User:Carl Fredrik (WIR)/Obese treatment

Management
The main treatment for obesity consists of dieting and physical exercise. Diet programs may produce weight loss over the short term, but maintaining this weight loss is frequently difficult and often requires making exercise and a lower food energy diet a permanent part of a person's lifestyle.

A 2013 systematic review of 1427 articles on obesity and weight-loss through food found that a variety of diets may lead to short-term weight loss. A low-fat, low glycemic index (GI), and high protein diet was more beneficial to long-term weight-loss retention than low fat, high GI, low protein diets. Intense counseling aimed towards promoting Mediterranean diets among the obese was shown to lower mortality in heart disease. Decreased intake of sweet drinks such a fruit drinks are correlated to weight-loss, lower risk of diabetes and lowering of blood pressure.

A smaller 2014 meta-analysis in JAMA found all types of low-carbohydrate and low-fat diets appear equally beneficial. The heart disease and diabetes risks associated with different diets also appear to be similar. Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%. Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child. Intensive behavioral counseling is recommended in those who are both obese and have other risk factors for heart disease.

Three medications, orlistat (Xenical), lorcaserin (Belviq) and a combination of phentermine and topiramate (Qsymia) are currently available and have evidence for long term use. Weight loss with orlistat is modest, an average of 2.9 kg (6.4 lb) at 1 to 4 years. Its use is associated with high rates of gastrointestinal side effects and concerns have been raised about negative effects on the kidneys. The other two medications are available in the United States but not Europe. Lorcaserin results in an average 3.1 kg weight loss (3% of body weight) greater than placebo over a year; however, it may increase heart valve problems. A combination of phentermine and topiramate is also somewhat effective; however, it may be associated with heart problems. There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death.

The most effective treatment for obesity is bariatric surgery. Surgery for severe obesity is associated with long-term weight loss, improvement in obesity related conditions, and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures. Complications occur in about 17% of cases and reoperation is needed in 7% of cases. Due to its cost and risks, researchers are searching for other effective yet less invasive treatments including devices that occupy space in the stomach.