[Overweight. III. Therapeutic strategies for weight reduction]

Obesity is a major health hazard. It increases the risk of cardiovascular disease, diabetes, mellitus and various malignancies. Minor weight loss (5-10% of body weight) appears to reduce this risk. (Very) low calorie diets alone are not effective in the long run. Regular physical exercise and behavioral interventions improve the effect of calorie restriction to an extent that is beneficial to health. Long term drug treatment is not recommended for the treatment of obesity. A number of appetite suppressants has been withdrawn from the market because of serious side effects during long term (> 3 months) use. Also, data on the efficacy of long term (> 1 year) drug treatment of obesity are not available. However, short term use to support calorie restriction might be helpful. Bariatric surgery is indicated and reasonably safe for morbidly obese patients (body mass index > or = 40 kg/m2), particularly for those who have other risk factors for cardiovascular disease. Adjustable gastric banding appears to be an effective and safe alternative to (vertical) gastroplasty.