How Effective is Lifestyle Management of Obesity?Wednesday, August 22, 2012
Over the next little while, I will be taking a few days off and so I will be reposting some of my favourite past posts. The following article was first posted on Apr 15, 2011:
Perhaps one of the most overused (and many would say ‘useless’) pieces of advise is that obesity management requires a lifestyle change.
While this may be true – there is nothing special about obesity when it comes to this recommendation, because guess what: living with diabetes requires lifestyle change, living with high blood pressure requires lifestyle change, living with asthma requires lifestyle change, living with celiac disease requires lifestyle change, in fact living with any chronic health problems requires lifestyle change.
So although, there is nothing special about recommending lifestyle change to help people better manage their weight, the question remains whether simply giving such lifestyle advise or following it actually works.
This was the topic of a paper just published by Sara Kirk (Dalhousie University, Halifax) and colleagues in the International Journal of Obesity, which presents an extensive review of the literature on lifestyle interventions for obesity with the aim to determine the most effective and promising practices for obesity management in adults.
From this review, three themes were derived from the highest level of available evidence.
These were targeted multi-component interventions for weight management, dietary manipulation strategies and delivery of weight management interventions, including health professional roles and method of delivery.
Not surprisingly, individually tailored multi-component long-term interventions were found to be the most effective (in fact there is little data to suggest that single (e.g. diet or exercise alone) or even double (e.g. diet + exercise) component interventions delivered in the short term are of any use at all).
This is of course very much in line with the fact that obesity should be viewed as a complex, chronic condition, requiring sustained contact with and support from trained health professionals (whether delivered in person or through web-based technologies).
The authors identified an important limitation of all intervention studies and thus any emerging remommendations in that:
“All of the current recommendations essentially look at obesity as a homogeneous condition that is amenable to treatment either simply by caloric reduction and/or increasing activity. No attempt is made to distinguish between different causes of obesity or even stages of obesity. The importance of identifying and thereby addressing the etiological determinants of positive energy balance is therefore critical to improving obesity management. Health professionals need to be aware of, and supportive to, these issues if individual behavior change is to be successful, and this is an area worthy of further consideration and review.”
In addition, although not the topic of this review, the authors acknowledge that more severe obesity will unlikely be managed by lifestyle interventions alone and will require the addition of pharmacological and/or surgical treatments as indicated.
The authors also note that:
“People seeking weight-loss support often present with a range of other issues that may hinder their ability to lose weight, including mental health issues, chronic pain and family or social barriers.”
These barriers may need to be addressed before any meaningful success in weight management (by lifestyle alone or otherwise) can be expected.
Overall, this paper makes it clear that there is very little evidence to support the rather simplistic lifestyle advice (‘eat less – move more’ = ELMM) often given to people trying to manage their weight – a fact that most people who have ever tried this approach are already well aware of.
In contrast, there is good evidence that individualised interventions that take a more holistic approach and are delivered by a multi-disciplinary team of health professionals in a manner consistent with best-practices in chronic disease management are most likely to succeed in the long-term. (note the word ‘likely’ in the previous sentence – as with any medical condition – there are no guarantees).
So, although none of this should come as a surprise to the regular readers of these pages, they will perhaps be happy to see that these thoughts are now finding their way into the mainstream obesity literature.
Hopefully, they will not just sit there but will actually become standard practice in obesity management.
Kirk SF, Penney TL, McHugh TL, & Sharma AM (2011). Effective weight management practice: a review of the lifestyle intervention evidence. International journal of obesity (2005) PMID: 21487396