Catálogo de publicaciones - libros

Behavioral weight control generally involves two phases: (1) weight loss induction and (2) weight maintenance. During the period of weight loss, energy intake via eating is reduced and energy expenditure resulting from physical activity is increased. During the period of weight maintenance, the person learns to match energy intake (eating habits) with energy expenditure (physical activity and exercise). The most effective behavioral weight loss programs have offered a combination of exercise, diet, and behavior modification. Specific treatment components can be used to enhance long-term successful weight management for adults and children. These components include, but are not limited to, (1) portion control and structured meal plans, (2) home-based and short-bout exercise prescriptions, (3) prolonged and regular therapeutic contact during weight loss induction, (4) utilization of social support throughout treatment, and (5) extended therapeutic contact or booster treatment to promote long-term weight maintenance. For long-term success, it is clear that the overweight person must sustain his or her efforts to change behavior patterns and prevent relapse by proactively modifying barriers to lifestyle behavior change. Further, behavioral weight management is most efficacious when the treatment plan is tailored to match an individual’s cultural, social, and motivational circumstances.

On the surface, weight maintenance may seem easier than weight loss because of the lower demand in terms of the number of calories to be reduced in the diet or added in energy expenditure through physical activity. However, the literature to date suggests that this reasoning may be deceptive. The prevention of obesity in childhood is particularly complex. Ultimately, to be successful, it will probably require broad efforts by families, schools, communities, and primary care physicians in concert with allied health professionals. At present we lack definitive evidence to support specific approaches to obesity prevention. This means that a vigorous and ongoing research effort is needed to provide evidence which will drive the prevention strategies of the future. Clinicians will continue to play a pivotal role in all types of preventive strategies, either through direct intervention or as advocates for environmental and policy changes.

Obesity is a chronic medical disease that is not going away any time soon. Physicians need all the education, tools, and resources possible to successfully help the overweight and obese patients in their practices. Weight loss medications alone are clearly not the answer. They represent, however, one evidencebased tool physicians can use in combination with lifestyle changes to increase long-term weight loss success in appropriate patients. Multiple studies have shown more patients can achieve a significant weight loss when they combine lifestyle and weight loss medications than either alone. Both sibutramine and orlistat have demonstrated effectiveness for obesity treatment and represent evidence-based tools physicians should consider using in appropriate patients. In the future, using combinations of weight loss medications along with new drugs in development may yield additional safe and long-term treatments to treat this serious metabolic disease.

Obesity is increasing in prevalence and its medical liabilities are, in large measure, related to the metabolic syndrome, a syndrome of insulin resistance. The drugs available at present for the treatment of obesity and the metabolic syndrome are few in number and limited in efficacy. This chapter reviewed the drugs approved for other indications that cause weight loss, drugs in the late development process that have not been approved, drugs in earlier stages of drug development for which clinical information is limited, drugs that have been dropped from development, and new potential drug targets for which essentially no clinical data yet exist. We also reviewed the nonprescription products sold for the treatment of obesity and the metabolic syndrome. The development pipeline of drugs for the treatment of obesity and the metabolic syndrome is rich. Because drugs to treat obesity are being developed in an era characterized by more sophisticated drug development tools than existed when hypertension drugs were being developed, much faster progress in developing safe and effective drugs for obesity and the metabolic syndrome is anticipated. With safe and effective drugs available, we anticipate that the chronic treatment of obesity with weight loss medication will become as well accepted and prevalent as is the chronic drug treatment of hypertension and diabetes in the medical practice of today.