Your browser does not support the NLM PubReader view.

Go to this page to see a list of supporting browsers.

Obesity management and scientific evidence

Article information

J Korean Med Assoc. 2011;54(3):250-265
Publication date (electronic) : 2011 March 16
doi : https://doi.org/10.5124/jkma.2011.54.3.250
Joong Myung Choi, MD1, Chun-Bae Kim, MD2,3
1Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
2Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Yonsei University, Wonju, Korea.
3Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Korea.
Corresponding author: Chun-Bae Kim, kimcb@yonsei.ac.kr
Received 2011 February 07; Accepted 2011 February 21.

Abstract

Obesity is now recognized as a critical target for public health intervention in many parts of the world, affecting virtually all age and socio-economic groups within both developed and developing countries. This study's objective is to provide an overview of the full range of methods and models available for weight loss, including some methods used by overweight and obese people without medical supervision. Many diverse approaches for achieving weight loss and weight maintenance have been evaluated. According to some evidence-based guidelines, in order to achieve the best treatment outcomes, it is recommended that a combination of dietary therapy with low-calorie diet, increased physical activity, and behavioral therapy be incorporated. Advances in treatment and innovative policy initiatives focusing on prevention could reverse the global problem of obesity and overweight. The most effective forms of treatment require collaboration among health care providers in primary care settings, including nurses, dietitians, psychologists, physicians, and psychiatrists. Effective strategies for weight loss require management strategies that combine dietary therapy and physical activity by using behavioral interventions. Thus, in the near future, the Korean government must develop evidence-based (clinical or community) guidelines for obesity management. Also, due to the lack of high quality primary studies on obesity management in Korea, future randomized clinical or community trials are recommended in this area.

Keywords: Obesity management; Evidence-based medicine; Scientific evidence; Systematic review; Clinical preventive service

Acknowledgement

This work was supported by the National Research of Korea Grant funded by the Korean Government (NRF-2010-413-B00024).

