Severe obesity: Introductory outlines and the conventional non surgical therapy

SummaryBackground & aimsSevere obesity is still increasing in recent years and is associated with a high rate of morbidity and mortality. Obesity is a chronic disease caused by the interaction of genetic factors with the environment; genetic determinants are multiple, concerning both the complex system of food intake and energy expenditure regulation, and metabolism. Even if bariatric surgery is currently considered the therapy of choice, conventional therapy should be considered. Goal of the therapy is to induce a life-long modification in lifestyle, achieving a stable weight reduction. Diets are defined as low-calorie diets (1000–1500 kcal/d) and very-low-calorie diets (≤800 kcal/d). Both the choice of the diet and the optimal distribution of macronutrients in low-calorie diets are still controversial issues. Aim of the paper was to examine and discuss the current methods of conventional therapy and their results.MethodsStudies on conventional therapy of severely obese subjects were reviewed, including type of diets, exercise, behaviour and pharmacological interventions.ResultsStructured, multidisciplinary, long duration interventions may obtain at 1 y a 5–15% weight loss, and the maintenance of the 22–73% of the weight lost.ConclusionsConventional therapy, if specifically programmed for severely obese persons and including maintenance programs, may obtain reasonably encouraging results.