Medical management of obesity

Medical therapy for obesity is still unsuccessful in the majority of patients at five-year follow-up. Physicians should not become discouraged, however, because the number of successful participants in weight loss programs is increasing. An effective medical weight loss program requires five basic elements: (1) an effective means of caloric restriction, either a balance of fuel sources in patients who are less than 30% above ideal body weight, or a very-low-calorie diet in patients with obesity that is a significant threat to their health; (2) extensive nutritional instruction, to enable the patient to make wise food choices that are varied and palatable; (3) an individual exercise program sufficient to maintain the patient's goal weight on maintenance food; (4) behavioral modification, to allow patients to control their food consumption; and (5) a mechanism for continuing support. Now that low-fat diets and very-low-calorie diets allow effective means of safe and rapid weight loss, progress must be made in preventing weight regain. Obesity is a lifelong disease, with remissions followed by relapses. Long-term therapeutic success depends on the rapid reinstitution of therapy by a nonjudgemental support team when a relapse occurs.