Wikipedia

Management of obesity

(Redirected from Treatment of obesity)

Management of obesity can include lifestyle changes, medications, or surgery. Although many studies have sought effective interventions, there is currently no evidence-based, well-defined, and efficient intervention to prevent obesity.[1]

Treatment for obesity often consists of weight loss via healthy nutrition and increasing physical exercise.[2][3][4][5] A 2007 review concluded that certain subgroups, such as those with type 2 diabetes and women who undergo weight loss, show long-term benefits in all-cause mortality, while long‐term outcomes for men are "not clear and need further investigation."[6]

The most effective treatment for obesity is bariatric surgery.[7] Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[8] Another study also found reduced mortality in those who underwent bariatric surgery for severe obesity.[9]

In June 2021, the US Food and Drug Administration (FDA) approved semaglutide injection sold under the brand name Wegovy for long-term weight management in adults. It is associated with a loss of 6-12% body weight along with mild gastrointestinal side effects.[10][11]

Another medication, orlistat, is widely available and approved for long-term use. Its use produces modest weight loss, with an average of 2.9 kg (6.4 lb) at 1 to 4 years, but there is little information on how these medications affect longer-term complications of obesity.[12][13][needs update] Its use is associated with high rates of gastrointestinal side effects.[13]

Diet programs can produce short-term weight loss and, to a lesser extent, over the long-term. Greater weight loss results, including amongst underserved populations, are achieved when proper nutrition is regularly combined with physical exercise and counseling.[4][12][14][15][16] Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child.[17]

Dieting

edit
Main article: Dieting
Treatment selection based on BMI[18][19]
Treatment 25-26.9 27-29.9 30-34.9 35-39.9 ≥40
Lifestyle intervention
(diet, physical activity,
behavior) 		Yes Yes Yes Yes Yes
Pharmacotherapy Not appropriate With co-morbidities Yes Yes Yes
Surgery Not appropriate Not appropriate Not appropriate With co-morbidities Yes

Diets to promote weight loss can be divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie.[20][better source needed] Many dietary patterns are effective.[4] A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate and low fat), with a 2–4 kilograms (4.4–8.8 lb) weight loss in all studies.[20] At two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized.[21] High protein diets do not appear to make any difference.[22] A diet high in added sugars such as those in soft drinks increases weight.[23] There is evidence that dieting alone can be effective for weight loss and improving health for obese individuals.[4][12] However, a large study of adults found that obesity was associated with differences in brain structure, largely due to shared genetic factors, suggesting that interventions for obesity should not focus solely on energy content, but also take into account the neurobehavioral profile that obesity is genetically associated with.[24]

Dieting for calorie restriction is advised for overweight individuals by the Dietary Guidelines for Americans and United Kingdom's NICE.[2][3][4][25]

Exercise

edit
See also: Physical exercise

With use, muscles consume energy derived from both fat and glycogen. Due to the large size of leg muscles, walking, running and cycling are the most effective means of exercise to reduce body fat.[26] Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel.[27][28] To maintain health, the American Heart Association recommends a minimum of 30 minutes of moderate exercise at least 5 days a week.

The Cochrane Collaboration found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1 kilogram weight loss over dieting alone. A 1.5 kilograms (3.3 pounds) loss was observed with a greater degree of exercise.[29] Even though exercise as carried out in the general population has only modest effects, a dose response curve is found and very intense exercise can lead to substantial weight loss. During 20 weeks of basic military training with no dietary restriction, obese military recruits lost 12.5 kg (28 lb).[30] High levels of physical activity seem to be necessary to maintain weight loss.[31] A pedometer appears useful for motivation. Over an average of 18-weeks of use, physical activity increased by 27% resulting in a 0.38 decrease in BMI.[32]

Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population.[33] The city of Bogota, Colombia, for example, blocks off 113 kilometers (70 mi) of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.[34]

In an effort to combat the issue, a primary school in Australia instituted a standing classroom in 2013.[35]

There is evidence that exercise alone is not sufficient to produce meaningful weight loss, but combining dieting and exercise provide the greatest health benefits and weight loss on the long term.[4][12]

Weight loss programs

edit

Weight loss programs involve lifestyle changes including diet modifications, physical activity and behavior therapy. This may involve eating smaller meals, cutting down on certain types of food and making a conscious effort to exercise more. These programs also enable people to connect with a group of others who are attempting to lose weight, in the hopes that participants will form mutually motivating and encouraging relationships.[36] Since 2013, the United States guidelines recommend treating obesity as a disease and actively treat obese people for weight loss.[4]

A number of popular programs exist including Weight Watchers, Overeaters Anonymous and Jenny Craig. These appear to provide modest weight loss (2.9 kg; 6.4 lb) over dieting on one's own (0.2 kg; 0.44 lb) over a two-year period,[12][37][38][39][40] similarly to non-commercial diets.[4][12] As of 2005, there was insufficient scientific evidence to determine whether Internet-based programs produce effective weight loss.[41] The Chinese government has introduced a number of "fat farms" where obese children go for reinforced exercise and has passed a law which requires students to exercise or play sports for an hour a day at school (see Obesity in China).[42][43]

In a structured setting with a trained therapist, these interventions produce an average weight loss of up to 8 kg in 6 months to 1 year,[4] and 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later.[44] There is a gradual weight regain after the first year of about 1 to 2 kg per year, but on the long-term this still results in weight loss.[4] Risk factors for cardiovascular disease and for diabetes are reduced for several years after taking part in a weight management programme, even if people regained weight.[45][46]

