Addressing overweight and obesity can be a daunting task for doctors. Below are practical tips based on the scientific literature that physicians can use in their practices.
Proactively address prevention with overweight patients. Being overweight is the #1 risk factor for obesity which, once present, may be more challenging to address. Therefore, doctors should not wait until patients develop obesity to address the importance of proper nutrition and physical activity.
Implement a multi-factorial intervention strategy. Physicians should construct an individualized treatment plan involving different treatment modalities. These may include highly structured diets (e.g., partial or full meal replacement), increases in physical activity, medications for appropriate candidates, and surgery for treatment resistant patients with clinically severe obesity.
Inform patients with obesity of the challenges to weight loss maintenance. Help patients understand that they may become more metabolically efficient with behavioral weight loss and have to ingest up to 300 fewer (or burn 300 more) calories as someone of the same weight who never had obesity just to maintain that weight. It may also be necessary to discuss the fact that dieting may be insufficient once they have had obesity for an extended period of time, and that the use of biologically-based treatments (e.g., medication or surgery) is not a reflection of weak will.
Continue to monitor progress and adjust treatment strategy as necessary. Address and provide resources for weight loss maintenance to patients who are able to achieve weight loss via lifestyle modification. A clinical weight management strategy should be ongoing and take into account the fact that weight loss maintenance is more difficult than weight loss. For example, medication may be considered at the point that behavioral weight loss efforts wane, prior to typical weight regain.
Recommend surgery when appropriate. Currently, bariatric surgery is the only effective long-term unimodal treatment for obesity. Attempt highly structured lifestyle modification and discuss pharmacotherapy first. Patients, particularly patients with clinically severe obesity, for whom this is not successful should be informed about the risks and potential benefits of bariatric surgery and provided with or referred for further information so an informed decision can be made.