References

1. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002. 2881723–1727.
2. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006. 2951549–1555.
3. Rennie KL, Jebb SA. Prevalence of obesity in Great Britain. Obes Rev 2005. 611–12.
4. Grant I, Fischbacher C, Whyte B. Obesity in Scotland: an epidemiology briefing 2007. Edinburgh: Scottish Public Health Observatory;
5. Toplak H, Bohnisch E, Hoppichler F, Lechleitner M, Ludvik B, Schmid P, Schoberberger R, Wallner S, Wascher T. Praxishandbuch adipositas 2002. Wien: Springer-Verlag;
6. Misra A, Singhal N, Khurana L. Obesity, the metabolic syndrome, and type 2 diabetes in developing countries: role of dietary fats and oils. J Am Coll Nutr 2010. 293 Suppl. 289S–301S.
7. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000. 894i–xii. 1–253.
8. Ministry of Health, Welfare and Family. 2007 national health and nutrition examination survey 2009. Seoul: Ministry of Health, Welfare and Family;
9. Jung YH, Seo MK, Lee JT, Jeong HS, Koh SJ, Chae SM, Kim MH. Analysis of health determinants of Korean 2007. Seoul: Korea Institute for Health and Social Affairs, Management Center for Health Promotion;
10. Guide to community preventive services [Internet]. Centers for Disease Control and Prevention 2005. updated 2005 June 14; cited 2008 Mar 24. Atlanta (GA): Centers for Disease Control and Prevention (US); Available from: http://www.thecommunityguide.org/obesity/index.html.
11. Wolf AM, Woodworth KA. Obesity prevention: recommended strategies and challenges. Am J Med 2009. 1224 Suppl 1. S19–S23.
12. Gandjour A, Westenhofer J, Wirth A, Fuchs C, Lauterbach KW. Development process of an evidence-based guideline for the treatment of obesity. Int J Qual Health Care 2001. 13325–332.
13. NHLBI Obesity Education Initiative. Practical guide to the identification, evaluation, and treatment of overweight and obesity in adults 2000. Bethesda (MD): National Institute of Health;
14. Bray GA. Pathophysiology of obesity. Am J Clin Nutr 1992. 55488S–494S.
15. Ockene JK, Edgerton EA, Teutsch SM, Marion LN, Miller T, Genevro JL, Loveland-Cherry CJ, Fielding JE, Briss PA. Integrating evidence-based clinical and community strategies to improve health. Am J Prev Med 2007. 32244–252.
16. Maryon-Davis A. Weight management in primary care: how can it be made more effective? Proc Nutr Soc 2005. 6497–103.
17. Katzel LI, Bleecker ER, Colman EG, Rogus EM, Sorkin JD, Goldberg AP. Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men. A randomized controlled trial. JAMA 1995. 2741915–1921.
18. Pi-Sunyer FX. Weight and non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1996. 633 Suppl. 426S–429S.
19. McCarron DA, Reusser ME. Body weight and blood pressure regulation. Am J Clin Nutr 1996. 633 Suppl. 423S–425S.
20. Felson DT. Weight and osteoarthritis. Am J Clin Nutr 1996. 633 Suppl. 430S–432S.
21. Ballard-Barbash R, Swanson CA. Body weight: estimation of risk for breast and endometrial cancers. Am J Clin Nutr 1996. 633 Suppl. 437S–441S.
22. Wadden TA, Phelan S. In : Wadden TA, Stunkard AJ, eds. Behavioral assessment of the obese patient. Handbook of obesity treatment 2002. New York: Guilford; 186–208.
23. Dickerson VM. Focus on primary care: evaluation, management, and treatment of obesity in women. Obstet Gynecol Surv 2001. 56650–663.
24. Lang A, Froelicher ES. Management of overweight and obesity in adults: behavioral intervention for long-term weight loss and maintenance. Eur J Cardiovasc Nurs 2006. 5102–114.
25. Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med 2005. 3532111–2120.
26. Aronne LJ, Wadden T, Isoldi KK, Woodworth KA. When prevention fails: obesity treatment strategies. Am J Med 2009. 1224 Suppl 1. S24–S32.
27. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription 2006. 7th edth ed. Baltimore: Lippincott Williams & Wilkins; 218.
28. Strychar I. Diet in the management of weight loss. CMAJ 2006. 17456–63.
29. NHLBI Obesity Education Initiative. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report 1998. Bethesda (MD): National Institute;
30. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr 2001. 21323–341.
31. St Jeor ST, Howard BV, Prewitt TE, Bovee V, Bazzarre T, Eckel RH. Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 2001. 1041869–1874.
32. Part B. Divisions 17-28, Articles B.24.300-B.24.304 [Internet]. Food and Drug Regulations 2002. updated 2002 Dec 12; cited 2005 Nov 16. Ottawa (ON): Health Canada; Available from: http://www.hc-sc.gc.ca/fn-an/legislation/index-eng.php.
33. Cummings S, Parham ES, Strain GW. Position of the American Dietetic Association: weight management. J Am Diet Assoc 2002. 1021145–1155.
34. Osei-Assibey G, Kyrou I, Adi Y, Kumar S, Matyka K. Dietary and lifestyle interventions for weight management in adults from minority ethnic/non-White groups: a systematic review. Obes Rev 2010. 11769–776.
35. Korean Society for the Study of Obesity. Obesity treatment guideline 2009 2009. Seoul: Korean Society for the Study of Obesity;
36. Kim MS, Ahn HS. Study on the effect of obesity management program in middle aged abdominal obese women: with focus on aroma massage. J Korean Soc Study Obes 2003. 1254–67.
37. Shim JH, Go DG, Yoo YJ. The effect of an obesity control program on body composition and blood lipid level among middle-aged obese women in a health center. J Korean Acad Community Health Nurs 2007. 18201–210.
38. Lee BS. Changes in body composition, health status, and dietary behavior for middle-aged obese women in a weight control program at a community health center. Korean J Food Nutr 2007. 20433–439.
39. Lee JW, Im JA, Lee DC. Effect of short-term obesity management program for local community residents. J Korean Acad Fam Med 2008. 29121–133.
40. Lee HS, Lee JW, Kim JM, Chang N. The effect of nutrition education and excercise program on body composition and dietary intakes, blood lipid and physical fitness in obese women (2): relationship between participation rates and effectiveness of obesity management program. Korean J Nutr 2010. 43260–272.
41. Lee HY. Effectiveness of obesity management programs: systematic review and meta-analysis. J Korean Soc Health Educ Promot 2007. 24131–146.
42. Briss PA, Brownson RC, Fielding JE, Zaza S. Developing and using the Guide to Community Preventive Services: lessons learned about evidence-based public health. Annu Rev Public Health 2004. 25281–302.
43. Owen N, Glanz K, Sallis JF, Kelder SH. Evidence-based approaches to dissemination and diffusion of physical activity interventions. Am J Prev Med 2006. 314 Suppl. S35–S44.
44. McMichael C, Waters E, Volmink J. Evidence-based public health: what does it offer developing countries? J Public Health (Oxf) 2005. 27215–221.