Attending group meetings for weight reduction programmes rather than receiving one-on-one support may increase the likelihood that obese people will lose weight. Those who participated in groups had more treatment time and were more likely to lose enough weight to improve their health. Study authors suggested that one explanation for the difference is that group participants spent more time with the clinician (or whoever delivered the programme) than those receiving one-on-one support.[47][48]

Comprehensive diet programs, providing counseling, targets for calorie intake and exercise, may be more efficient than dieting without guidance ("self-help"),[12][49][50] although the evidence is very limited.[51] Following comprehensive lifestyle modifications, the average maintained weight loss is more than 3 kg (6.6 lb) or 3% of total body mass, and could be sustained for five years,[15] and up to 20% of the individuals maintain a weight loss of at least 10% (average of 33 kg).[14] There is some evidence that fast weight loss produce greater long-term weight loss than gradual weight loss.[12][15] Moderate on-site comprehensive lifestyle changes produce a greater weight loss than usual care, of 2 to 4 kg on average in 6 to 12 months.[4] High-intensity comprehensive programs usually yield more weight loss than moderate or low-intensity, with about 35% to 60% of overweight individuals maintaining more than 5 kg weight loss after 2 years.[4]

The NICE devised a set of essential criteria to be met by commercial weight management organizations to be approved.[52]

The Transtheoretical Model (TTM) has been used as a framework to assist the design of lifestyle modification programmes, including weight management. A systematic review found that there is insufficient evidence to draw conclusions regarding the effects of TTM-based programs targeting weight loss that included dietary or physical activity interventions, or both (and also combined with other interventions), on sustainable weight loss (one year or longer) in overweight and obese adults. However, very low quality evidence points that this approach may induce positive changes in physical activity and dietary habits, such as increased in exercise duration and frequency, improvement in fruits and vegetables consumption, and reduced dietary fat intake.[53]

Medication

edit
Main article: Anti-obesity medication
 
Orlistat (Xenical), the most commonly used medication to treat obesity and sibutramine (Meridia), a withdrawn medication due to cardiovascular side effects

Anti-obesity medications currently approved by the FDA for weight loss

edit

Several anti-obesity medications are currently approved by the FDA for long term use.[54][55][56]

  • Semaglutide (Wegovy) is currently approved by the FDA for long-term use, being associated with a 6-12% loss in body weight compared to placebo.[57]
  • The combination drug phentermine/topiramate (Qsymia) is approved by the FDA as an addition to a reduced-calorie diet and exercise for chronic weight management.[58]
  • Orlistat reduces intestinal fat absorption by inhibiting pancreatic lipase. Over the longer term, average weight loss on orlistat is 2.9 kg (6.4 lb). It leads to a reduced incidence of diabetes, and has some effect on cholesterol. However, there is little information on how it affects the longer-term complications or outcomes of obesity.[13]
  • Racemic amphetamine, phendimetrazine, diethylpropion, and phentermine are approved by the FDA for short term use.[55][59]

Other medications

edit
  • Bupropion, topiramate, and zonisamide are sometimes used off-label for weight loss.[55][59]
  • The usefulness of certain drugs depends upon the comorbidities present. Metformin is preferred in overweight diabetics and for those gaining weight because taking clozapine for schizophrenia, as it may lead to mild weight loss in comparison to sulfonylureas or insulin.[60][61] The thiazolidinediones, on the other hand, may cause weight gain, but decrease central obesity.[62] Diabetics also achieve modest weight loss with fluoxetine and orlistat over 12–57 weeks.[63]
  • Rimonabant (Acomplia), another drug, had been withdrawn from the market. It worked via a specific blockade of the endocannabinoid system. It has been developed from the knowledge that cannabis smokers often experience hunger, which is often referred to as "the munchies". It had been approved in Europe for the treatment of obesity but has not received approval in the United States or Canada due to safety concerns.[64][65] European Medicines Agency in October 2008 recommended the suspension of the sale of rimonabant as the risk seem to be greater than the benefits.[66]
  • Sibutramine (Meridia), which acts in the brain to inhibit deactivation of the neurotransmitters, thereby decreasing appetite was withdrawn from the UK market in January 2010 and United States and Canadian markets in October 2010 due to cardiovascular concerns.[56][67][68] In 2010 it was found that sibutramine increases the risk of heart attacks and strokes in people with a history of cardiovascular disease.[69][70]
  • Fenfluramine and dexfenfluramine were withdrawn from the market in 1997,[55] while ephedrine (found in the traditional Chinese herbal medicine má huáng made from the Ephedra sinica) was removed from the market in 2004.[71]
  • Lorcaserin used to be approved by the Food and Drug Administration for use in the treatment of obesity before being withdrawn due to cancer risk.[72]
  • Recombinant human leptin is very effective in those with obesity due to congenital complete leptin deficiency via decreasing energy intake and possibly increases energy expenditure. This condition is, however, rare and this treatment is not effective for inducing weight loss in the majority of people with obesity. It is being investigated to determine whether or not it helps with weight loss maintenance.[73]
  • Though hypothesized that supplementation of vitamin D may be an effective treatment for obesity, studies do not support this.[74] There is also no strong evidence to recommend herbal medicines for weight loss.[75]

