Obesity

Lifestyle modifications

INTRODUCTION

  • Aim for an initial 10% weight loss over a 6 months period (2)
  • A combination of reduced calorie intake and physical activity is more effective than either alone (2)
  • Multicomponent interventions are recommended. It includes behavioral change strategies that increase physical activity, decrease inactivity, improve eating behavior, reduce energy intake and increase dietary quality (1)
  • Take into account individual preferences, social circumstances, degree of obesity, increased health risk, and comorbidities (1)
  • Include behavioral intervention as appropriate (1): Self monitoring of behavior and progress, stimulus control, goal setting, slowing rate of eating, ensuring social support, problem solving, assertiveness, cognitive restructuring (modifying thoughts), reinforcement of changes, relapse prevention, strategies for dealing with weight gain

NUTRITION

  • Total energy intake should be less than daily energy expenditure (1)
  • No diet has shown itself superior to others in the long term (> 1 year) (2)
  • A daily 600kcal deficit or diets low in fat content in combination with expert support and intensive follow up (14 consultations in 6 months) are recommended for a sustained weight loss (1)
  • Low calorie diets: 800-1600 kcal/day may be considered, but may be nutritionally incomplete (1)
  • More relevant for people who need to lose weight fast, eg. before joint replacement surgery
  • Maximum 12 weeks
  • Ensure that the diet is nutritionally complete

PHYSICAL ACTIVITY

  • Weight loss is greater in diet and exercise programs than in diet only programs. Exercise only programs is not effective for weight loss (2)
  • Encourage physical activity even though it does not lead to weight loss, as it reduces risk of diabetes type 2 and cardiovascular disease (1)
  • 45-60 min of moderate intensity activity a day (1)
  • For people who have lost weight: 60-90 min of activity a day may be needed to avoid weight gain (1)
  • Resistance exercise is recommended (2)

References

1) https://www.nice.org.uk/guidance/cg189/chapter/Recommendations

2) https://bestpractice.bmj.com/topics/en-us/211/management-approach


Resources

Weight loss calculator

BMI calculator

Body fat calculator

Waist to hip ratio calculator

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

Evidence based on observational / cohort studies is written in CURSIVE font