gms | German Medical Science

Aims: We will provide a review of therapeutic strategies used to treat obesity. We refer to single treatment studies and meta-analyses of conventional, pharmacological and surgical treatments.

Methods: PubMed search using the terms “obesity” and “randomized” and “treatment” or “therapy”. We focussed on recent studies and reviews including Cochrane reviews.

Results: Obesity can be treated via conventional, pharmacological and surgical means, other modes of treatment are at an experimental level only and will not be covered in this review. In childhood and adolescence bariatric surgery is only infrequently performed, in adults this type of therapy is restricted to subjects with grade III obesity (BMI ≥ 40 kg/m² or with grade II obesity and concurrent obesity related relevant medical disorders. Despite risks inherent to bariatric surgery, recent studies suggest that mortality can be reduced over a ten year period in comparison to obese controls. Pharmacological treatments have the disadvantage that the average weight loss in excess of placebo is a mere 3-4 kilograms. In addition, cessation of drug treatment implies renewed weight gain. Finally, a host of side effects pose a serious obstacle to the development of novel drugs. Conventional therapy usually attempts to achieve behavioural modification of food intake and physical activity. Short term effects of such treatments are readily achieved in the vast majority of subjects motivated to participate in a weight loss program. However, renewed weight gain is common to all such approaches. After three years the effects of a typical 12 week intervention have almost disappeared.

Conclusions: There is no ideal treatment of common obesity. Many studies have not adequately assessed side effects of treatments. The major problem of pharmacological and conventional treatments is renewed weight gain after cessation of the intervention.