Surgery

edit
Main article: Bariatric surgery

Bariatric surgery ("weight loss surgery") is the use of surgical intervention in the treatment of obesity. As every operation may have complications, surgery is only recommended for severely obese people (BMI > 40) who have failed to lose weight following dietary modification and pharmacological treatment. Weight loss surgery relies on various principles: the two most common approaches are reducing the volume of the stomach (e.g. by adjustable gastric banding and vertical banded gastroplasty), which produces an earlier sense of satiation, and reducing the length of bowel that comes into contact with food (e.g. by gastric bypass surgery or endoscopic duodenal-jejunal bypass surgery[76][77]), which directly reduces absorption. Band surgery is reversible, while bowel shortening operations are not. Some procedures can be performed laparoscopically. Complications from weight loss surgery are frequent.[78]

Surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[8] A marked decrease in the risk of diabetes mellitus, cardiovascular disease and cancer has also been found after bariatric surgery.[8][79] Marked weight loss occurs during the first few months after surgery, and the loss is sustained in the long term. Bariatric surgery, particularly Roux-en-Y gastric bypass and sleeve gastrectomy, have demonstrated effectiveness in promoting weight loss and improving diabetes outcomes among severely obese individuals. A 2021 Evidence Update for Clinicians found that Roux-en-Y gastric bypass patients experienced slightly better weight loss and diabetes control outcomes than sleeve gastrectomy patients, though with a higher risk for rehospitalization and need for additional surgeries.[80]

In one study there was an unexplained increase in deaths from accidents and suicide, but this did not outweigh the benefit in terms of disease prevention.[79] When the two main techniques are compared, gastric bypass procedures are found to lead to 30% more weight loss than banding procedures one year after surgery.[81] For obese individuals with non-alcoholic fatty liver disease (NAFLD), bariatric surgery improves or cures the liver.[82][83]

A preoperative diet such as low-calorie diets or very-low-calorie diet, is usually recommended to reduce liver volume by 16-20%, and preoperative weight loss is the only factor associated with postoperative weight loss.[84][85] Preoperative weight loss can reduce operative time and hospital stay.[84][86][87] although there is insufficient evidence whether preoperative weight loss may be beneficial to reduce long-term morbidity or complications.[87][88] Weight loss and decreases in liver size may be independent from the amount of calorie restriction.[85]

Ileojejunal bypass, in which the digestive tract is rerouted to bypass the small intestine, was an experimental surgery designed as a remedy for morbid obesity.

The effects of liposuction on obesity are less well determined. Some small studies show benefits[89] while others show none.[90] A treatment involving the placement of an intragastric balloon via gastroscopy has shown promise. One type of balloon led to a weight loss of 5.7 BMI units over 6 months or 14.7 kg (32 lb). Regaining lost weight is common after removal, however, and 4.2% of people were intolerant of the device.[91]

An implantable nerve simulator which improves the feeling of fullness was approved by the FDA in 2015.[92]

In 2016 the FDA approved an aspiration therapy device that siphons food from the stomach to the outside and decreases caloric intake.[93] As of 2015 one trial shows promising results.[94]

Health policy

edit

Obesity is a complex public health and policy problem because of its prevalence, costs, and health effects.[95] As such, managing it requires changes in the wider societal context and effort by communities, local authorities, and governments.[96] Public health efforts seek to understand and correct the environmental factors responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct junk food marketing to children,[97] and decreasing access to sugar-sweetened beverages in schools.[98] The World Health Organization recommends the taxing of sugary drinks.[99] When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.[100]

Mass media campaigns seem to have limited effectiveness in changing behaviors that influence obesity. At the same time they can increase knowledge and awareness regarding physical activity and diet, which might lead to changes in the long term. Campaigns might also be able to reduce the amount of time spent sitting or lying down and positively affect the intention to be active physically.[101][102] Nutritional labelling with energy information on menus might be able to help reducing energy intake while dining in restaurants.[103]

Since there is a relationship between obesity and automobile travel, interventions relating to transportation infrastructure (for example, policy aimed at encouraging the use of public transportation) could potentially reduce obesity.[104][105]

Clinical protocols

edit

Much of the Western world has created clinical practice guidelines in an attempt to address rising rates of obesity. Australia,[106] Canada,[5] the European Union,[107] the United Kingdom, [108] and the United States[109] have all published statements since 2004.

In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:[109][needs update]

  1. People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
  2. If these goals are not achieved, pharmacotherapy can be offered. The person needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
  3. Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide.
  4. In people with a BMI over 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The person needs to be aware of the potential complications.
  5. Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.

A clinical practice guideline by the US Preventive Services Task Force (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a healthy diet in unselected people in primary care settings, but that intensive behavioral dietary counseling is recommended in those with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.[110][111] A survey of primary care physicians in the United States[112] found that although clinical guidelines do not consider overweight to be a risk factor that increases mortality,[113] physicians often report believing that being overweight increases all-cause mortality.

