Treatment of obesity – Related resources

Cochrane reviews

• Chromium picolinate supplementation might possibly result in a modest weight reduction in obese or overweight adults compared to placebo, but the evidence in insufficient. Data on possible adverse effects are lacking.
• Green tea preparations may be associated with a small weight reduction of questionable clinical significance .
• Low glycaemic index diets may increase weight loss and improve lipid profiles better than control diets .
• Chitosan may be more effective than placebo in the short-term treatment of overweight and obesity but the evidence comes mainly from poor quality studies .
• An increase in physical activity (usually endurance-type training) without a change of diet reduces overweight only a few kilograms .
• Intragastric balloon therapy appears not to reduce weight more than the conventional therapies in obesity and it carries the risk of adverse events .
• Psychological interventions, particularly behavioural and cognitive-behavioural strategies, enhance weight reduction in people with overweight or obesity. They are predominantly useful when combined with dietary and exercise strategies .
• Orlistat appears to reduce the weight and blood pressure of hypertensive patients in the short term, but long-term effects and effect on mortality and cardiovascular morbidity is unclear .

Other evidence summaries

• Guar gum is not effective in weight reduction and causes adverse effects .
• Ephedrine, ephedrine plus caffeine, or dietary supplements containing ephedra may be effective in producing a modest short-term weight loss as compared to placebo .
• Motivational interviewing in a scientific setting may be effective in the treatment of a broad range of behavioural problems and risk factors .
• Case management approach with personal contacts appears to be an effective way of supporting maintenance of weight loss in overweight or obese adults with additional cardiovascular risk factors .
• Physical activity combined with a low-energy diet appears to improve weight reduction results with no more than a few kilograms compared with a low-energy diet alone .
• Acupuncture seems to have no effect on weight reduction although there is no evidence from controlled trials .
• Waist-to-hip ratio appears to have a graded and highly significant association with myocardial infarction risk in most ethnic groups worldwide. The use of waist-to-hip ratio instead of BMI appears to improve the risk estimate of myocardial infarction .
• Weight loss seems to improve health-related quality of life in some trials, but the effect is probably small and the trials are of poor quality .
• Case management approach with personal contacts appears to be an effective way of supporting maintenance of weight loss in overweight or obese adults with additional cardiovascular risk factors .

Literature

• Eckel RH. Clinical practice. Nonsurgical management of obesity in adults. N Engl J Med 2008 May 1;358(18):1941-50.
• Padwal RS, Majumdar SR. Drug treatments for obesity: orlistat, sibutramine, and rimonabant. Lancet 2007 Jan 6;369(9555):71-7.
• Sjöström L, Rissanen A, Andersen T, Boldrin M, Golay A, Koppeschaar HP, Krempf M. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group. Lancet 1998 Jul 18;352(9123):167-72.
• Noël PH, Pugh JA. Management of overweight and obese adults. BMJ 2002 Oct 5;325(7367):757-61.
• Mustajoki P, Pekkarinen T. Very low energy diets in the treatment of obesity. Obes Rev 2001 Feb;2(1):61-72.
• Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001 Nov;74(5):579-84.
• Sjöström L. Surgical intervention as a strategy for treatment of obesity. Endocrine 2000 Oct;13(2):213-30.
• McTigue KM, Harris R, Hemphill B ym. McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, Lohr KN. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003 Dec 2;139(11):933-49.
• Li Z, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, Hilton L, Suttorp M, Solomon V, Shekelle PG, Morton SC. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med 2005 Apr 5;142(7):532-46.
• Lindström J, Ilanne-Parikka P, Peltonen M et al; Finnish Diabetes Prevention Study Group. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 2006 Nov 11;368(9548):1673-9.
• Galani C, Schneider H. Prevention and treatment of obesity with lifestyle interventions: review and meta-analysis. Int J Public Health 2007;52(6):348-59.
• Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ 2007 Dec 8;335(7631):1194-9.