The current status of treatment for obesity in adults.
This review has considered the current status of the treatment of obesity from the point of view of a new theory and a new classification. The theory states that obesity is the result of regulated, homeostatic processes that maintain body fat at an elevated level. The classification divides obesity into three categories--mild, moderate, and severe. Severe obesity, more than 100% overweight, which afflicts 0.5% of the female obese population is most effectively treated by surgical measures, particularly ones that reduce the size of the stomach and of its opening into the lower gastrointestinal tract. Such surgery may produce very large weight losses with relatively few untoward consequences, suggesting that it acts by lowering a body weight set point. Moderate obesity, 41 to 100% overweight, afflicts 9% of the female obese population. It is currently treated under medical auspices either by diets that may achieve satisfactory weight loss but poor maintenance of this loss, or by behavior modification that achieves good maintenance, but only modest weight loss. Medication is of limited value because of its continued efficacy, rather than because, as was thought, tolerance develops to its effects. It appears to lower a body weight set point and cessation of medication is followed by a rapid rebound in body weight. For this reason, medication should probably be used either for an indefinite period of time or not at all. Mild obesity, 20 to 40% overweight, afflicts 90% of the female obese population and today is largely managed by large organizations, both commercial and nonprofit. The basis of treatment is behavior modification in groups, a liberal, balanced diet, and exercise. Despite very high drop-out rates from these organizations, their low costs result in favorable cost/effective ratios, and they are continuing to increase the number of obese people that they treat.
D001521:Behavior Therapy / Q000379:methods; D001835:Body Weight; D003131:Combined Modality Therapy; D004038:Diet, Reducing; D004435:Eating; D002149:Energy Intake; D006801:Humans; D007082:Ileum / Q000601:surgery; D007583:Jejunum / Q000601:surgery; D009765:Obesity / Q000628:therapy*; D012657:Self-Help Groups