Canada developed and published evidence-based practice guidelines in 2006. The guidelines attempt to address the prevention and management of obesity at both the individual and population levels in both children and adults.[5] The European Union published clinical practice guidelines in 2008 in an effort to address the rising rates of obesity in Europe.[107] Australia came out with practice guidelines in 2004.[106]

References

edit
  1. ^ Chiolero A (October 2018). "Why causality, and not prediction, should guide obesity prevention policy". The Lancet. Public Health. 3 (10): e461–e462. doi:10.1016/S2468-2667(18)30158-0. PMID 30177480.
  2. ^ a b US Department of Health and Human Services. (2017). "2015–2020 Dietary Guidelines for Americans - health.gov". health.gov. Skyhorse Publishing Inc. Retrieved 30 September 2019.
  3. ^ a b Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. (September 2019). "2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. 140 (11): e596–e646. doi:10.1161/CIR.0000000000000678. PMC 7734661. PMID 30879355.
  4. ^ a b c d e f g h i j k l Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. (June 2014). "2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society". Circulation. 129 (25 Suppl 2): S102–S138. doi:10.1161/01.cir.0000437739.71477.ee. PMC 5819889. PMID 24222017.
  5. ^ a b c Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]". CMAJ. 176 (8): S1-13. doi:10.1503/cmaj.061409. PMC 1839777. PMID 17420481.
  6. ^ Poobalan AS, Aucott LS, Smith WC, Avenell A, Jung R, Broom J (November 2007). "Long-term weight loss effects on all cause mortality in overweight/obese populations". Obesity Reviews. 8 (6): 503–513. doi:10.1111/j.1467-789X.2007.00393.x. PMID 17949355. S2CID 42859237.
  7. ^ Colquitt JL, Pickett K, Loveman E, Frampton GK (August 2014). "Surgery for weight loss in adults". The Cochrane Database of Systematic Reviews. 2014 (8): CD003641. doi:10.1002/14651858.CD003641.pub4. PMC 9028049. PMID 25105982.
  8. ^ a b c Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al. (August 2007). "Effects of bariatric surgery on mortality in Swedish obese subjects". The New England Journal of Medicine. 357 (8): 741–752. doi:10.1056/NEJMoa066254. PMID 17715408. S2CID 20533869.
  9. ^ Peeters A, O'Brien PE, Laurie C, Anderson M, Wolfe R, Flum D, et al. (December 2007). "Substantial intentional weight loss and mortality in the severely obese". Annals of Surgery. 246 (6): 1028–1033. doi:10.1097/SLA.0b013e31814a6929. PMID 18043106. S2CID 21151854.
  10. ^ Office of the Commissioner (2021-06-21). "FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014". FDA. Retrieved 2022-07-21.
  11. ^ Wilding JP, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. (March 2021). "Once-Weekly Semaglutide in Adults with Overweight or Obesity". The New England Journal of Medicine. 384 (11): 989–1002. doi:10.1056/NEJMoa2032183. PMID 33567185. S2CID 231883214.
  12. ^ a b c d e f g h Thom G, Lean M (May 2017). "Is There an Optimal Diet for Weight Management and Metabolic Health?" (PDF). Gastroenterology (Review). 152 (7): 1739–1751. doi:10.1053/j.gastro.2017.01.056. PMID 28214525.
  13. ^ a b c Rucker D, Padwal R, Li SK, Curioni C, Lau DC (December 2007). "Long term pharmacotherapy for obesity and overweight: updated meta-analysis". BMJ. 335 (7631): 1194–1199. doi:10.1136/bmj.39385.413113.25. PMC 2128668. PMID 18006966.
  14. ^ a b Wing RR, Phelan S (July 2005). "Long-term weight loss maintenance". The American Journal of Clinical Nutrition. 82 (1 Suppl): 222S–225S. doi:10.1093/ajcn/82.1.222S. PMID 16002825.
  15. ^ a b c Anderson JW, Konz EC, Frederich RC, Wood CL (November 2001). "Long-term weight-loss maintenance: a meta-analysis of US studies". The American Journal of Clinical Nutrition (Meta-analysis). 74 (5): 579–584. doi:10.1093/ajcn/74.5.579. PMID 11684524.
  16. ^ Katzmarzyk PT, Martin CK, Newton RL, Apolzan JW, Arnold CL, Davis TC, et al. (September 2020). "Weight Loss in Underserved Patients - A Cluster-Randomized Trial". The New England Journal of Medicine. 383 (10): 909–918. doi:10.1056/NEJMoa2007448. PMC 7493523. PMID 32877581.
  17. ^ Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. (May 2012). "Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence". BMJ. 344: e2088. doi:10.1136/bmj.e2088. PMC 3355191. PMID 22596383.
  18. ^ Matarese LE, Pories WJ (December 2014). "Adult weight loss diets: metabolic effects and outcomes". Nutrition in Clinical Practice (Review). 29 (6): 759–767. doi:10.1177/0884533614550251. PMID 25293593.
  19. ^ The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (National guidelines). National Institutes of Health, National Heart, Lung, and Blood Institute, NHLBI Obesity Education Initiative, North American Association for the Study of Obesity. 2000.
  20. ^ a b Strychar I (January 2006). "Diet in the management of weight loss". CMAJ. 174 (1): 56–63. doi:10.1503/cmaj.045037. PMC 1319349. PMID 16389240.
