Endocrine Abstracts

Overeating and decreased activity are the fundamental problems underlying the development of obesity, thus any therapy aimed at helping the obese patient must have a dietary and exercise component.

In general three forms of lifestyle interventions are used; exercise, diet and behavioural therapy. Exercise alone produces an average weight loss of 1.8 kg (0–4 kg) with a higher intensity of exercise leading to a greater weight loss. Diastolic blood pressure, triglycerides, HDL and glucose also significantly improve independent of weight loss. Diet alone is more effective than exercise, producing an average peak weight loss of 5kg (0.5–12.5 kg) at 6–12 months, with this effect then waning with time. No diet is better than any other. The greater the reduction in calories and the more contact, the greater the weight loss. Behavioural therapies produce a similar weight loss to that seen with exercise, with an average loss of 2.3 kg (1.4–3.1 kg). The more frequent the contact and the longer the program the greater the benefit.

Addition of exercise to a diet results in greater weight loss (average 10.7 kg), and also helps to maintain weight loss. The combination of diet or exercise with behavioural therapy results in a similar weight loss. Combination of all three interventions results in the greatest weight loss of 12–15 kg.

All studies that have examined the effect of weight loss drugs have used these in combination with lifestyle intervention. If given alone they are no more effective than the combination of diet and exercise. In combination with group lifestyle programs or behavioural therapies their effectiveness can be increased by 100% (5 kg vs 12 kg).

Individuals who exercise and lose weight prior to bariatric surgery are less likely to have postoperative complications and lose more weight at a faster rate. Continuing to exercise post operatively results in greater loss of fat mass and higher gain in lean body mass than the non-exercising individuals.

In summary lifestyle intervention provides benefits at all stages in the management of patients with obesity and should be encouraged no matter what form of therapy is being offered.