J Korean Med Assoc.  2011 Mar;54(3):250-265.

Obesity management and scientific evidence

• Choi JM
• Kim CB

Abstract

Obesity is now recognized as a critical target for public health intervention in many parts of the world, affecting virtually all age and socio-economic groups within both developed and developing countries. This study's objective is to provide an overview of the full range of methods and models available for weight loss, including some methods used by overweight and obese people without medical supervision. Many diverse approaches for achieving weight loss and weight maintenance have been evaluated. According to some evidence-based guidelines, in order to achieve the best treatment outcomes, it is recommended that a combination of dietary therapy with low-calorie diet, increased physical activity, and behavioral therapy be incorporated. Advances in treatment and innovative policy initiatives focusing on prevention could reverse the global problem of obesity and overweight. The most effective forms of treatment require collaboration among health care providers in primary care settings, including nurses, dietitians, psychologists, physicians, and psychiatrists. Effective strategies for weight loss require management strategies that combine dietary therapy and physical activity by using behavioral interventions. Thus, in the near future, the Korean government must develop evidence-based (clinical or community) guidelines for obesity management. Also, due to the lack of high quality primary studies on obesity management in Korea, future randomized clinical or community trials are recommended in this area.

Keyword

Obesity management; Evidence-based medicine; Scientific evidence; Systematic review; Clinical preventive service

MeSH Terms

Caloric Restriction
Cooperative Behavior
Developing Countries
Evidence-Based Medicine
Health Personnel
Humans
Korea
Motor Activity
Obesity
Organization and Administration
Overweight
Primary Health Care
Psychiatry
Public Health
Weight Loss

Figure

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  Figure 1 Trend of prevalence of obesity in Korean adult (≥19 years old)

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  Figure 2 Relationship of body mass index (BMI) to risk (mortality). The curvilinear plot is based on data adapted from the American Cancer Society study. As BMI increases the excess risk rises. A healthy or good body weight range is between 19 and 27 kg/m2 (From Bray GA. Am J Clin Nutr 1992;55:488S-494S, with permission from American Society for Nutrition) [14].

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  Figure 3 Burden of disease, preventability, and research and translation gaps (From Ockene JK, et al. Am J Prev Med 2007;32:244-252, with permission from Elsevier) [15].

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  Figure 4 Treatment algorithm for the assessment of patients with overweight and obesity. BMI, body mass index; F, females; Hx, history; M, males (From NHLBI Obesity Education Initiative. Practical guide to the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda [MD]: National Institute of Health; 2000) [13].

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  Figure 5 The triple-tier pathway for weight management (From Maryon-Davis A. Proc Nutr Soc 2005;64:97-103, with permission from Cambridge University Press) [16].

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  Figure 6 Summary flow chart on the prevention and therapy of obesity in Germany. BMI, body mass index. a)Healthy lifestyle means living according to the recommendations of the best practice program. b)Referral to specialist (diabetologist with focus on obesity, surgeon), if necessary (From Gandjour A, et al. Int J Qual Health Care 2001;13:325-332, with permission from Afschin Grandjour) [12].

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  Figure 7 Mean weight loss in 4 treatment groups of Wadden trial (From Wadden TA, et al. N Engl J Med 2005;353:2111-2120, with permission from Massachusetts Medical Society) [25].

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