  21. ^ Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. (February 2009). "Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates". The New England Journal of Medicine. 360 (9): 859–873. doi:10.1056/NEJMoa0804748. PMC 2763382. PMID 19246357.
  22. ^ Schwingshackl L, Hoffmann G (April 2013). "Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis". Nutrition Journal. 12: 48. doi:10.1186/1475-2891-12-48. PMC 3636027. PMID 23587198.
  23. ^ Te Morenga L, Mallard S, Mann J (January 2012). "Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies". BMJ. 346: e7492. doi:10.1136/bmj.e7492. hdl:20.500.12799/4871. PMID 23321486.
  24. ^ Vainik U, Baker TE, Dadar M, Zeighami Y, Michaud A, Zhang Y, et al. (September 2018). "Neurobehavioral correlates of obesity are largely heritable". Proceedings of the National Academy of Sciences of the United States of America. 115 (37): 9312–9317. Bibcode:2018PNAS..115.9312V. doi:10.1073/pnas.1718206115. PMC 6140494. PMID 30154161.
  25. ^ "Obesity: maintaining a healthy weight and preventing excess weight gain". pathways.nice.org.uk. 8 March 2023.
  26. ^ Gwinup G (1987). "Weight loss without dietary restriction: efficacy of different forms of aerobic exercise". The American Journal of Sports Medicine. 15 (3): 275–279. doi:10.1177/036354658701500317. PMID 3618879. S2CID 1973279.
  27. ^ Sahlin K, Sallstedt EK, Bishop D, Tonkonogi M (December 2008). "Turning down lipid oxidation during heavy exercise--what is the mechanism?". Journal of Physiology and Pharmacology. 59 (Suppl 7): 19–30. PMID 19258655.
  28. ^ Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. (August 2007). "Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association". Circulation. 116 (9): 1081–1093. doi:10.1161/CIRCULATIONAHA.107.185649. PMID 17671237.
  29. ^ Shaw K, Gennat H, O'Rourke P, Del Mar C (October 2006). "Exercise for overweight or obesity". The Cochrane Database of Systematic Reviews. 2006 (4): CD003817. doi:10.1002/14651858.CD003817.pub3. PMC 9017288. PMID 17054187.
  30. ^ Lee L, Kumar S, Leong LC (February 1994). "The impact of five-month basic military training on the body weight and body fat of 197 moderately to severely obese Singaporean males aged 17 to 19 years". International Journal of Obesity and Related Metabolic Disorders. 18 (2): 105–109. PMID 8148923.
  31. ^ Bessesen DH (June 2008). "Update on obesity". The Journal of Clinical Endocrinology and Metabolism. 93 (6): 2027–2034. doi:10.1210/jc.2008-0520. PMID 18539769.
  32. ^ Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. (November 2007). "Using pedometers to increase physical activity and improve health: a systematic review". JAMA. 298 (19): 2296–2304. doi:10.1001/jama.298.19.2296. PMID 18029834. S2CID 3008531.
  33. ^ Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, et al. (May 2002). "The effectiveness of interventions to increase physical activity. A systematic review". American Journal of Preventive Medicine. 22 (4 Suppl): 73–107. doi:10.1016/S0749-3797(02)00434-8. PMID 11985936.
  34. ^ "www.paho.org". Pan American Health Organization. Retrieved January 10, 2009.
  35. ^ "World's first standing classroom launched in Australia - The Times of India". The Times Of India.
  36. ^ Baron M (November 2004). "Commercial weight-loss programs". Health Care Food & Nutrition Focus. 21 (11): 8–9. PMID 15559885.
  37. ^ Heshka S, Anderson JW, Atkinson RL, Greenway FL, Hill JO, Phinney SD, et al. (April 2003). "Weight loss with self-help compared with a structured commercial program: a randomized trial". JAMA. 289 (14): 1792–1798. doi:10.1001/jama.289.14.1792. PMID 12684357.
  38. ^ Atallah R, Filion KB, Wakil SM, Genest J, Joseph L, Poirier P, et al. (November 2014). "Long-term effects of 4 popular diets on weight loss and cardiovascular risk factors: a systematic review of randomized controlled trials". Circulation: Cardiovascular Quality and Outcomes (Systematic review of RCTs). 7 (6): 815–827. doi:10.1161/CIRCOUTCOMES.113.000723. PMID 25387778.
  39. ^ Vakil RM, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Lee CJ, et al. (June 2016). "Direct comparisons of commercial weight-loss programs on weight, waist circumference, and blood pressure: a systematic review". BMC Public Health (Systematic review). 16: 460. doi:10.1186/s12889-016-3112-z. PMC 4888663. PMID 27246464.
  40. ^ Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, et al. (April 2015). "Efficacy of commercial weight-loss programs: an updated systematic review". Annals of Internal Medicine (Systematic review). 162 (7): 501–512. doi:10.7326/M14-2238. PMC 4446719. PMID 25844997.
  41. ^ Tsai AG, Wadden TA (January 2005). "Systematic review: an evaluation of major commercial weight loss programs in the United States". Annals of Internal Medicine. 142 (1): 56–66. doi:10.7326/0003-4819-142-1-200501040-00012. PMID 15630109. S2CID 2589699.
  42. ^ Hewitt D (May 23, 2000). "China battles obesity". BBC. Retrieved August 8, 2009.
  43. ^ MacLeod C (August 1, 2007). "Obesity of China's kids stuns officials". USA Today. Retrieved August 8, 2009.