Article information Continued

Copyright © 2011 Korean Medical Association

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Figure 1

Trend of prevalence of obesity in Korean adult (≥19 years old)

Figure 2

Figure 2

Relationship of body mass index (BMI) to risk (mortality). The curvilinear plot is based on data adapted from the American Cancer Society study. As BMI increases the excess risk rises. A healthy or good body weight range is between 19 and 27 kg/m2 (From Bray GA. Am J Clin Nutr 1992;55:488S-494S, with permission from American Society for Nutrition) [14].

Figure 3

Figure 3

Burden of disease, preventability, and research and translation gaps (From Ockene JK, et al. Am J Prev Med 2007;32:244-252, with permission from Elsevier) [15].

Figure 4

Figure 4

Treatment algorithm for the assessment of patients with overweight and obesity. BMI, body mass index; F, females; Hx, history; M, males (From NHLBI Obesity Education Initiative. Practical guide to the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda [MD]: National Institute of Health; 2000) [13].

Figure 5

Figure 5

The triple-tier pathway for weight management (From Maryon-Davis A. Proc Nutr Soc 2005;64:97-103, with permission from Cambridge University Press) [16].

Figure 6

Figure 6

Summary flow chart on the prevention and therapy of obesity in Germany. BMI, body mass index. a)Healthy lifestyle means living according to the recommendations of the best practice program. b)Referral to specialist (diabetologist with focus on obesity, surgeon), if necessary (From Gandjour A, et al. Int J Qual Health Care 2001;13:325-332, with permission from Afschin Grandjour) [12].

Figure 7

Figure 7

Mean weight loss in 4 treatment groups of Wadden trial (From Wadden TA, et al. N Engl J Med 2005;353:2111-2120, with permission from Massachusetts Medical Society) [25].

Table 1

Assessment of overweight and obese patients

Table 1

From NHLBI Obesity Education Initiative. Practical guide to the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda (MD): National Institute of Health; 2000 [13].

Table 2

Classification of overweight and obesity by body mass index (BMI), waist circumference, and associated disease risk

Table 2

a)Disease risk for type 2 diabetes mellitus, hypertension, and cardiovascular disease.

b)Increased waist circumference can also be a marker for increased risk even in persons of normal weight.

From World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253 [7].

Table 3

Relative risk of health problems associated with obesity

Table 3

NIDDM, non-insulin-dependent diabetes mellitus; CHD, coronary heart disease.

From World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253 [7].

Table 4

Recommendations relevant to reducing obesity from Guide to Community Preventive Services through March 2006

Table 4

From Centers for Disease Control and Prevention. Guide to community preventive services. Atlanta (GA): Centers for Disease Control and Prevention (US); 2005 [10].

Table 5

Progressive therapeutic modalities for obesity

Table 5

From Dickerson VM. Obstet Gynecol Surv 2001;56:650-663, with permission from Wolters Kluwer Health [23]

Table 6

Response to behavior therapy for obesity with extended contact (weekly or biweekly sessions >6 months)

Table 6

Bw, biweekly; D, diet; E, exercise; WF, weight-focused; EF, exercise-focused; H, home-based exercise; G, group-based exercise; Lb, long-bout exercise; Sb, short-bout exercise; SbE, short-bout exercise with home equipment. a)Included short-term use of a low-calorie liquid diet. b)Included use of low-calorie or balanced-deficit diet. IOMC, Institute of Medicine Criterion for successful long-term loss (≥5% body weight lost and maintained for>1 year). *,c)Means with differing superscripts indicate significant between-group differences (p<0.05) (From Lang A, et al. Eur J Cardiovasc Nurs 2006;5:102-114, with permission from Elsevier) [24].

Table 7

Efficacy and safety of weight loss medications

Table 7

a)Data obtained from only one trial.

b)Data obtained from the Diabetes Prevention Program Trial; individuals with impaired fasting glucose were treated with drug.

From Aronne LJ, et al. Am J Med 2009;122(4 Suppl 1):S24-S32, with permission from Elsevier [26]

Table 8

Centers for Disease Control and Prevention evidence-based recommendations for promoting physical activity

Table 8

From Wolf AM, et al. Am J Med 2009;122(4 Suppl 1):S19-S23, with permission from Elsevier [11]

Table 9

Characteristics of weight loss diets

Table 9

NCEP, National Cholesterol Education Program; CV, cardiovascular; LCD, low-calorie diet; VLCD, very-low-calorie diet.

From Strychar I. CMAJ 2006;174:56-63, with permission from Canadian Medical Association [28].

Table 10

Key characteristics and primary result of included studies

Table 10

*denotes significant vs. control

AHA, American Heart Association; BMI, body mass index; HELP, Healthy Eating and Lifestyle Program; LCD, low-calorie diet: VLCD, very low-calorie diet.

From Osei-Assibey G, et al. Obes Rev 2010;11:769-776, with permission from John Wiley and Sons [34]