Minireview: Hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150:2518–2525.

47. Cummings DE. Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery. Int J Obes (London). 2009;33(suppl1):S33–S40.

48. Neff LM, Kushner RF. Emerging role of GLP-1 rec. agonists in the treatment of obesity. Diabetes Metab Syndr Obes. 2010;3:263–273.

Acta Medica Marisiensis

The Journal of The University of Medicine and Pharmacy of Targu-Mures

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 320 320 32
PDF Downloads 177 177 16