  44. ^ Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK (July 2007). "Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002". American Journal of Preventive Medicine. 33 (1): 34–40. doi:10.1016/j.amepre.2007.02.040. PMID 17572309.
  45. ^ Fischer, Kathrin (2023-09-25). "Weight regain does not eliminate the benefits of weight management programmes". NIHR Evidence. Retrieved 2023-09-25.
  46. ^ Hartmann-Boyce, Jamie; Theodoulou, Annika; Oke, Jason L.; Butler, Ailsa R.; Bastounis, Anastasios; Dunnigan, Anna; Byadya, Rimu; Cobiac, Linda J.; Scarborough, Peter; Hobbs, F.D. Richard; Sniehotta, Falko F.; Jebb, Susan A.; Aveyard, Paul (April 2023). "Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis". Circulation: Cardiovascular Quality and Outcomes. 16 (4). doi:10.1161/CIRCOUTCOMES.122.009348. ISSN 1941-7713. PMC 10106109. PMID 36974678.
  47. ^ "Group programmes for weight loss may be more effective than one-to-one sessions". NIHR Evidence (Plain English summary). 2021-08-27. doi:10.3310/alert_47460. S2CID 241732368.
  48. ^ Abbott S, Smith E, Tighe B, Lycett D (June 2021). "Group versus one-to-one multi-component lifestyle interventions for weight management: a systematic review and meta-analysis of randomised controlled trials" (PDF). Journal of Human Nutrition and Dietetics. 34 (3): 485–493. doi:10.1111/jhn.12853. PMID 33368624. S2CID 229691531.
  49. ^ Kernan WN, Inzucchi SE, Sawan C, Macko RF, Furie KL (January 2013). "Obesity: a stubbornly obvious target for stroke prevention". Stroke (Review). 44 (1): 278–286. doi:10.1161/STROKEAHA.111.639922. PMID 23111440.
  50. ^ Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, et al. (April 2015). "Efficacy of commercial weight-loss programs: an updated systematic review". Annals of Internal Medicine. 162 (7): 501–512. doi:10.7326/M14-2238. PMC 4446719. PMID 25844997.
  51. ^ Allan K (2018). "4.4 Group‐based interventions for weight loss in obesity.". In Hankey C (ed.). Advanced nutrition and dietetics in obesity. Wiley. pp. 164–168. ISBN 9780470670767.
  52. ^ Avery A (2018). "4.7 Commercial weight management organisations for weight loss in obesity.". In Hankey C (ed.). Advanced nutrition and dietetics in obesity. Wiley. pp. 177–182. ISBN 9780470670767.
  53. ^ Mastellos N, Gunn LH, Felix LM, Car J, Majeed A, et al. (Cochrane Metabolic and Endocrine Disorders Group) (February 2014). "Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults". The Cochrane Database of Systematic Reviews. 2014 (2): CD008066. doi:10.1002/14651858.CD008066.pub3. PMC 10088065. PMID 24500864.
  54. ^ "FDA approves Belviq to treat some overweight or obese adults". FDA. June 27, 2012. Retrieved 8 July 2012.
  55. ^ a b c d "WIN – Publication – Prescription Medications for the Treatment of Obesity". National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. Archived from the original on January 13, 2009. Retrieved January 14, 2009.
  56. ^ a b "www.fda.gov". Food and Drug Administration.
  57. ^ Office of the Commissioner (2021-06-21). "FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014". FDA. Retrieved 2022-07-19.
  58. ^ "FDA approves weight-management drug Qsymia". Food and Drug Administration. July 17, 2012.
  59. ^ a b "Evekeo Prescribing Information" (PDF). Arbor Pharmaceuticals LLC. April 2014. pp. 1–2. Retrieved 11 August 2015.
  60. ^ Siskind DJ, Leung J, Russell AW, Wysoczanski D, Kisely S (2016-06-15). Holscher C (ed.). "Metformin for Clozapine Associated Obesity: A Systematic Review and Meta-Analysis". PLOS ONE. 11 (6): e0156208. Bibcode:2016PLoSO..1156208S. doi:10.1371/journal.pone.0156208. PMC 4909277. PMID 27304831.
  61. ^ UK Prospective Diabetes Study (UKPDS) Group (September 1998). "Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group". Lancet. 352 (9131): 854–865. doi:10.1016/S0140-6736(98)07037-8. PMID 9742977. S2CID 19208426.
  62. ^ Fonseca V (December 2003). "Effect of thiazolidinediones on body weight in patients with diabetes mellitus". The American Journal of Medicine. 115 (Suppl 8A): 42S–48S. doi:10.1016/j.amjmed.2003.09.005. PMID 14678865.
  63. ^ Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J (January 2005). "Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus". The Cochrane Database of Systematic Reviews. 2005 (1): CD004096. doi:10.1002/14651858.CD004096.pub2. PMC 6718205. PMID 15674929.
  64. ^ "Anti-obesity drug no magic bullet". Canadian Broadcasting Corporation. January 2, 2007. Retrieved 2008-09-19.
  65. ^ "FDA Briefing Document NDA 21-888 Zimulti (rimonabant) Tablets, 20 mg Sanofi Aventis Advisory Committee" (PDF). Food and Drug Administration. June 13, 2007. Retrieved 2008-09-19.
  66. ^ "www.emea.europa.eu" (PDF).
  67. ^ "Abbott Laboratories Voluntarily Withdraws Weight-loss Drug Sibutramine (Meridia) from the Canadian Market - Health Canada Information Update 2010-10-08". 2012-10-23.
  68. ^ "www.nice.org.uk" (PDF). Archived from the original (PDF) on 2010-11-06.
  69. ^ "Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review". Food and Drug Administration.
