Treatment of overweight and obesity: Lifestyle, pharmacologic, and surgical options

Recent statistics indicate that overweight and obesity have become an increasingly serious clinical and socioeconomic problem worldwide, and one of the greatest public health challenges of our time. In the United States, 133.6 million (66%) adults are overweight or obese (body mass index [BMI] ≥25 kg/m2), with 63.3 million (31.4%) considered to be obese (BMI ≥30 kg/m2). The International Obesity Task Force estimates that worldwide at least 1.1 billion adults are overweight, including 312 million who are obese. Overweight and obese patients are at an increased risk for developing numerous cardiometabolic complications, including hypertension, type 2 diabetes mellitus, dyslipidemia, and cardiovascular diseases, as well as conditions such as osteoarthritis, obstructive sleep apnea, hepatobiliary diseases, and certain types of cancers. Owing to the major health risks and complications associated with obesity, which negatively affect quality of life and reduce average life expectancy, in addition to placing an enormous burden on health care resources, the treatment of overweight and obesity is a public health imperative. Treatment must begin with long-term lifestyle changes, including increased physical activity and dietary modifications. For overweight and obese individuals for whom lifestyle changes alone are insufficient, pharmacotherapy may be added. However, patients who choose adjunctive pharmacotherapy should be advised of the risks and benefits of drug therapy, the lack of long-term safety data, and the temporary and modest nature of the weight loss that can be achieved with these agents. Bariatric surgery is an effective treatment option for morbidly obese patients or obese patients with multiple comorbidities who have not been successful in achieving sufficient weight loss with nonsurgical approaches. However, appropriate candidates for bariatric surgery must also be committed to long-term lifestyle changes.