Reviews and Perspectives with Hobart Lee: Weight Management

Reviews and Perspectives with Hobart Lee: Weight Management

Hobart Lee, MD, and Heidi James, MD

Hoby and Heidi take on the topic of helping our patients lose weight. 

• Obesity and weight are influenced by complex personal and sociocultural factors.
• Physicians can both advocate for changes at the broader societal level and help their individual patients.
• Hoby and Heidi review 4 aspects of weight management:
• Healthy eating
• A permanent change to eating habits is needed, so patients must enjoy what they’re eating to ensure adherence.
• Target the “low-hanging fruit” of dietary changes first; for many, this is sugary, high-calorie beverages.
• Keeping a food diary can shed light on eating habits.
• When possible, involve a dietitian.
• Be cautious in recommending currently popular diets.
• Exercise
• “Lose weight in the kitchen, get fit in the gym.”
• Exercise does not contribute as much to weight loss as many would like to believe, but it is an important part of an overall healthy lifestyle.
• Recommend “exercise snacking” - multiple shorter bouts of exercise throughout the day for those who find it hard to exercise in longer sessions.
• Medication
• Hoby and Heidi are late adopters of weight loss meds because of their side effects, the fact that they result in only a small amount of weight loss, and that the weight is often regained once the meds are stopped.
• There is concern that taking medication will bypass the development of a healthy lifestyle. 
• Semaglutide, an injectable glucagon-like peptide-1 (GLP1) agonist, shows promise for both a more favorable side effect profile and larger weight loss. 
• Medication cost is a barrier.
• Surgery
• Bariatric surgery is an option for select patients.
• Weight regain is a possibility after surgery, so pre- and postoperative support is important.

PEARL: Obesity and weight are influenced by complex personal and sociocultural factors. Physicians can both advocate for changes at the broader societal level and help their individual patients.

REFERENCES:

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
Knowler WC, Barrett-Connor E, Fowler SE, et al. N Engl J Med. 2002;346(6):393-403. doi: 10.1056/NEJMoa012512. https://pubmed.ncbi.nlm.nih.gov/11832527/

Evidence Summary: Weight loss to prevent obesity-related morbidity and mortality in adults: behavioral interventions. https://www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary/obesity-in-adults-interventions

Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial
Jakicic JM, Winters C, Lang W, Wing RR. JAMA. 1999;282(16):1554-1560. doi: 10.1001/jama.282.16.1554. https://pubmed.ncbi.nlm.nih.gov/10546695/

Once-weekly semaglutide in adults with overweight or obesity
Wilding JPH, Batterham RL, Calanna S, et al. N Engl J Med. 2021;384(11):989. doi: 10.1056/NEJMoa2032183. https://pubmed.ncbi.nlm.nih.gov/33567185/

The Diet Fix: Why Diets Fail and How to Make Yours Work
Freedhoff Y. http://www.thedietfix.com/

RELATED SEGMENTS:

PCMA Archive 2018 January: Effect of Alternate-day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults