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
Ian L. - January 1, 2022 12:04 PM
For Retirees and people over 60 regular long walking helps some as in the 10,000 Steps a day movement . So you would be walking for one to two hours a day five days a week weather allowing . Walking clubs are out there a problem - safely So they have walking clubs who pick scenic safe walking trails in parks but the crime rate cannot be ignored in some lands . Security is paramount in those areas . Its outdoor gyms in the Covid 19 era or indoor well ventilated gyms with tinted windows part open and mega hepa filters and spacing. Indoor gyms insist on recommended vaccination.
Heidi J., MD - January 6, 2022 11:26 AM
Good suggestions, Ian. Thanks!