  70. ^ James WP, Caterson ID, Coutinho W, Finer N, Van Gaal LF, Maggioni AP, et al. (September 2010). "Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects" (PDF). The New England Journal of Medicine. 363 (10): 905–917. doi:10.1056/NEJMoa1003114. hdl:2437/111825. PMID 20818901.
  71. ^ Rados C (2004). "Ephedra ban: no shortage of reasons". FDA Consumer. 38 (2): 6–7. PMID 15101356.
  72. ^ "Lorcaserin (Belviq) Withdrawn From US Market Due to Cancer Risk". Medscape. Retrieved 2022-07-19.
  73. ^ Kelesidis T, Kelesidis I, Chou S, Mantzoros CS (January 2010). "Narrative review: the role of leptin in human physiology: emerging clinical applications". Annals of Internal Medicine. 152 (2): 93–100. doi:10.7326/0003-4819-152-2-201001190-00008. PMC 2829242. PMID 20083828.
  74. ^ Pathak K, Soares MJ, Calton EK, Zhao Y, Hallett J (June 2014). "Vitamin D supplementation and body weight status: a systematic review and meta-analysis of randomized controlled trials". Obesity Reviews. 15 (6): 528–537. doi:10.1111/obr.12162. PMID 24528624. S2CID 8660739.
  75. ^ Maunder A, Bessell E, Lauche R, Adams J, Sainsbury A, Fuller NR (June 2020). "Effectiveness of herbal medicines for weight loss: A systematic review and meta-analysis of randomized controlled trials". Diabetes, Obesity & Metabolism. 22 (6): 891–903. doi:10.1111/dom.13973. PMID 31984610.
  76. ^ Sullivan S (2015). "Endoscopic Treatment of Obesity". In Jonnalagadda SS (ed.). Gastrointestinal Endoscopy: New Technologies and Changing Paradigms. Springer. pp. 61–82. ISBN 9781493920327. Retrieved 18 March 2016.
  77. ^ Muñoz R, Escalona A (2015). "Chapter 51: Endoscopic Duodenal-Jejunal Bypass Sleeve Treatment for Obesity". In Agrawal S (ed.). Obesity, Bariatric and Metabolic Surgery: A Practical Guide. Springer. pp. 493–498. ISBN 9783319043432. Retrieved 18 March 2016.
  78. ^ Encinosa WE, Bernard DM, Chen CC, Steiner CA (August 2006). "Healthcare utilization and outcomes after bariatric surgery". Medical Care. 44 (8): 706–712. doi:10.1097/01.mlr.0000220833.89050.ed. PMID 16862031. S2CID 8434284.
  79. ^ a b Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. (August 2007). "Long-term mortality after gastric bypass surgery". The New England Journal of Medicine. 357 (8): 753–761. doi:10.1056/NEJMoa066603. PMID 17715409. S2CID 8710295.
  80. ^ "Comparing the Benefits and Harms of Bariatric Procedures - Evidence Update for Clinicians | PCORI". Patient-Centered Outcomes Research Institute (PCORI). 2021-07-15. Retrieved 2024-10-30.
  81. ^ Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD (October 2008). "Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures". The American Journal of Medicine. 121 (10): 885–893. doi:10.1016/j.amjmed.2008.05.036. PMID 18823860.
  82. ^ Chitturi S, Wong VW, Chan WK, Wong GL, Wong SK, Sollano J, et al. (January 2018). "The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 2: Management and special groups". Journal of Gastroenterology and Hepatology. 33 (1): 86–98. doi:10.1111/jgh.13856. PMID 28692197. S2CID 29648173.
  83. ^ Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK (December 2008). "Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis". Clinical Gastroenterology and Hepatology. 6 (12): 1396–1402. doi:10.1016/j.cgh.2008.08.012. PMID 18986848.
  84. ^ a b Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, et al. (September 2016). "Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations". World Journal of Surgery (Professional society guidelines). 40 (9): 2065–2083. doi:10.1007/s00268-016-3492-3. PMID 26943657.
  85. ^ a b Holderbaum M, Casagrande DS, Sussenbach S, Buss C (February 2018). "Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review". Surgery for Obesity and Related Diseases (Systematic review). 14 (2): 237–244. doi:10.1016/j.soard.2017.09.531. PMID 29239795.
  86. ^ Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. (2008). "Does weight loss immediately before bariatric surgery improve outcomes: a systematic review". Surgery for Obesity and Related Diseases. 5 (6): 713–721. doi:10.1016/j.soard.2009.08.014. PMID 19879814.
  87. ^ a b Roman M, Monaghan A, Serraino GF, Miller D, Pathak S, Lai F, et al. (February 2019). "Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes". The British Journal of Surgery (Meta-analysis). 106 (3): 181–189. doi:10.1002/bjs.11001. hdl:2381/43636. PMID 30328098.
  88. ^ Cassie S, Menezes C, Birch DW, Shi X, Karmali S (2010). "Effect of preoperative weight loss in bariatric surgical patients: a systematic review". Surgery for Obesity and Related Diseases (Systematic review). 7 (6): 760–7, discussion 767. doi:10.1016/j.soard.2011.08.011. PMID 21978748.
  89. ^ Giugliano G, Nicoletti G, Grella E, Giugliano F, Esposito K, Scuderi N, D'Andrea F (April 2004). "Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women". British Journal of Plastic Surgery. 57 (3): 190–194. doi:10.1016/j.bjps.2003.12.010. PMID 15006519.
  90. ^ Klein S, Fontana L, Young VL, Coggan AR, Kilo C, Patterson BW, Mohammed BS (June 2004). "Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease". The New England Journal of Medicine. 350 (25): 2549–2557. doi:10.1056/NEJMoa033179. PMID 15201411.
  91. ^ Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J (July 2008). "Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis". Obesity Surgery. 18 (7): 841–846. doi:10.1007/s11695-007-9331-8. PMID 18459025. S2CID 10220216.
  92. ^ "FDA approves first-of-kind device to treat obesity". fda.gov. January 14, 2015. Retrieved 18 January 2015.
  93. ^ FDA release. June 14, 2016
  94. ^ Kumar N (July 2015). "Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration". World Journal of Gastrointestinal Endoscopy. 7 (9): 847–859. doi:10.4253/wjge.v7.i9.847. PMC 4515419. PMID 26240686.
  95. ^ Satcher D (2001). The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Publications and Reports of the Surgeon General. U.S. Dept. of Health and Human Services, Public Health Service, Office of Surgeon General. ISBN 978-0-16-051005-2. PMID 20669513.
  96. ^ Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. (September 2018). "Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation Statement". JAMA. 320 (11): 1163–1171. doi:10.1001/jama.2018.13022. PMID 30326502.
  97. ^ Barnes B (18 July 2007). "Limiting Ads of Junk Food to Children". The New York Times. Retrieved 24 July 2008.
  98. ^ "Fewer Sugary Drinks Key to Weight Loss". U.S. Department of Health and Human Services. Retrieved 18 October 2009.
  99. ^ "WHO urges global action to curtail consumption and health impacts of sugary drinks". WHO. Retrieved 13 October 2016.
  100. ^ Brennan Ramirez LK, Hoehner CM, Brownson RC, Cook R, Orleans CT, Hollander M, et al. (December 2006). "Indicators of activity-friendly communities: an evidence-based consensus process". American Journal of Preventive Medicine (Research Support). 31 (6): 515–524. doi:10.1016/j.amepre.2006.07.026. PMID 17169714.
  101. ^ Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. (2019-05-02). "Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence". Public Health Research. 7 (8): 1–206. doi:10.3310/phr07080. hdl:1893/29477. PMID 31046212.
  102. ^ "How can local authorities reduce obesity? Insights from NIHR research". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 19 May 2022.
  103. ^ Crockett RA, King SE, Marteau TM, Prevost AT, Bignardi G, Roberts NW, et al. (February 2018). "Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption". The Cochrane Database of Systematic Reviews. 2 (2): CD009315. doi:10.1002/14651858.CD009315.pub2. PMC 5846184. PMID 29482264.
  104. ^ King, Douglas M.; Jacobson, Sheldon H. (1 March 2017). "What Is Driving Obesity? A Review on the Connections Between Obesity and Motorized Transportation". Current Obesity Reports. 6 (1): 3–9. doi:10.1007/s13679-017-0238-y. ISSN 2162-4968.
  105. ^ McCormack, Gavin R.; Virk, Jagdeep S. (1 September 2014). "Driving towards obesity: A systematized literature review on the association between motor vehicle travel time and distance and weight status in adults". Preventive Medicine. 66: 49–55. doi:10.1016/j.ypmed.2014.06.002. hdl:1880/115549. ISSN 0091-7435.
  106. ^ a b "Obesity Guidelines Website". Australian Government Department of Health and Ageing. Retrieved Oct 25, 2009.
  107. ^ a b Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, et al. (April 2008). "Management of obesity in adults: European clinical practice guidelines". Obesity Facts. 1 (2): 106–116. doi:10.1159/000126822. PMC 6452117. PMID 20054170.
  108. ^ "Overview | Obesity: identification, assessment and management | Guidance | NICE". www.nice.org.uk. 2014-11-27. Retrieved 2024-08-08.
  109. ^ a b Snow V, Barry P, Fitterman N, Qaseem A, Weiss K, et al. (Clinical Efficacy Assessment Subcommittee of the American College of Physicians) (April 2005). "Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians". Annals of Internal Medicine. 142 (7): 525–531. doi:10.7326/0003-4819-142-7-200504050-00011. PMID 15809464. Fulltext.
  110. ^ U.S. Preventive Services Task Force (June 2003). "Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale". American Family Physician. 67 (12): 2573–2576. PMID 12825847. Archived from the original on 2014-02-24. Retrieved 2014-02-24.
  111. ^ Pignone MP, Ammerman A, Fernandez L, Orleans CT, Pender N, Woolf S, et al. (January 2003). "Counseling to promote a healthy diet in adults: a summary of the evidence for the U.S. Preventive Services Task Force". American Journal of Preventive Medicine. 24 (1): 75–92. doi:10.1016/S0749-3797(02)00580-9. PMID 12554027.
  112. ^ Mathur MB, Mathur VS (May 2023). "Primary Care Physicians' Perceptions of the Effects of Being Overweight on All-cause Mortality". Epidemiology. 34 (3): e19–e20. doi:10.1097/EDE.0000000000001590. PMC 10368371. PMID 36727941. S2CID 256499920.
  113. ^ Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. (June 2014). "2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society". Circulation. 129 (25 Suppl 2): S102–S138. doi:10.1161/01.cir.0000437739.71477.ee. PMC 5819889. PMID 24222017.
edit
Retrieved from "https://en.wikipedia.org/w/index.php?title=Management_of_obesity&oldid=1254379707"